Choline benefits in fertility and pregnancy from a Registered Dietitian

Hi there! My name is Rebekah. I'm a Registered Dietitian who specializes in helping active mamas navigate pregnancy and postpartum nutrition. As an active mama myself, I've been there - the constant questions, the anxiety, the uncertainty around what to eat, what's safe, navigating nausea and constipation...the list of google searches were endless. One of these searches included learning more about choline. A nutrient that really doesn't get enough spotlight - although it definitely should! Let's talk about it.

When you're planning a pregnancy or already pregnant, you probably focus on folate, iron, and a good prenatal vitamin - and for good reason. But choline is an essential nutrient that often gets overlooked, despite playing a unique and important role in fetal development. Getting enough choline before conception and throughout pregnancy supports feritlity, baby's brain development, helps the placenta function, and may reduce some birth-defect risks.Office of Dietary Supplements+1

What does choline do? Choline is a building block for cell membranes (phosphatidylcholine), a precursor for the neurotransmitter acetylcholine (important for memory and muscle control), and a key methyl donor in one-carbon metabolism - the same biochemical system that folate participates in. Those functions make choline particularly important during periods of rapid growth, like fetal development.Office of Dietary Supplements

Benefits for fetal brain development Animal studies and growing human evidence suggest that higher maternal choline intake during pregnancy supports fetal brain development and may improve children’s attention, memory and other cognitive outcomes. Controlled feeding and randomized trials have reported better measures of sustained attention and working memory in children whose mothers consumed higher amounts of choline during pregnancy. While more long-term studies are still underway, current human trials and systematic reviews point to potentially meaningful neurodevelopmental benefits.FASEB Journal+2eCommons+2

Potential to lower risk of neural tube defects and support the placenta.

Beyond cognition, choline contributes to fetal growth and placental function. Some observational data and mechanistic studies suggest that low maternal choline intake is associated with increased risk of neural tube defects and other developmental problems; adequate choline may help modulate gene expression important to early development. While folate remains the primary preventive nutrient for neural tube defects, choline likely acts alongside folate and other methyl donors to support neural tube closure and healthy placental biology.Ego Journal+1

How much is recommended - and are most people meeting it? Authoritative bodies set Adequate Intake (AI) values because a precise RDA hasn’t been established. For pregnancy, the AI is commonly reported around 450 mg/day (and increases to ~550 mg/day during late pregnancy and while breastfeeding). Despite this, dietary surveys consistently show that most pregnant people do not reach the AI, and many prenatal vitamins do not contain meaningful amounts of choline. That means intentionality with your diet or a choline-containing supplement may be necessary to reach recommended intakes.Office of Dietary Supplements+1

Safety and upper limits Choline from food is generally safe. The Institute of Medicine/National Academy of Medicine established a Tolerable Upper Intake Level (UL) of 3,500 mg/day for adults to avoid side effects (e.g., hypotension, fishy body odor, sweating, GI symptoms). Most prenatal dosing and food-based approaches are well below this threshold. As always, discuss supplements with your dietitian and physician before starting them.NCBI+1

Practical tips

• Prioritize choline-rich foods: eggs (especially yolks), beef and chicken liver, lean meats, fish, dairy, soy, and peanuts are good sources. One large egg provides roughly 125–150 mg of choline.The Nutrition Source

• Check your prenatal: many prenatal multivitamins don’t include choline — look for formulas listing choline (choline bitartrate, phosphatidylcholine) or speak to your provider about adding a supplement.Office of Dietary Supplements

• Aim for a food-first approach when possible, and supplement if intake is likely inadequate or if advised by your healthcare team.
  

Bottom line Choline is an essential, underappreciated nutrient for anyone planning pregnancy and during gestation. Prioritizing choline through diet (and supplements when needed) supports fetal brain development, placental health, and overall pregnancy nutrition - and is one more practical step toward giving a baby the best start.

If you’re unsure whether you’re getting enough choline - or want personalized guidance to support a strong, healthy pregnancy - I can help. Book a nutrition consultation or consider joining my next cohort of my Fueling Motherhood programs for active mamas where you will learn exactly what to eat, how much you need, and how to confidently fuel your growing body and baby.

References

1. Office of Dietary Supplements (NIH). Choline — Health Professional Fact Sheet. (2022). Office of Dietary Supplements

2. American College of Obstetricians and Gynecologists (ACOG). Nutrition during pregnancy — FAQ. ACOG

3. Bahnfleth CL, et al. Prenatal choline supplementation improves child sustained attention and working memory (controlled feeding study). FASEB J. (2022). FASEB Journal

4. Brinkman JE, et al. Randomized controlled trial of maternal choline — long-term cognitive outcomes (2021). eCommons

5. Dymek A, et al. Choline—An Underappreciated Component of a Mother-to-Be’s Diet (MDPI Nutrients, 2024). MDPI

6. Institute of Medicine / National Academy of Medicine. Dietary Reference Intakes for Choline; Tolerable Upper Intake Level (UL = 3,500 mg/day for adults). NCBI

7. Harvard T.H. Chan School of Public Health. The Nutrition Source — Choline. The Nutrition Source