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Choline, an Overlooked Nutrient for Fertility and Pregnancy

by Margaret Wertheim MS RD

When it comes to fertility and pregnancy, folic acid, iron and calcium are the vitamins and minerals that tend to get much of the attention. We would argue that there are quite a few other nutrients that don’t get nearly enough attention, and one of these is choline. Choline is an essential nutrient that your body can synthesize in small amounts, but the majority must be obtained in your diet. While you may constantly hear about the importance of folic acid for the prevention of neural tube defects like spina bifida, research indicates that higher choline intake during pregnancy is associated with lower risk of neural tube defects as well. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage, and in one study was associated with poorer egg and embryo quality in women with PCOS undergoing IVF. Furthermore, choline is a precursor to the neurotransmitter, acetylcholine, which is involved in memory and muscle control. In a study in rodents, when mothers consumed higher levels of choline, their offspring had significantly better memory throughout their lives. Thus choline intake during pregnancy may have a very long-term impact on memory and brain function from infancy into adulthood.

According to the National Health and Nutrition Examination Survey, the average choline intake in pregnant women is only about 338 mg/day, while the daily requirement during pregnancy is 450 mg. Daily choline needs increase to 550 mg while breastfeeding, as breast milk is a rich source of choline. Good food sources of choline include eggs, meat and fish, dairy, legumes, and certain whole grains, nuts and seeds. Vegans and vegetarians with limited intake of eggs and dairy products are at increased risk of having a choline-deficient diet. Very few prenatal vitamins contain any choline at all, and those that do usually contain only very small amounts. Luckily, Prenate Pro and Prenatal Plus both contain 200 mg choline, which can give you the extra boost you need to ensure you’re meeting your daily choline requirement. That being said, it’s also absolutely essential to include choline-rich foods in your diet on a daily basis.

Linus Pauling Institute at Oregon State University: Choline

Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Am Diet Assoc . 2010; 110:1198-1206

Berker, et al. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Reproductive Endocrinology . 2009; 24(9):2293-2302.

Zeisel, et al. Importance of methyl donors during reproduction. Am J Clin Nutr. 2009; 89( suppl):673S-677S.