Choline.

What choline does

The body uses choline to make components of cell membranes called phospholipids. It also uses choline to make acetylcholine, a chemical messenger involved in nerve and muscle function. It also participates in lipid transport and metabolism. The liver makes some choline, but this does not usually meet all needs.1

Food and different product forms

Choline is present in a range of foods, including eggs, meat, fish, dairy, legumes and some vegetables. Supplements may contain choline salts, phosphatidylcholine or lecithin. Their amounts and forms vary, so the product label and the specific research question matter.1

Why does choline matter in pregnancy?

Choline contributes to fetal growth and nervous-system development, and nutritional needs increase during pregnancy. Food remains an important source; not all prenatal supplements contain choline, and amounts vary. US dietary guidance and food availability may differ from those elsewhere. A healthcare professional or registered dietitian can discuss dietary needs and whether a particular supplement is appropriate.

Population reference values differ. US authorities set an adequate intake for adults aged 19 and older of 550 mg a day for men and 425 mg for women; the US values during pregnancy and breastfeeding are 450 mg and 550 mg respectively.

EFSA’s European adequate intakes are 400 mg for adults, 480 mg during pregnancy and 520 mg during breastfeeding. These are estimates of adequate total intake from food and supplements, not supplement doses or individual prescriptions. Discuss your circumstances with a clinician or dietitian.412

Does extra choline improve a child’s development?

The question is still being studied. In a 2012 US trial, 140 pregnant women were randomly assigned phosphatidylcholine or placebo from pregnancy through the early postpartum period. Researchers tested 99 infants at 10 and 12 months and found no statistically significant differences between groups on the measured memory, language or general development tests. This does not prove that choline is unimportant, or rule out effects in people with different diets, at other ages or with other formulations. It also does not establish that extra supplementation benefits every pregnancy. The study measured specific tests, not a child’s complete future abilities. A separate controlled feeding study followed 20 children to age seven after their mothers were assigned to different choline intakes during the third trimester. Children in the higher-intake group performed better on one sustained-attention task. This is an encouraging finding, but the follow-up was very small, used a particular task and compared two intake levels rather than choline with no choline. The two studies differed in design and child age; neither establishes a supplement recommendation or guarantees a developmental outcome.35

Claims and safety

Choline needs vary with life stage and individual circumstances, including pregnancy. Choline is being studied in several areas, but evidence for a particular supplement and health outcome cannot be assumed from its role in normal biology. Excessive intake can cause unpleasant effects and liver toxicity. US guidance sets an upper limit from food and supplements combined of 3,500 mg a day for adults 19 and older and 3,000 mg for ages 14–18, including during pregnancy and lactation. These are not targets and do not apply to high-dose treatment under medical supervision. Excessive intake is associated with fishy body odour, vomiting, heavy sweating or salivation, low blood pressure and liver toxicity.1