There’s no question that nutrition for pregnant and nursing moms is important. In fact, experts recommend a balanced diet, supplemented with a high-quality prenatal vitamin, in the months before a woman hopes to conceive to ensure that she’s getting all the nutrients she needs for a successful conception, pregnancy, and baby. One of those nutrients is choline. And if you haven’t heard of it, you aren’t alone. Dr. Taylor Wallace, America’s Favorite Food Scientist and an expert on choline, calls it the “under-consumed and under-appreciated essential nutrient.” He’s right–in spite of its importance, choline is worryingly absent in so many mainstream prenatal vitamin formulas.
We sat down with Dr. Wallace for a rundown on choline and why it’s so critical for pregnant and nursing moms, plus how to be sure you and your baby are getting enough.
- Choline is an essential nutrient, particularly during pregnancy and breastfeeding, but it’s often overlooked in prenatal vitamin formulas.
- Dr. Taylor Wallace, a choline expert, describes it as under-consumed and under-appreciated, and says as many as 92% of pregnant women don’t get the recommended amount of choline.
- The first 1,000 days post-conception to a child’s second birthday is a crucial nutrition-sensitive window for brain development, and insufficient amounts of choline can be detrimental to an infant’s cognitive development and maintenance in the latter stages of life.
- The best way to get adequate amounts of choline is to incorporate choline-rich foods like whole eggs and seafood, and take a daily prenatal vitamin high in choline.
What is Choline?
Choline is a B-vitamin like nutrient produced in small amounts in the human body, though not nearly enough to meet our biological need (this is why it is considered an “essential” nutrient). In 1998, the National Academy of Medicine (NAM) recognized choline as an essential nutrient, but the memo didn’t really get out. It’s a head scratcher, considering choline’s many important roles in our bodies, from metabolic to structural to regulatory. This is a nutrient important for brain development, memory, liver and muscle function, and the composition of cellular membranes–clearly, we need it. And yet, due to lack of awareness by health professionals “choline has been shown to be ranked last among common nutrients as a nutrient to recommend in a healthy diet,” says Dr. Wallace. Worse, he says just 6% of obstetricians and gynecologists report that they’re likely to recommend choline-rich foods to pregnant women.
In early pregnancy, before many women even know they’re pregnant, sufficient amounts of choline are particularly important. It’s used to support maternal organs, including the uterus and kidneys, and for placental growth. Like folate, choline also supports proper spinal cord and brain development and protects against neural tube defects. Adequate third trimester choline intake is linked to babies with faster information processing speeds, as well as moderately improved visual memory and attention span in childhood. These effects have been shown to extend into childhood.
Dr. Wallace’s own research shows other benefits of choline–it can decrease risk factors for preeclampsia and reduce plasma cortisol levels in babies, which could reduce risks of stress-related disease later in life.
Bottom line–choline is among the most important nutrients before, during, and after pregnancy. And it’s all related to what’s known as the 1,000-day window. This nutrition-sensitive timeframe, from conception to a child’s second birthday, is associated with tremendous brain development–something that can affect the rest of a child’s life. And it’s closely linked to maternal nutrition, even before pregnancy.
This is why experts recommend that hopeful moms-to-be eat a balanced, wholesome diet and begin taking a prenatal vitamin. Critical brain development takes place in the earliest stages of pregnancy, well before those two pink lines appear. And that development doesn’t stop. A three year old has three-quarters the brain volume of an adult, and nutritional deficiencies–including choline–will directly affect how the brain grows and develops. But timing is so critical. Dr. Wallace emphasizes that “subsequent repletion of a nutrient like choline outside of the first 1,000 days window may not compensate for the detriment due to nutrient deficiency or inadequacy."
What’s the Daily Recommended Serving of Choline?
According to the NAM, recommended daily allowances of choline can vary between 125 and 550 mg daily, depending on age and gender. During pregnancy, the recommendation is 450 mg per day. For nursing moms, it’s 550 mg per day. Human milk is rich in choline, explains Dr. Wallace, which means a mother’s daily requirement increases.
It’s quite a bit in both scenarios, which is why it’s so important to understand where to get choline. In addition to specific foods, this is where a high-quality prenatal vitamin comes in. Here’s the thing–choline is either completely overlooked in many of the most popular and well-known prenatal vitamins, or it’s included in insufficient amounts. “It’s shocking that most prenatal formulas don’t contain choline, or have it in such low amounts, considering how critical it is for baby’s brain development,” says Dr. Wallace. It’s especially concerning considering that like NAM, the American Medical Association (AMA) has been recommending prenatal vitamin supplementation with choline since June 13, 2017.
In spite of these recommendations, “92% of pregnant women don’t get the recommended amount of choline in their diets that helps build the baby's brain, promotes DHA transfer across the placenta, and eases the baby’s response to environmental stress,” says Dr. Wallace. That’s a disturbingly high percentage, and it highlights the fact that choline education and additional research is sorely needed. It also means that women need to be really picky about prenatals.
The good news? Beli has you covered. “Beli’s modern prenatal is one of the first to include 400 mg of a highly absorbable form of choline that gives women the nutrients they need to support a growing baby in pregnancy and post-pregnancy,” says Dr. Wallace. Pair it with foods naturally rich in choline, which include:
- Eggs, 150 mg apiece
- Salmon, 187 mg in a 3-oz serving
- Milk, 38 mg in an 8-oz serving
- Almonds, 15 mg in a 1-oz serving
- Brussels sprouts, 32 mg in a ½ cup serving
- Grass-fed beef, 55 mg in a 3-oz serving
- Chicken, 58 mg in a ½ cup serving
Of course, most diets don’t include enough choline-rich foods to ensure you’re hitting the recommended daily allowance, and those following vegan or vegetarian diets are particularly at risk. “Choline intakes are predominantly derived from animal-sourced foods,” notes Dr. Wallace. Again, that’s where your prenatal vitamin (the one with choline!) comes in. But awareness and education are an important first step. Dr. Wallace is a staunch advocate in that arena. “Targeted education to the obstetrics and gynecology communities is a good start,” he says, “however, all health professionals need to be aware of food sources of choline.”
Here at Beli, we tip our hats to you, Dr. Wallace, and we couldn’t agree more. Like you, we’re doing what we can to education moms and moms-to-be about this essential nutrient.