Choline Intake for Pregnancy and Breastfeeding

Choline Intake for Pregnancy and Breastfeeding

CHOLINE INTAKE FOR PREGNANCY AND BREASTFEEDING

In addition to a daily prenatal vitamin and a daily prenatal DHA supplement, I also recommend a daily prenatal choline supplement.

What is Choline?

Choline is a macronutrient found in foods. Choline is in the B vitamin family . It is essential in fetal brain development. Choline is a precursor to acetylcholine. Acetylcholine is a neurotransmitter that sends signals in the brain. Acetylcholine, and therefore choline, are important for memory, muscle control and brain function.

Choline is involved in many of the same metabolic pathways as folate, including methylation. Everyone knows folate — or its synthetic supplemental version, folic acid — due to its vital role in the prevention of neural tube. Did you know choline is equally as important as folate for preventing neural tube defects?!

The major reason choline is not making headlines in prenatal nutrition is that it’s a new kid on the block, relatively speaking. The first time we had a recommended intake for choline was 1998. The data used to set that recommendation was fairly weak; it was set based on a depletion-repletion study conducted in adult men & set at a minimum level to prevent liver damage. These figures were then adjusted upwards for pregnancy/lactation based on estimates of fetal needs.

Consuming adequate levels of choline during pregnancy is essential to ensure normal fetal brain development.

Our current recommended intake for pregnancy is set at 450 mg. Many of the supplementation studies have compared choline intakes of 480 mg (slightly above the recommended intake) to 930 mg per day. The women receiving 930 mg/day consistently show improved outcomes, as do their babies.

In children aged 7 years old, those born to mothers with the highest intake of choline during pregnancy have better visual memory compared to those with the lowest intake. Interestingly, this study found that maternal intake of related nutrients, like vitamin B12 and folate, did not have a significant influence on cognitive test performance. (Am J Epidemiology, 2012)

How Much Choline do You Need?

According to the Institute of Medicine, pregnant women should consume at least 450mg of Choline per day. Furthermore, breastfeeding women should consume at least 550mg of Choline per day. Most people do not consume this much choline. Although Choline is present in many different foods it is present in fairly low quantities. According to the National Institute of Heath, the average woman consumes 278mg of choline per day. Furthermore, 90–95% of pregnant women are deficient in choline.

What Foods contain Choline?

Most dietary choline comes from animal sources. My favorite source of choline is eggs. One egg contains 147mg of choline. Most of the time you are consuming at least 2 eggs, and that is more than 50% of your recommended daily choline intake right there. Most of the other foods high in choline are meat products such as beef, chicken and fish. However, it is possible to find choline in vegetarian sources. Soybeans, for example contain 107mg of choline in half a cup and 1 cup of cooked quinoa contains 43mg of choline.

Aside from egg yolks and liver, other foods rich in choline include: organ meats (like kidney, heart, giblets), fish roe, wild game (especially caribou and venison), fatty fish (especially salmon), pork skin (think chicharones), beef, lamb, pork, poultry, and dairy products. Bacon is actually a surprisingly rich source of choline, too (eggs + bacon anyone?).



Obtaining Adequate Choline on a Vegetarian Diet

As mentioned above, certain plant foods do contribute to choline intake, especially shiitake mushrooms, beans/legumes, nuts/seeds, and cruciferous vegetables. These still count, but the quantity required to meet choline demands, particularly in pregnancy in lactation, makes it virtually impossible to do with diet alone. In fact, I have yet to see a vegan pregnancy meal plan with adequate choline.

If you can’t/don’t want to consume eggs, I highly recommend a choline supplement, such as choline bitartrate, phosphatidylcholine, or sunflower lecithin (which is naturally rich in phosphatidylcholine) to meet your needs.

OTHER BENEFITS TO CHOLINE

COVID: Pregnant women who take extra choline supplements may mitigate the negative impact that viral respiratory infections, including COVID-19, can have on their babies, according to a new study from researchers in the Departments of Psychiatry and Obstetrics and Gynecology at the University of Colorado Anschutz Medical Campus. The new study, published in the Journal of Psychiatric Research, specifically looked at whether higher prenatal choline levels can help protect the fetus’s developing brain even if the mother contracts a viral respiratory infection in early pregnancy. The results reveal higher prenatal choline levels mitigate the fetal impact of virus infection. “It’s important for the healthcare community, and soon to be mothers, to be aware that a natural nutrient can be taken during pregnancy, just like folic acid and other prenatal vitamins, to protect fetuses and newborns from brain development issues. Later on in life, these development issues can lead to mental illness,” Freedman adds. Choline levels sufficient to protect the fetus often require dietary supplements.

“High choline intake during gestation and early postnatal period has been repeatedly described as a robust cognitive enhancing regimen and is neuroprotective in a variety of animal models of neuronal damage. Data showing that maternal choline supply during pregnancy modifies fetal DNA and histone methylation suggest that a concerted epigenomic mechanism contributes to these long-term effects of varied choline intake in utero.” (Clin Chem Lab Med, 2013)

Preeclampsia: Choline intakes at levels more than DOUBLE our current recommended intake optimize placental function, may reduce the risk of preeclampsia, and improve infant cognitive development and reaction time. (Placenta, 2016; FASEB, 2013; FASEB, 2018)

Placenta: Choline also enhances the transport of nutrients across the placenta, including DHA; note the nutrient synergy. (J Nutri, 2017; Metabolism, 2008) Some of the richest food sources of choline also contain DHA, such as egg yolks and salmon.







