Choline concern: Only one-in-four pregnant Aussie women meeting guidelines

The significance of choline supplementation during pregnancy for cognitive development is gaining increasing recognition.

The American Academy of Pediatrics has acknowledged choline as a crucial nutrient for brain development and has urged pediatricians to ensure that pregnant women and young children receive sufficient choline in their diets. 

However, in 2017, the American Medical Association (AMA) reported that prenatal choline supplementation was uncommon. Similarly, a study conducted in Canada found that only 3% of pregnant women were taking choline supplements during pregnancy. Furthermore, most current prenatal multivitamins and supplements either do not contain choline or contain very low amounts (typically 30-50 mg). 

Therefore, pregnant women who rely solely on multivitamins and supplements are unlikely to meet the recommended choline intake, in contrast to other nutrients like folate and vitamin B12.

This is perhaps because the importance of maintaining optimal choline intake during pregnancy is not widely known, underscoring the need for education and increased public awareness regarding the significance of choline-rich foods in maternal diets.

A new study by Australian researchers​ assessed choline intake using a food questionnaires from pregnant women enrolled in the population-derived birth cohort, the Barwon Infant Study (BIS).

Dietary choline was calculated by aggregating all choline-containing components based on data obtained through food frequency questionnaires over a period of 28 weeks.

Dietary factors obtained from the food frequency questionnaire were assessed for their association with both daily dietary choline intake and serum levels.

These included: energy intake, fibre intake, protein intake, iron intake, omega-3 and omega-6 fatty acid intake and supplementation, alcohol intake, fish oil supplementation, and folate intake and supplementation. 

Additionally, during the third trimester, serum levels of total choline-containing compounds, including choline-c, phosphatidylcholine, and sphingomyelin, were quantified using nuclear magnetic resonance metabolomics. The primary approach employed for this study was multivariable linear regression.

Data used in this study was collected between 2010 and 2013 in Australia, and as a result, choline reference values were based on the Nutrient Reference Values for Australia and New Zealand. Daily recommended choline levels for ANZ stands at 440mg/day. These values are lower than the recommended choline intake during pregnancy in countries such as Canada and the United States, which is 450mg/day. 

In this study, only 23% of pregnant women met the recommended choline intake of 440 mg/day during pregnancy, and only 27 women (2.6%) were taking prenatal supplements containing choline (≥ 50 mg per dose) daily during pregnancy. 

Following the guidelines set by the National Institutes of Health (NIH), it is estimated that only 20.3% of the women in the study (207 women) would have achieved adequate choline intake during pregnancy based on the higher recommendations of Canada or the US (450mg/day). 

These numbers could be increased by enhanced education efforts by institutions and the government  to ensure that pregnant women attain optimal daily choline intake through a combination of dietary sources and supplementation.

Source: European Jounal of Nutrition J Nutr. 

The distribution of dietary choline intake and serum choline levels in Australian women during pregnancy and associated early life factors​

doi: 10.1007/s00394-023-03186-w

Authors, Lada Staskova, et al