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CHOLINE during PREGNANCY might be more important that you think

What is the first thing you learn when you become pregnant? I bet that your doctor told you to take folic acid to prevent neural tube defects. Am I right?:) We can discuss in depth about folate... I will shorty wrote post on this one...so stay tuned ;)


Researches are now exploring, that not only folate, but also other nutrients contribute to lowering the risk of neural tube defects. One of them is choline...



THE ROLE OF CHOLINE


Choline is an essential nutrient that plays an outsized role in the fetal brain while it is developing in the womb. Robert R. Freedman, M.D- proffessor and chairman in University of Colorado School of Medicine, have perfectly explaind...

"The fetal brain is hyperactive as it assembles itself. Of the 20,000 genes we humans have, more are devoted to building the brain than anything else. And most of them are most active (about tenfold more) before birth compared with after.Just before birth all this activity needs to quiet down, however. The brain is settling down...This turns out to be the final step right before delivery, the last of five or six distinct steps which correspond with major changes in brain organization. In each step...you not only get more memory and more function (as you do each time you upgrade your computer), but you also install a new operating system. In the early brain, each operating system is installed by the one that came before it.”

WOMEN & CHOLINE


Young women are designed to have the extra capacity to make choline, because estrogen induces the gene that catalyzes the biosynthesis of choline. [1]

On the other side, “special populations”, like vegan, vegetarians, pregnant or breastfeeding mothers and postmenopausal women are more prone to deficiency, while their body’s needs for choline increases during those stages of life.

Additionally, higher intakes of choline may be particularly important for women with certain genetic variations (SNP)


WHAT HAPPENS IN PREGNANCY


Choline is needed throughout pregnancy in considerable amounts for various purposes, not only to prepare the brain’s inhibitory system but also to build the walls of cells throughout the body.[2]

A mother delivers large amounts of choline across placenta to the fetus, which greatly increases demand on the choline stores of the mother. Furthermore, after birth she also delivers large amounts of choline through breastmilk to the baby.[3]


FOLATE & CHOLINE ROLES IN BODY


However, several lines of evidence suggest that not only folates but also choline, B12 and methylation metabolisms are involved in neural tube defects.[4] While choline exhibits nutritional synergies with vitamins involved in folate metabolism and the methionine cycle, such as B6 and B12, and nutrients such as omega-3 fatty acids, none of these substances can functionally replace it.[5] Therefore, when diet is deficient in these nutrients the need for dietary choline rises.


On the other hand, there's been some evidence in animal studies showing, that supplementaion with DHA and choline might enhace neurodevelopment of the fetal hippocampus better than eighter supplement alone. The human study found that women who supplemented with high-dose choline (930 mg daily) produced higher amounts of DHA enriched phosphatidylcholine.[6]


(Choline and DHA-Docosahexaenoic Acid are both components of the phospholipid bilayer of cell membranes in brain.)


RECOMMENDED AMOUNTS


If you haven't already checked the post: »The secret of Choline«, go ahead and do it ;).

While European Food Safety Authority estimates 450mg/day for pregnant women[7], the results of clinical trial indicate that supplementing with a 930mg of choline pre day during pregnancy might also benefit both, mother and fetus. The same goes for lactating mothers, who delivers large amounts of choline through breastmilk to the baby. Intakes exceeding 550mg of choline daily during lactation also enhace choline content of breast milk.[8]


BENEFITS-WHAT DOES RESEARCH SAYS



SUPPLEMENTING


Choline rich foods include egg yolks, liver, beef, poultry, salmon, pork, milk, legumes, cauliflower,broccoli, Brussels sprouts ect. However, analyses are showing, that only 10-5% of pregnant women meet the adequate intake of choline.[9]


Most of women experience nausa or food aversions during pregnancy, therefore there's even a greater chance they won't meet the dietary need of choline through food alone. While although a carefull planned diet may provide the daily needs for pregnant women (450mg), it's unlikely that intake would be met daily during pregnancy.


Further, current dietary trends are doing no good...A lot of choline rich foods these days have a bad reputation. Government, have raised caution about pregnant women consuming undercooked eggs, that is why women may avoid eating them altogether. Red meats are avoided because of their high saturated content...liver is not commonly eaten...


There was a study, which examined the choline content in the top 25 prenatal multivitamins, to see if they meet the daily recommended intake of choline for pregnant women (450mg daily). Results: none of them contain the recommended amount of choline.[10]


While highest amounts of choline tend to be found in animal-based foods, vegetarians and vegans typically have a very difficult time meeting choline needs through food sources alone. In those cases supplementing might be essential.


If you are curious about meeting your needs and/or supplementing with choline, be sure to first discuss it with your physician or qualified health professional.


BOTTOM LINE


Research suggests that getting adequate levels of choline may have protective benefits for mom during pregnancy and lifelong benefits for baby.

While folate has been suggested for a pregnant women for decades, research now suggest that in addition to reduce the risk of neural tube defects, it might be essential also to supplement also with choline.

However, getting enough nutrients for a diet should be your priority.


DISCLAMER


This post provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.



REFERENCES:


[1] Office of Dietary Supplements (2017, March). NIH-National Institutes of Health. Available from: https://ods.od.nih.gov/factsheets/Choline-Consumer/#h5

[2] The American Psychiatric Association; Perinatal Phosphatidylcholine Supplementation and Early Childhood Behavior Problems: Evidence for CHRNA7 Moderation. (2015, December 7). Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2015.15091188

[3] Zeisel S. H. (2013). Nutrition in pregnancy: the argument for including a source of choline. International journal of women's health, 5, 193-9. doi:10.2147/IJWH.S36610

[4] Imbard, A., Benoist, J.-F., & Blom, H. (2013). Neural Tube Defects, Folic Acid and Methylation. International Journal of Environmental Research and Public Health, 10(9), 4352–4389. doi:10.3390/ijerph10094352

[5] Rajdl, D., Racek, J., Trefil, L., Stehlik, P., Dobra, J., & Babuska, V. (2016). Effect of Folic Acid, Betaine, Vitamin B₆, and Vitamin B12 on Homocysteine and Dimethylglycine Levels in Middle-Aged Men Drinking White Wine. Nutrients, 8(1), 34. doi:10.3390/nu8010034

[6] Allyson A West, Jian Yan, Xinyin Jiang, Cydne A Perry, Sheila M Innis, Marie A Caudill; Choline intake influences phosphatidylcholine DHA enrichment in nonpregnant women but not in pregnant women in the third trimester, The American Journal of Clinical Nutrition, Volume 97, Issue 4, 1 April 2013, Pages 718–727, https://doi.org/10.3945/ajcn.112.050211

[7], [8] file:///C:/Users/Uporabnik/Downloads/nutrients-10-01513.pdf

[9] https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

[10]Bell CC, Aujla J (2016) Prenatal Vitamins Defcient in Recommended Choline Intake for Pregnant Women. J Fam Med Dis Prev 2:048. 10.23937/2469-5793/1510048