Rachel Corradetti-Sargeant, BSc Kin, ND
Choline may still fly under the radar compared to folate or DHA, but an expanding body of research, including pivotal 2025 studies, now positions it as a must-have nutrient across the entire reproductive journey. From preconception and fertility to pregnancy, fetal brain development, and postpartum recovery, choline’s roles are truly foundational.
Preconception: Supporting Fertility and Reducing Inflammation
Before pregnancy even begins, choline plays a critical role in preparing the body for conception. One of its most impactful functions is balancing homocysteine levels, an amino acid associated with inflammation and increased risk of cardiovascular and reproductive complications. Elevated homocysteine can impair implantation, increase miscarriage risk, and negatively impact egg and sperm quality.
Choline, acting as a methyl donor, helps convert homocysteine to methionine, reducing systemic inflammation and creating a more favourable environment for conception. This function aligns with choline’s synergistic action alongside folate and vitamin B12 in one-carbon metabolism, which supports DNA synthesis and methylation — essential processes for healthy reproductive cells and early embryo development.
Moreover, choline supports the quality of gametes. In females, it aids oocyte maturation, ensuring proper cell division and membrane formation. In males, choline supports sperm motility and integrity, key factors for successful fertilization. Recent studies also suggest that its anti-inflammatory and antioxidant properties further protect reproductive cells during this critical window.
Fertility & Ovarian Physiology
New mechanistic evidence strengthens choline’s importance for ovarian function. A 2023 pig model study demonstrated that dietary choline enhanced follicular development, increased corpus luteum count, and upregulated steroidogenic genes (CYP11A1 and LHR). Interestingly, choline also shifted the gut microbiome toward steroid hormone pathways, suggesting a potential choline–microbiome–ovary axis.
While human trials are ongoing, these animal findings highlight the potential for choline to directly support ovarian physiology and improve fertility outcomes.
Pregnancy: Neural Tube and Brain Development
Perhaps choline’s most well-established role is in fetal neural tube and brain development. Similar to folate, choline is crucial for neural tube closure in early gestation, reducing the risk of severe birth defects such as spina bifida and anencephaly.
Beyond neural tube formation, choline supports brain development throughout pregnancy. It contributes to the synthesis of phosphatidylcholine and sphingomyelin (key neuronal membrane components), and it is vital for the neurotransmitter acetylcholine, which underlies learning and memory.
Landmark randomized controlled trials have shown that consuming 930 milligrams per day (compared to the standard 480 milligrams per day) during the third trimester results in improved sustained attention and information processing speed in offspring, with benefits persisting into childhood and adolescence.
A 2025 systematic review led by Nguyen and colleagues synthesized data from multiple trials and cohort studies, noting mixed but generally supportive findings on neurodevelopmental outcomes. Despite some variability, these robust trials consistently suggest that higher maternal choline intake provides measurable cognitive advantages.
Cellular Communication and Epigenetics
Choline’s role doesn’t end with brain development. It is essential for cellular communication via phospholipids in cell membranes and for DNA synthesis and methylation. Proper methylation ensures healthy gene expression and regulates numerous biological pathways during fetal development.
Inadequate maternal choline intake can disrupt these epigenetic processes, potentially leading to long-term metabolic and developmental consequences for the child.
Adverse Pregnancy Outcomes
Choline’s benefits also extend to reducing adverse pregnancy outcomes. A 2024 meta-analysis found that higher maternal choline levels reduce the risk of adverse outcomes by nearly half. A 2025 review further underscores choline’s protective role against neural tube defects, cognitive delays, preeclampsia, gestational diabetes, and preterm birth.
Despite these benefits, fewer than 12% of pregnant individuals meet the adequate intake recommendations, highlighting a critical nutritional gap.
Postpartum and Lactation
Choline continues to be crucial after birth. It supports maternal tissue repair, cognitive recovery, and lactation. Through breast milk, choline provides ongoing brain and immune support to infants during their rapid developmental period.
For new mothers, postpartum nutritional depletion is common, and adequate choline intake helps replenish essential nutrient stores, supporting both maternal health and infant outcomes.
Dietary Needs and Sources
The National Institutes of Health recommends at least 450 milligrams per day of choline during pregnancy and 550 milligrams per day during lactation. However, evidence from recent trials suggests 930 milligrams per day during late pregnancy may offer optimal cognitive benefits for the baby.
Key dietary sources include:
Eggs (two eggs provide about 300 milligrams, mostly in the yolk)
Lean meats
Chicken liver
Salmon
Soybeans and legumes
Quinoa
Brussels sprouts
Broccoli
Potatoes
Practical meal planning: Food sources to the rescue
A balanced whole‑food approach makes sense—and it’s tasty too. Rich sources include:
- Egg yolk – approx. 150 mg per large egg
- Beef liver – up to 400 mg per serving
- Meats and poultry – 65–120 mg per 85 g cooked
- Fish (cod, shrimp) – 70–85 mg per 85 g
- Dairy, beans, nuts, and cruciferous vegetables also contribute
To hit ~ 450 mg/day, you can build a day around:
- 2 eggs (300 mg),
- 3 oz cooked lean meat (75 mg),
- 1 cup broccoli + ½ cup soybeans (40 mg),
- 1 cup milk or yogurt (40 mg) = ~ 455 mg
For individuals with dietary restrictions (such as vegetarians and vegans), achieving these targets through food alone can be challenging, making supplementation an important consideration. Notably, many prenatal vitamins contain insufficient choline, so label checks and healthcare guidance are essential.
