Why Choline Matters in Every Trimester – and While Breastfeeding

If there’s one nutrient we’re not talking about enough during pregnancy and breastfeeding, it’s choline. While folate has long taken centre stage in prenatal health, choline is just as critical—particularly when it comes to your baby’s brain development, your own mental health, and even labour outcomes.

What Is Choline?

Choline is an essential nutrient that plays a key role in:

• Brain development and cognitive function

• Cell membrane formation

• Neurotransmitter synthesis, particularly acetylcholine, vital for memory and muscle control

• Epigenetic programming, affecting how genes are expressed

It is so crucial that in 2017, the American Medical Association recommended adding choline to prenatal vitamins, yet most prenatal supplements in the UK and US still do not contain the recommended amount.

First Trimester: Laying the Neural Foundation

In the first trimester, your baby’s neural tube—which develops into the brain and spinal cord—begins to form. Choline is essential during this period for:

• Neural tube closure and development

• Reducing risk of neural tube defects (Zeisel & Niculescu, 2006)

• Initiating early brain structure formation, particularly the hippocampus, responsible for memory

Studies show that choline deficiency in early pregnancy may impair fetal brain development and contribute to long-term cognitive issues (Caudill, 2010).

Second Trimester: Brain Wiring in Progress

The second trimester is a period of rapid neurogenesis—when neurons form and begin to connect.

• Choline enhances neuronal proliferation and differentiation

• Supports the development of the corpus callosum, which connects the brain’s hemispheres

• Promotes healthy placental function, potentially reducing risks of preeclampsia and intrauterine growth restriction

A 2018 randomized controlled trial published in FASEB Journal showed that higher maternal choline intake (930 mg/day) improved infant processing speed and attention span at 4, 7, 10, and 13 months compared to the recommended 480 mg/day (Caudill et al., 2018).

Third Trimester: Cognitive Programming and Labour Protection

In the final trimester, your baby’s brain is growing rapidly, and choline helps shape the brain’s architecture for life.

• Supports myelination (protective coating around nerves)

• Reduces the impact of prenatal stress on the fetus by modulating cortisol exposure (Jiang et al., 2012)

• Plays a role in epigenetic programming, protecting against later-life mental health disorders like schizophrenia and ADHD

Intrapartum Benefits

Emerging research shows that choline also plays a role in labour and birth outcomes:

• Choline contributes to smooth muscle function, potentially supporting uterine contractility

• Adequate choline levels may reduce the risk of preterm labour and protect against infections, especially when combined with DHA (Yan et al., 2012; Wu et al., 2013)

• It also improves placental resilience, which may be protective in prolonged labour or cases of maternal inflammation

Postpartum and Breastfeeding: Nourishing Baby’s Brain from Birth

Choline demand remains very high during lactation, even higher than during pregnancy (550 mg/day for breastfeeding women).

• Breast milk is naturally rich in choline, especially in the first few months, to support ongoing brain growth

• Low choline status in mothers leads to lower levels in breast milk, which may impair infant memory and attention

• Choline also supports maternal mental health, improving cognitive function and potentially reducing postpartum depression risk

Supplementing with choline while breastfeeding may enhance infant memory development and stress resilience (Caudill, 2020).

Are You Getting Enough?

Unfortunately, around 90–95% of pregnant women fail to meet the adequate intake (AI) for choline (Wallace & Fulgoni, 2016). This is particularly concerning given that:

• Vegan and vegetarian diets are often low in choline

• The body’s ability to synthesize choline is insufficient during pregnancy

• Common food sources like eggs, liver, and meat may be under-consumed during pregnancy due to aversions or dietary choices

Key Takeaways

✅ Aim for at least 450 mg/day in pregnancy and 550 mg/day while breastfeeding.
✅ Supplement if needed—particularly if you don’t eat eggs or animal products.
✅ Look for prenatal vitamins that contain choline bitartrate or choline citrate.
✅ Combine choline with DHA and other methyl donors like folate and B12 for synergistic effects.

Final Word

Choline is not just another nutrient—it’s a lifelong investment in your child’s cognitive health and your own well-being. By ensuring optimal intake in each trimester and during breastfeeding, you can lay down the foundation for a resilient, high-functioning brain and smoother birth outcomes.

“We are what our mothers ate during pregnancy.”
— Steven Zeisel, MD, PhD, choline researcher

References

• Zeisel, S.H. & Niculescu, M.D. (2006). Perinatal choline influences brain structure and function. Nutr Rev 64(4):197–203.

• Caudill, M.A. (2010). Pre- and postnatal health: evidence of increased choline needs. J Am Diet Assoc 110(8):1198–1206.

• Caudill, M.A. et al. (2018). Maternal choline supplementation improves child sustained attention. FASEB J 32(4):2172–2180.

• Jiang, X. et al. (2012). Maternal choline levels modulate fetal cortisol and stress regulation. Endocrinology 153(5):1803–1811.

• Yan, J. et al. (2012). Choline and DHA interactions in pregnancy. Nutr Rev 70(10):623–631.

• Wallace, T.C. & Fulgoni, V.L. (2016). Usual choline intakes are below adequate intake levels. Nutr Today 51(5):234–240.