The Growing importance of Choline in Prenatal Human Nutrition – Dr. Eric Ciappio, Balchem Human Nutrition and Health

Podcast Topic

Part three of the podcast series from the 2022 Tri-State Dairy Nutrition Conference is Dr. Eric Ciappio’s presentation about the importance of choline in prenatal human nutrition. Dr. Ciappio is with Balchem Corporation.


Dr. Eric Ciappio, Balchem Human Nutrition and Health

Episode 83: The Growing importance of Choline in Prenatal Human Nutrition


Dr. Ciappio begins with an overview of one of the main roles of choline in the body: supporting overall brain health and cognitive function, primarily through its role as a precursor to the neurotransmitter acetylcholine. (3:20)

Eric then reviews several key pieces of research from the literature, beginning with a prospective cohort study looking at choline intake of the mother during pregnancy and the visual-spatial memory of their child seven years later. Moms who were in the highest quartiles of choline intake were correlated with significant improvement in visual-spatial memory of their children measured seven years later. (5:45)

Researchers at Cornell investigated two levels of choline supplementation for pregnant women during the second and third trimester. One group received low choline, 25 milligrams, or 550 milligrams a day of choline, slightly more than the daily recommended intake for pregnant women. Women in the high choline group had higher blood choline throughout the experiment and that increased choline was also observed in cord blood at delivery. (6:48)

Another Cornell study compared two groups of pregnant women, one who received approximately the recommended daily intake for choline and one who received roughly twice the recommended daily intake of choline during the third trimester. These were achieved through a controlled diet prepared in a metabolic kitchen plus supplemental choline. Once babies were delivered, cognitive testing was performed regularly from four months to 13 months. Babies born to mothers who consumed the higher dietary choline level had significantly faster visual processing speed compared to those born to the lower dietary group of women. Additionally, the number of days of prenatal exposure to choline was actually significantly associated with a faster reaction time, even within the lower choline intake group. (8:39)

These same children were followed up at seven years of age with no additional intervention and subjected to a sustained attention test. Children born to the high choline-supplemented group of women had a significantly higher score overall on the sustained attention test. The beneficial effects of maternal choline supplementation during the third trimester of pregnancy are still present at age seven. (14:46)

Choline also has a second important role in lipid metabolism, primarily to help generate phosphocholine and phosphatidylcholine which play both structural and functional roles: a structural component in the overall cell membranes and helps to transport specific lipids throughout the body. In particular, choline is critical for DHA transport. DHA is critical for maternal nutrition, as it is implicated in reduction of risk of preterm birth and overall support of the development of the eye and the brain (19:54)

In the study with 25 vs 550 milligrams of choline supplementation during the second and third trimesters (6:46), the researchers also supplemented the two groups with DHA. Supplementation with choline plus DHA during pregnancy improved DHA status better than just supplementing with DHA alone. (22:48)

In large dietary intake surveys of choline across the United States, just 6% of adult women in the United States get enough choline in their diet. Less than one in 20 pregnant women are getting enough choline in their diet relative to the daily recommended intake. Reviewers of the dietary guidelines showed that many prenatal supplements do not contain choline or only contain small amounts inadequate to meet recommendations. Similar observations have been reported worldwide. Furthermore, DHA inadequacy is common in pregnant and lactating women. (24:11)

Dr. Ciappio concludes his presentation with the reminder that choline is an essential nutrient that helps support the growth and development of the brain and supports brain health throughout the lifespan. Despite these benefits, just 4% of pregnant women in the United States get enough choline in their diet. Expert groups are calling on manufacturers to increase the amount of choline in prenatal supplements. (26:25)

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