Importance Of Choline For Pregnancy And Breastfeeding.

It seems like Choline is becoming fully recognized by medical professionals as important nutrient to take during pregnancy and breastfeeding. It is just as important as folic acid for Neural Tube Defects (NTD) prevention, but unlike folic acid, choline also plays a major role in brain and nervous system development of fetus and other important development functions of both mother and child, and should be taken through all of the pregnancy and breastfeeding.

Choline is water-soluble nutrient and a part of vitamin B family. It is essential for our health, specifically proper brain development and function and liver function. It is a precursor to a neurotransmitter Acetyl-choline, which plays an important role in memory. This is why choline is considered a nootropic supplement.  It also plays a major role in methylation and stress management. Humans can produce phosphatidylcholine in the liver or consume choline through diet. Both are important and choline is considered an essential nutrient.

Role of Choline during pregnancy and breastfeeding.

Pregnancy and lactation is a time when women need Choline the most, as it is used to support fetus’s developing nervous system and woman’s choline stores are usually depleted at this time. Most of mother’s choline stores go to amniotic fluid, which often contains ten times more choline than mother’s blood. Just like with folic acid, higher dietary intake of choline shortly before conception and during early pregnancy are associated with a lower risk of NTD in infants. A case-control study (424 NTD cases and 440 controls) found that women with highest choline and betaine intake, in combination, had as much as 72% lower risk of a NTD-affected pregnancy.

Choline is also necessary for building cellular membranes during rapid fetal and mother’s tissue expansion in the second and third term. Low choline intake during pregnancy has been associated with elevated homocysteine levels, preeclampsia and a risk of premature birth and a very low birth weight.

Human brain growth is most rapid during the third trimester of pregnancy and continues to be rapid for around five years after birth. During this time, the demand is high for sphingomyelin, which is made from choline, because this material is used to insulate nerve fibers. In humans, brain does not become similar to its adult structure until baby is around four-five years old. By feeding infants formula instead of breast milk, and also through differences in choline amount in the breast milk of mothers consuming different choline levels, the still-developing brain of an infant may be impacted, which may contribute to the differences in memory and recall in adults.

Choline can be found in breast milk in its various forms and choline levels within breast milk are correlated with choline levels in maternal blood, so the more choline is in mother’s diet, the more choline a child will get through breastfeeding. However, choline content in breast milk from mothers delivering preterm is much lower than the choline content from mothers delivering at term, because mothers delivering before full term may not have adequate mammary development, and may not reach full mammary development by the time they begin producing mature milk. Despite this, research showed significant improvement at 18 months and at 7.5–8 years of age in IQ score among preterm infants who were fed breast milk via tube in comparison to those who were not fed breast milk, suggesting that even if the mammary gland may be “immature”, breast milk produced by it still has benefit. Researchers (Lucas et al.) also found that consumption of mothers’ milk instead of formula was significantly related to increase in IQ later in life. This further underlines the importance of adequate intake of choline during pregnancy and breastfeeding as well as the importance of breastfeeding.

Human milk is very rich in choline, but formulas derived from other sources, particularly soy, have lower total choline concentrations than human milk (and also lack other important nutrients, such as long-chain polyunsaturated fatty acids, oligo-saccharides, thyroid-stimulating hormone, nerve growth factor, enzymes, etc.), and overall serum free choline concentrations are lower in formula-fed infants than in breast-fed infants, even though many formulas are now fortified with choline.

Choline also protects babies from stress as they exposed to high levels of cortisol in utero. If a pregnant woman is under a lot of stress, or suffering from anxiety or depression, her unborn child have an increased risk of stress-related and metabolic disorders. The consumption of 930 mg of choline in the third trimester of pregnancy is linked to a 33% lower concentration of the stress hormone cortisol, compared to those who consumed 430 mg a day. Consumption of choline during pregnancy may also protect the baby later in life from mental health conditions, high blood pressure and type 2 diabetes.

Mothers can also benefit from choline intake. Because they often run low on choline due to developing fetus requirements, supplementing with choline might help with pregnancy related “foggy brain”. Although it is not yet officially recognized as one of the side effects of pregnancy, many women report decrease in memory and concentration during the first term (and sometimes throughout the whole pregnancy) and presumably, this might be because they become deficient in choline and other nutrients. Because choline is considered a nootropic, taking it alongside a good prenatal multivitamin formula might provide expecting mothers with much needed energy and concentration.

Dietary sources of choline and intake limits that are considered safe during pregnancy.

Egg yolks, wheat germ, Atlantic cod, broccoli, cauliflower and other cruciferous vegetables,  chicken and turkey, brewer’s yeast, quinoa and amaranth, whole young soybeans (edamame), spinach, almonds, brown rice and grapefruit are amongst the richest sources of dietary choline that are safe to eat during pregnancy.

As a dietary supplement Choline Chloride or Choline Bitartare are the safest forms of choline to take during pregnancy as they have no potential gastrointestinal side effects of phosphatidylcholine that is found in soy lecithin granules.

The adequate intake of choline for women is 425 mg per day and much higher for pregnant and breastfeeding women. The table below shows the daily Adequate Intake Levels and Upper Limits for choline in milligrams, taken from a report published in 2000 by the American Institute of Medicine (adopted from Wikipedia).

Age AI UL
Infants
0–6 months
7–12 months
(mg/day)
125
150
(mg/day)
ND
ND
Children
1–3 yrs
4–8 yrs
200
250
1000
1000
Pregnancy
≤ 18 yrs
19–30 yrs
31–50 yrs
450
450
450
3000
3500
3500
Lactation
≤ 18 yrs
19–30 yrs
31–50 yrs
550
550
550
3000
3500
3500

Choline has very high toxicity limits, with mild effects, starting at around 7g per day. Therefore it is considered safe, as it is near impossible to take more than 3g a day, regardless of one’s diet. Even the strongest choline supplements on the market only offer maximum intake of around 1g – 1.5g per day. The upper limit (UL) intake of choline for adults is 3.5 g daily, but this level will be hard to reach even through both diet and recommended supplement intake. Individuals with trimethylaminuria (fish odor syndrome), renal disease, liver disease, depression, and Parkinson’s disease may have increased susceptibility to the adverse effects of choline in doses higher than 3.5g per day.

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1 comment to Importance Of Choline For Pregnancy And Breastfeeding.

  • Toni

    It should be noted that it’s best to buy l-choline bitartrate, not dl-choline bitartrate. If unsure, check with the manufacturer.

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