Supplements
International guidelines—from agencies like the USDA, FDA, Canada, Australia, and FIGO—now explicitly include choline as essential during pregnancy.
In the U.S.:
- Prenatal vitamins aren’t required to include choline.
- An analysis of top prenatal multivitamins showed none contained the recommended ≥ 450 mg/d choline; most offered ≤ 55 mg. That discrepancy highlights the need for separate choline supplementation or intentional dietary planning.
Supplement thoughtfully: choose a high-quality, third‑party tested form (e.g., choline bitartrate or phosphatidylcholine).
- Choline bitartrate is commonly used in clinical RCTs and pharmaceutical-grade supplements
- Phosphatidylcholine (lecithin) shows good absorption with fewer GI effects
- Microbiota convert excess choline into TMAO, so excess supplementation without balance may have other implications—stick within recommended ranges.
Monitor: dosing under the 3500 mg UL is safe; typical therapeutic studies stayed < 1000 mg/d.
Practical Takeaways
1. Start before conception: Optimize choline intake to support gamete quality, lower inflammation, and improve implantation chances.
2. Aim for 450–550 milligrams per day minimum, but consider 930 milligrams per day in late pregnancy for potential cognitive benefits.
3. Pair with folate and B12 for enhanced methylation support.
4. Continue postpartum, especially when breastfeeding, to support both maternal recovery and infant brain development.
5. Close the intake gap: Recognize that most people do not meet dietary recommendations, and consider supplements as needed.
Final Word
The 2025 evidence reinforces that choline is no longer optional — it’s a cornerstone nutrient for fertility, pregnancy, and postpartum health. Its ability to influence reproductive outcomes, fetal brain development, and long-term cognitive performance makes it an indispensable part of your nutritional strategy.
By proactively including choline-rich foods and appropriate supplements, you’re not only supporting your own health but also setting up future generations for better health outcomes. As research evolves, one message is clear: choline is a must-have, not a nice-to-have.
Dr. Corradetti-Sargeant was destined for a career in Naturopathic Medicine – she’s part total science nerd and part no-holds-barred health nut. During her undergraduate studies in Kinesiology at the University of Western Ontario, she learned that conceiving would likely be a struggle. She worked with a naturopathic doctor to overcome these issues, and it became clear to her that becoming a naturopathic doctor was her destiny.
She studied at the National College of Natural Medicine in Portland, Oregon, and the Canadian College of Naturopathic Medicine in Toronto, Ontario. She is licensed through the College of Naturopaths of Ontario and is a professional member of the Canadian and Ontario Associations of Naturopathic Doctors, as well as the Endocrinology Association of Naturopathic Physicians. She is also licensed to prescribe a small schedule of pharmaceuticals granted to naturopathic doctors, and has completed training in intravenous therapy.
She treats her patients with personalized, functional, and integrative medicine. With special interests in fertility, she is passionate about empowering her patients to make healthy changes that help them conceive.
When Dr. Corradetti-Sargeant is not seeing patients, she’s running triathlons, contributing to magazine articles (look for her in Clean Eating and Elle magazines), or making a giant mess in the kitchen, whipping up the latest healthy desserts!
References
Derbyshire E. Do we need to revisit current recommendations for choline intake during pregnancy? Nutrients. 2019;11(8):1823. [https://doi.org/10.3390/nu11081823](https://doi.org/10.3390/nu11081823)
National Institutes of Health. Choline: Fact sheet for health professionals. Office of Dietary Supplements. [https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/](https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/)
Pande Putu Ida Oktayani and colleagues. “Choline in pregnant women: a systematic review and meta-analysis.” Nutrition Reviews, 2023. Available at: https://pubmed.ncbi.nlm.nih.gov/38607338/
Ross, Robert G., et al. “Prenatal choline supplementation improves child sustained attention.” FASEB Journal, 2022. Available at: https://pubmed.ncbi.nlm.nih.gov/34962672/
Caudill, Marie A., et al. “Choline—An underappreciated component of a mother-to-be’s diet.” Nutrients, vol. 16, no. 11, 2024. Available at: https://www.mdpi.com/2072-6643/16/11/1767/
Strupp, Barbara J., et al. “The effect of maternal choline intake on offspring cognition.” medRxiv preprint, 2025. Available at: https://www.medrxiv.org/content/10.1101/2025.02.27.25322999.full
Oktayani, Pande Putu Ida, et al. “Choline in pregnancy and lactation: essential knowledge for clinicians.” Nutrients, vol. 17, no. 9, 2025. Available at: https://www.mdpi.com/2072-6643/17/9/1558/
Nguyen, Hien T., et al. “Choline during pregnancy and child neurodevelopment.” Nutrition Reviews, 2025. Available at: https://pubmed.ncbi.nlm.nih.gov/40077755/
Nguyen, Hien T., et al. “Choline during pregnancy and child neurodevelopment: a systematic review of randomized controlled trials and observational studies.” ResearchGate, 2025. Available at: https://www.researchgate.net/publication/389557043
Bell CC and Aujla J. “Prenatal Vitamins Deficient in Recommended Choline Intake for Pregnant Women.” Journal of Family Medicine and Disease Prevention, vol. 2, 2016, p. 048. https://www.clinmedjournals.org/articles/jfmdp/journal-of-family-medicine-and-disease-prevention-jfmdp-2-048.php
