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—constantly asking questions, feeling anxious, and uncertain about what to eat. What’s safe? How do I navigate nausea and constipation? The list of Google searches was endless! One of those searches led me to learn more about choline. This nutrient really doesn’t get enough spotlight, although it definitely should! Let’s talk about it.

The Importance of Choline in Pregnancy

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. It plays a unique and important role in fetal development. Getting enough choline before conception and throughout pregnancy supports fertility, brain development, helps the placenta function, and may reduce some birth-defect risks. Office of Dietary Supplements

What Does Choline Do?

Choline is a building block for cell membranes (phosphatidylcholine). It’s a precursor for the neurotransmitter acetylcholine, which is important for memory and muscle control. Choline is also a key methyl donor in one-carbon metabolism—the same biochemical system that folate participates in. These 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. It 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

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 an 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

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 about 550 mg/day during late pregnancy and while breastfeeding. Despite this, dietary surveys consistently show that most pregnant people do not reach the AI. Many prenatal vitamins do not contain meaningful amounts of choline. That means being intentional with your diet or considering a choline-containing supplement may be necessary to reach recommended intakes. Office of Dietary Supplements

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 like hypotension, fishy body odor, sweating, and 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

Practical Tips for Increasing Choline Intake

• 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. It’s one more practical step toward giving your 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 the Fueling Motherhood programs for active mamas. You’ll 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