Choline During Pregnancy: The Missing Piece of the Prenatal Nutrition Puzzle

When we think about pregnancy supplements, folic acid usually takes centre stage. Iron often follows close behind. Yet one nutrient continues to fly under the radar despite growing evidence of its importance: choline.

Reviews published in 2024 found that only around 11% of pregnant women meet recommended choline intakes. At the same time, higher maternal choline status was associated with a significantly lower risk of adverse pregnancy outcomes.

Are we paying enough attention to choline?

Why Choline Matters

Choline is an essential nutrient involved in:

• Foetal brain development

• Cell membrane formation

• Nervous system function

• DNA methylation and gene expression

• Healthy placental function

You can think of choline as one of the building blocks that helps create and organise new cells during pregnancy.

Why Deficiency Is So Common

Many women are unaware of choline recommendations because it is not routinely discussed alongside folate and iron.

The recommended intake during pregnancy is approximately 450 mg per day.

Unfortunately, many common prenatal vitamins contain little or no choline.

The Best Food Sources

Eggs remain one of the richest and most accessible sources.

Other good options include:

• Salmon and sardines

• Chicken and turkey

• Lean beef

• Dairy products

• Soybeans and edamame

• Legumes

Should Everyone Supplement?

Not necessarily.

A food-first approach remains ideal whenever possible. However, for women who eat few eggs, follow vegetarian or vegan diets, or struggle with food aversions during pregnancy, supplementation may be worth discussing with their healthcare team.

As always, supplementation should be personalised rather than automatic.

My Clinical Perspective

I believe choline deserves much more attention in prenatal nutrition conversations.

We now have growing evidence that many women are not meeting recommendations and that maternal choline status may influence pregnancy outcomes. While it may not receive the same attention as folate, it is becoming increasingly clear that both nutrients play complementary roles in supporting healthy development.

The goal is not to create anxiety around another nutrient to track. Instead, it is about identifying one of the most common nutritional gaps and addressing it proactively.