During pregnancy, the demand for choline increases due to its essential role in neural tube formation, brain development, lipoprotein synthesis, liver function, and lipid metabolism. Large amounts of choline are delivered to the developing fetus across the placenta — the concentration of choline in amniotic fluid may be up to 10 times greater than in maternal blood.[1] The delivery of choline to the fetus depletes maternal choline levels, as does lactation. As such, it’s crucial for pregnant and lactating women to maintain high levels of choline while breastfeeding to avoid depleting their choline stores.
Low maternal choline intakes or plasma choline levels are associated with an up to 2.4-fold greater risk for neural tube defects.[2] Intervention studies have shown that higher maternal choline intakes (550 to 1,000 mg per day) during the second half of pregnancy and the early postnatal period are safe and have favorable effects on the offspring’s memory, attention, and visual-spatial learning.[2] Choline is also associated with better maternal health and well-being.[3]
For this reason, the adequate intake (AI) for choline is 450 mg per day for pregnant women and 550 mg per day for lactating women — or 6%–30% higher than the AI for non-pregnant women.
Among women of childbearing age, choline intake from food sources ranges from 244 to 443 mg per day. Women in Europe report an average choline intake of 291 (France) to 374 (Sweden) mg per day, while women in the United States get an estimated 250–443 mg per day, and Australian women have an average choline intake of 244 mg per day. Less than 5% of Australian women had a choline intake that reached or exceeded the AI of 425 mg per day.[4]
Most pregnant women consume below the AI for choline, with average estimated intakes of 190–383 mg per day. Choline intakes for pregnant women in the United States range from 281 to 332 mg per day and are similar among women from Canada (306–383 mg per day), the United Kingdom (338 mg per day), Australia (51 mg per day), Belgium (274–280 mg per day), China (255 mg per day), Jamaica (279 mg per day), New Zealand (310 mg per day), and Latvia (336 mg per day). Lower levels of choline intake have been reported for pregnant women in Bangladesh (190 mg per day). There’s little evidence to indicate that choline intake changes across trimesters of pregnancy or when choline from supplements is included.[4] Choline intake during lactation has been less well characterized but has been reported to be in the range of 257 to 346 mg per day.
In summary, with little exception, few women of childbearing age or who are pregnant/lactating appear to consume enough choline despite its critical relevance for fetal growth and development.