Choline is an essential nutrient that most of us haven’t heard of! The good news is the body makes its own, but, not enough. Most needs to come from our diet. Particularly during pregnancy where it plays a key role in important things like developing healthy brains and nervous systems. Recent research has also found that having enough could potentially mitigate some of the negative potential impact form COVID-19. Unfortunately many of us do not get enough.  Particularly during pregnancy. We’re going to take a quick look at what it is, why it matters, the research around how it can potentially help to protect your baby from COVID and how to get more. 

So, what on earth is Choline?! 

It is an important nutrient which plays a role in many of our bodily functions. It is also key for fetal development. The guidelines suggest that pregnant women require an intake of 450mg/day which rises to 550mg/day during lactation. In fact, it is really important for pregnancy and research is growing in support of it’s role in development of a baby. See chart below (source: 7)

Most of us do not get enough… 

The data shows most of us are deficient. Also, check out your prenatal vitamin. Chances are it does not contain Choline. The good news is that we can get it from a variety of different sources in the diet (more to come below).

Why it could be particularly important in a COVID world: 

There is still so much we don’t understand about COVID and particularly the impact on a pregnant woman and developing baby. We do know however that increased inflammation in the body is not what we want. Click here for more. The current understanding (which is evolving) of how COVID could potentially impact a baby is not direct transmission through the placenta. Instead it is about the ‘maternal inflammatory response to the virus’ (1). That can influence things like brain development and the placenta. In fact, we know inflammation in the placenta is also a potential cause of preterm birth.

Translation: We know one of the damaging impacts of COVID on the body is that the body’s own protective mechanism (inflammation) goes into overdrive. Damaging other tissues. During pregnancy when the mother has a bacteria or viral infection inflammation in the body when at high levels can cause damage to an unborn baby’s development. We have seen this with Influenza (which is why all pregnant women are recommended to be immunised), H1N1 and SARS. Click here for more. COVID-19 can (based on current understanding) can cause this excessive inflammatory response.

The good news! 

Whilst this can seem scary and obviously no one wants to get infected particularly during the delicate and anxious time of pregnancy. There does seem to be something we can do to help ‘take the edge off’ if unfortunately we do catch the dreaded bug.

The good news is that this research (1) is showing that ‘higher prenatal Choline levels may help protect the foetus developing brain even if the mother contracts a viral respiratory infection in early pregnancy.’

How it can protect little brains: 

During pregnancy the immune system reacts differently vs non-pregnancy. Click here for more on that -. One important caveat and addressing one common outdated misconception: it is not ‘suppressed’. It is altered in it’s response. It also changes depending on what stage of pregnancy we are in. Clever stuff…

When it comes to brain development the start of the second trimester is particularly important to protect against maternal inflammation.

Long standing research on brain development shows that core parts of the brain are being formed between weeks 11-16. Particularly related to infant attention and other self-regulatory behaviour that when go wrong are linked to things like ADHD, ASD and Schizophrenia. These are known as Inhibitory Interneurons in the Hippocampus. During this time period they are ‘most vulnerable to maternal inflammation.’ (1)

How does Choline work to protect the brain? 

It is quite a complex mechanism, but, research has shown that maternal choline supplementation decreases inflammation from the immune reaction of the mother. (1) Reducing a key inflammatory marker (IL-6) in the fetal brain.

Translation: it is showing evidence of protecting a developing brain from the damaging impact of the body’s immune response.

This is not just related to COVID which is reassuring. Whilst we know very little about COVID currently, there have been four very high quality trials around Choline supplementation (double blind, placebo-controlled studies: ie. gold standard) and three of these studies have found ‘significant’ effects on infant cognition and behaviour (1). None reported serious adverse effects. Good news!

There is also evidence that getting enough later in pregnancy may be beneficial: 

There is some evidence (7) that the amount of choline during pregnancy could influence stress reactivity in a child. In fact: higher Choline intake (930 vs 480mg choline/day) throughout the third trimester influenced a key gene which acts as mediator of stress reactivity in the body. Known as the placental corticotropin-releasing hormone (CRH) gene. (7).

We all known that too much stress is no good thing.

This is a regulatory protein that acts on the body’s stress response system: the HPA axis. The study found lower blood cortisol (key stress hormone) concentrations in the newborns of mothers consuming 930 vs. 480 mg choline/day.

Ok, so it’s good to have enough Choline. But how much is ‘enough’? 

The American Medical Association (AMA) in 2017 published new advice stating that prenatal vitamin supplements should contain ‘evidence-based’ amounts of choline [4]. Similarly, in 2018, the American Academy of Pediatrics recognised choline as a ‘brain-building’ nutrient.

The National Academy of Medicine establishes adequate intake (AI) level at 450 mg choline/day during pregnancy and 550 mg choline/day during lactation [5].

Once again, most of us are not getting enough: 

Although widely distributed in the diet, choline is absent from most prenatal vitamins. The stats also show that less than ten percent of pregnant women achieve target intake levels [7]. So: 90% of us need to be getting more! 

So how do we get more? 

The good news is that it is found throughout our diets. In food it’s usually found in the form of phosphatidylcholine. Below is a breakdown of some of the best sources. The good news is that there are sources for whatever your dietary preferences may be (vegan/vegetarian etc).

Supplements: 

We are always cautious on supplements. Click here for the key things to know before you take them.  

It is also imperative to talk to your doctor before taking anything during pregnancy, particularly if you’re on other medication. However, if you think you may not be getting enough (a blood test can tell you) then a supplement could be the way to go. Particularly during these COVID times.

In terms of dosage safety. It is always best to stick to recommended guidelines: that is 450mg/day during pregnancy and 550mg/day during pregnancy. Talk to your doctor!

In term of safety and upper levels: The tolerable upper intake level (UL) of choline is 3.5 g/day for adults. These were established to prevent hypotension and fishy body odour [8]. To date, none of the trials conducted in healthy pregnant women have reported any adverse effects of choline supplementation at levels ranging from 550–900 mg/day. Once again though, stick to the recommended guidelines and chat to your doctor.

References:

1) Freedman R, Hunter S, Law AJ: Maternal Choline and respiratory coronavirus effects on fetal brain development. 

2) https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

3)

4) https://reader.elsevier.com/reader/sd/pii/S0022395620304544?token=C68B9966065C390B65CB67A6403D7278D459CDACC9BFBF56026A730A3A13959CA23275E885FCA504DE5F1509121BE51D

5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722688/#B3-nutrients-11-01823

6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722688/#B3-nutrients-11-01823

7) Hunter W. Korsmo, Xinyin Jiang, and Marie A. Caudill: Choline: Exploring the Growing Science on Its Benefits for Moms and Babies: MDPI Nutrients: 2019 Aug: 11(8)1823

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