When discussing maternal nutrition, many nutrients come to mind and most of the time, choline is not on top of the list. As we explore the relationship between maternal nutrition and choline requirements, we will open a gateway to a realm where cellular development, neural tube formation and cognitive outcomes converge. This article explores choline’s role during pregnancy and breastfeeding, aiming to highlight the physiological intricacies that underscore its essentiality for optimal fetal development and long-term health outcomes.  

WHAT IS CHOLINE? 

Choline is classified as an essential nutrient because your body requires it for normal body functions- it plays an important role in brain, muscle, and liver function. Although our bodies can produce a small amount of choline, majority of it needs to be supplied by the food we consume. Animal-derived products generally have higher levels of choline than plant-derived products. Foods that naturally contain choline include eggs (one of the highest food sources of choline), salmon, chicken livers and milk1.  Research suggests that not meeting our choline requirements can have negative effects on our memory as well as our brain function2. 

CHOLINE DURING PREGNANCY AND BREASTFEEDING 

Recently, choline has been coined the term “neuroprotectant”, meaning it plays a critical role in normal function and growth of the early brain. Fetal and infant demand for choline is elevated and the requirements exceed the amount that the human body can make, thus making it an essential component of a mum’s diet3. 

Pregnancy and breastfeeding are a time in a mum’s life where nutrient requirements are increased, this is true for choline too. Thus, the supply of choline in a mum’s diet is of critical importance. During pregnancy, choline plays an important role in the baby’s brain development. Studies suggest that a woman’s choline intake during pregnancy, and possibly lactation can support normal brain development for the baby. A low intake of choline during conception and pregnancy can increase the risk of the baby developing neural tube defects like Spina Bifida. Most expecting mums consume sufficient folate to prevent neural tube defects, but choline plays an important role in reducing the risk too. Expecting mums should ensure they consume adequate amounts of both nutrients2. 

The recommended intake of choline for pregnant mums is 450mg per day. Research shows that dietary intake of choline for most pregnant women is significantly below their requirements. Consuming just two eggs, provides more than half your choline requirements for the day, during pregnancy2.  Not only does not consuming sufficient choline during pregnancy create potential risks for the unborn baby but it can also result in a choline deficiency for mum too4. 

Human milk is a rich source of choline, meaning that breastfeeding further increases the maternal demand for choline5. Choline requirements increase to 550mg whilst breastfeeding which is 100mg more than during pregnancy! This increase in requirements is to ensure that the mum meets the extra demand for her own body and that her growing baby also consumes sufficient choline for growth and development. The choline content of breast milk directly affects the circulating choline levels of the baby6. 

This new phase of your life is exciting, exhausting, and rewarding all at the same time. Maternal nutrition ensures that BOTH baby and mum receive all the nutrients they require. The role of choline stands as a beacon highlighting a pathway to optimal health for both mum and baby. As we navigate the vast terrain of maternal nutrition, let this conclusion echo a call to action- a recognition of the underrated but critical role that choline plays, urging a paradigm shift in maternal nutrition strategies and a deeper appreciation for the profound impact of this often- overlooked nutrient. 

REFERENCES

1. Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today. 2018 Nov-Dec;53(6):240-253. doi: 10.1097/NT.0000000000000302. Epub 2018 Nov 13. PMID: 30853718; PMCID: PMC6259877.
2. Early Life Nutrition Alliance. Choline. 2022.
3. Derbyshire E, Obeid R. Choline, Neurological Development and Brain Function: A Systematic Review Focusing on the First 1000 Days. Nutrients. 2020 Jun 10;12(6):1731. doi: 10.3390/nu12061731. PMID: 32531929; PMCID: PMC7352907.
4. Obeid R, Derbyshire E, Schön C. Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies. Adv Nutr. 2022 Dec 22;13(6):2445-2457. doi: 10.1093/advances/nmac082. PMID: 36041182; PMCID: PMC9776654.
5. Zeisel SH, da Costa KA. Choline: an essential nutrient for public health. Nutr Rev. 2009 Nov;67(11):615-23. doi: 10.1111/j.1753-4887.2009.00246.x. PMID: 19906248; PMCID: PMC2782876.
6. Ilcol, Y.O., Ozbek, R., Hamurtekin, E., Ulus, I.H. Choline status in newborns, infants, children, breast-feeding women, breast-fed infants and human breast milk. J Nutr Biochem. 2005 Aug;16(8):489-99. doi: 10.1016/j.jnutbio.2005.01.011. PMID: 16043031.

BY: Bianca Jonischkeit /   DATE: January 2024

DATE OF NEXT REVIEW: January