Choline content of foods (mg/100 g)



Meats

Vegetables



Bacon, cooked

124.89

Bean, snap

13.46

Beef, trim-cut, cooked

78.15

Beetroot

6.01

Beef liver, pan fried

418.22

Broccoli

40.06

Chicken, roasted, with skin

65.83

Brussels sprout

40.61

Chicken, roasted, no skin

78.74

Cabbage

15.45

Chicken liver

290.03

Carrot

8.79

Cod, atlantic

83.63

Cauliflower

39.10

Ground beef, 75–85% lean, broiled

79.32–82.35

Sweetcorn, yellow

21.95

Pork loin cooked

102.76

Cucumber

5.95

Shrimp, canned

70.60

Lettuce, iceberg

6.70

Dairy products (cow)

Lettuce, romaine

9.92

Butter, salted

18.77

Pea

27.51

Cheese

16.50–27.21

Sauerkraut

10.39

Cottage cheese

18.42

Spinach

22.08

Milk, whole/skimmed

14.29–16.40

Sweet potato

13.11

Sour cream

20.33

Tomato

6.74

Yogurt, plain

15.20

Zucchini

9.36

Grains

Fruits



Oat bran, raw

58.57

Apple

3.44

Oats, plain

7.42

Avocado

14.18

Rice, white

2.08

Banana

9.76

Rice, brown

9.22

Blueberry

6.04

Wheat bran

74.39

Cantaloupe

7.58

Wheat germ, toasted

152.08

Grape

7.53

Others

Grapefruit

5.63

Bean, navy

26.93

Orange

8.38

Egg, hen

251.00

Peach

6.10

Olive oil

0.29

Pear

5.11

Peanut

52.47

Prune

9.66

Soybean, raw

115.87

Strawberry

5.65

Tofu, soft

27.37

Watermelon

4.07

^Foods are raw unless noted otherwise. Contents are approximate sums of free choline and choline containing phospholipids.

Daily values

The following table contains updated sources of choline to reflect the new Daily Value and the new Nutrition Facts and Supplement Facts Labels. It reflects data from the U.S. Department of Agriculture, Agricultural Research Service. FoodData Central, 2019.

Selected Food Sources of Choline

Food

Milligrams (mg) per serving

Percent DV*

Beef liver, pan fried, 3 oz (85 g)

356

65

Egg, hard boiled, 1 large egg

147

27

Beef top round, separable lean only, braised, 3 oz (85 g)

117

21

Soybeans, roasted, ​1⁄2 cup

107

19

Chicken breast, roasted, 3 oz (85 g)

72

13

Beef, ground, 93% lean meat, broiled, 3 oz (85 g)

72

13

Cod, Atlantic, cooked, dry heat, 3 oz (85 g)

71

13

Mushrooms, shiitake, cooked, ​1⁄2 cup pieces

58

11

Potatoes, red, baked, flesh and skin, 1 large potato

57

10

Wheat germ, toasted, 1 oz (28 g)

51

9

Beans, kidney, canned, ​1⁄2 cup

45

8

Quinoa, cooked, 1 cup

43

8

Milk, 1% fat, 1 cup

43

8

Yogurt, vanilla, nonfat, 1 cup

38

7

Brussels sprouts, boiled, ​1⁄2 cup

32

6

Broccoli, chopped, boiled, drained, ​1⁄2 cup

31

6

Cottage cheese, nonfat, 1 cup

26

5

Tuna, white, canned in water, drained in solids, 3 oz (85 g)

25

5

Peanuts, dry roasted, ​1⁄4 cup

24

4

Cauliflower, 1 in (2.5 cm) pieces, boiled, drained, ​1⁄2 cup

24

4

Peas, green, boiled, ​1⁄2 cup

24

4

Sunflower seeds, oil roasted, ​1⁄4 cup

19

3

Rice, brown, long-grain, cooked, 1 cup

19

3

Bread, pita, whole wheat, 1 large (6 1⁄2 in or 17 cm diameter)

17

3

Cabbage, boiled, ​1⁄2 cup

15

3

Tangerine (mandarin orange), sections, ​1⁄2 cup

10

2

Beans, snap, raw, ​1⁄2 cup

8

1

Kiwifruit, raw, ​1⁄2 cup sliced

7

1

Carrots, raw, chopped, ​1⁄2 cup

6

1

Apples, raw, with skin, quartered or chopped, ​1⁄2 cup

2

0

DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for choline is 550 mg for adults and children age 4 years and older. The FDA does not require food labels to list choline content unless choline has been added to the food. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

The U.S. Department of Agriculture’s (USDA’s) FoodData Central lists the nutrient content of many foods and provides a comprehensive list of foods containing choline arranged by nutrient content.

Dietary recommendations

Recommendations are in milligrams per day (mg/day). The European Food Safety Authority (EFSA) recommendations are general recommendations for the EU countries. The EFSA has not set any upper limits for intake. Individual EU countries may have more specific recommendations. The National Academy of Medicine (NAM) recommendations apply in the United States, Australia and New Zealand.

Choline recommendations (mg/day)

Age

EFSA adequate intake

US NAM adequate intake

US NAM tolerable upper intake levels

Infants and children

0–6 months

Not established

125

Not established

7–12 months

160

150

Not established

1–3 years

140

200

1,000

4–6 years

170

250

1,000

7–8 years

250

250

1,000

9–10 years

250

375

1,000

11–13 years

340

375

2,000

Males

14 years

340

550

3,000

15–18 years

400

550

3,000

19+ years

400

550

3,500

Females

14 years

340

400

3,000

15–18 years

400

400

3,000

19+ y

400

425

3,500

If pregnant

480

450

3,500 (3,000 if ≤18 y)

If breastfeeding

520

550

3,500 (3,000 if ≤18 y)

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