Scientific Articles

Key Articles on the Importance of Choline for your Prenatal Patients

One A Day® Prenatal Advanced Multivitamin provides 110 mg of choline.

Studies show the importance of adding choline for neurocognitive development 

Below you will find scientific articles discussing the importance of choline for proper fetal brain development and function.* Supplementing the maternal diet with additional choline (480 mg to 930 mg) during the perinatal period improves offspring cognitive outcomes and protects against some neural insult.

 

    • Choline is an essential nutrient that can be likened to docosahexaenoic acid (DHA). 
    • Supplementing the maternal diet with additional choline during the perinatal period improves offspring cognitive outcomes and protects against some neural insults. 
    • Higher intakes of choline during pregnancy may afford additional health benefits for both mother and child. 
    • Most pregnant and lactating women are not consuming recommended intakes of choline and would likely benefit from increasing dietary and/or supplemental choline intake. 

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    • Higher maternal second-trimester choline intake (406 vs. 253 mg) per day was associated with modestly higher visual memory score at age 7 years as measured by the Wide Range Assessment of Memory and Learning, Second Edition (WRAML2). 
    • There was a suggestive positive association (P=0.06) between second-trimester choline intake and the nonverbal Kaufman Brief Intelligence Test (KBIT-2) score, which measures nonverbal intelligence. 
    • There was a stronger association of child memory with second-trimester choline intake than with first-trimester intake. This finding may suggest a stronger effect of choline on brain formation in midgestation than early in pregnancy. 

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    • Pregnant women (N=26) were randomized to receive either 480 or 930 mg choline a day until delivery. Infant information processing speed and visuospatial memory were tested at 4, 7, 10 and 13 months of age. 
    • The results concluded significantly faster saccade reaction time, a measure of information processing speed, among infants born to mothers consuming the higher level of choline intake throughout their third trimester. 
    • The estimated mean saccade reaction time for infants in the 930 mg choline a day group was 22.6 ms faster (P=0.03) than the mean saccade reaction time for infants in the 480 mg choline a day group. Infants in the 930 mg choline a day group were consistently faster to react to pictures across the four assessment ages. 
    • Furthermore, for the 480 mg choline a day group, there was a significant linear effect of exposure duration (infants exposed longer showed faster reaction times), suggesting that even modest increases in maternal choline intake during pregnancy may produce cognitive benefits for offspring.

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    • Choline plays a key role in fetal development, particularly the brain. Studies have suggested that during pregnancy, particularly the third trimester, fetal organ growth is extremely rapid and large amounts of choline are required for membrane biosynthesis, hippocampal neurons, growth of the placenta, and maternal organs such as the kidneys and uterus. 
    • Low maternal dietary choline intake (290 mg/day) has shown to increase the risk for having a baby with a neural tube defect by approximately two times. 
    • Adequate choline intake levels of 425, 450 and 550 mg/day were developed for nonpregnant, pregnant, and breastfeeding women, respectively. 
    • Postnatal choline concentrations increase 50% to 100% in the mammary glands of breastfeeding women. Increased choline exposure can beneficially affect cognitive function. This period corresponds to synaptogenesis, a formation of synapses between neurons in the nervous system. 

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    • Both the American Academy of Pediatrics and the American Medical Association have recently reinforced the importance of maternal choline intake during pregnancy and lactation, and recognize that failure to provide choline and other key essential nutrients during the first 1,000 days post conception may result in lifelong deficits in brain function. 
    • Higher choline intakes lowered the placental expression and circulating protein levels of soluble fms-like tyrosine kinase-1 (sFLT1), a vascular endothelial growth factor receptor implicated in the pathogenesis of preeclampsia. 
    • The rapidly growing body of evidence relating inadequate maternal choline intakes to potential health consequences in the offspring warrants a need for health professionals to better communicate the need for choline-rich foods and supplementation.

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    • An individual’s requirement for choline is dependent on common genetic variants in genes required for choline, folate and 1-carbon metabolism, potentially increasing more than one-third of the population’s susceptibly to organ dysfunction. 
    • Only about 10% of Americans and 8% of pregnant women currently meet their gender- and life stage-specific adequate intake for choline. 
    • Choline is an essential nutrient needed for proper liver, muscle and brain functions; lipid metabolism; and cellular membrane composition and repair6.
    • Low maternal choline intakes during pregnancy have been shown to increase the risk of both neural tube defects and cleft palates. 
    • The results from a long-term follow-up study (Nevins et al. 2018) revealed that higher maternal choline intakes during the third trimester of pregnancy revealed lasting benefits of the higher maternal choline intake on child attention, memory and problem-solving at age 7 years7.

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    *This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease

    1. Caudill MA. Choline and perinatal nutrition: what healthcare providers need to know. Division of Nutritional Sciences, Cornell University. 
    2. Boeke CE, Gillman MW, Hughes MD, Rifas-Shiman SL, Villamor E, Oken E. Choline intake during pregnancy and child cognition at age 7 years. American Journal of Epidemiology. 2013;177(12):1338–1347. 
    3. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double‐blind, controlled feeding study. FASEB Journal: official publication of the Federation of American Societies for Experimental Biology. 2018;32(4):2172–2180. 
    4. Caudill MA. Pre- and postnatal health: evidence of increased choline needs. Journal of the American Dietetic Association. 2010;110(8):1198–1206. 
    5. Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Zeisel SH. Choline: The neurocognitive essential nutrient of interest to obstetricians and gynecologists. Journal of Dietary Supplements. 2019:1–20. 
    6. Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. Choline: The underconsumed and underappreciated essential nutrient. Nutrition Today. 2018;53(6):240–253. 
    7. Nevins JEH, Beckman KA, Bahnfleth CL, Drewes BM, Caudill MA, Strupp BJ, Canfield RL. Maternal choline supplementation during pregnancy improves executive functioning in children at age 7 y. Presented at: American Society for Nutrition Annual Meeting; Boston, MA; June 9Y12, 2018. 

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