In my book I explain how important good nutrition is, not just during pregnancy but also during the preparation phase and after giving birth. One nutrient that doesn’t get a lot of media space is choline.
If you’re new to this nutrient, it’s a cousin to the B-vitamins. Choline plays a central role in brain development, liver function, cell membrane integrity, and methylation.
In pregnancy, the demand for this nutrient increases significantly, yet over 90% of women aren’t getting enough.
A 2025 review (PMID: 40362867) pulled together the last decade of choline research specifically in pregnancy and lactation, and the findings are hard to ignore.
Here are a few highlights:
- Choline accumulates in certain tissues during pregnancy. Relative to maternal blood levels, choline is 50x higher in the placenta, 10x higher in amniotic fluid, and 6-7x higher in foetal blood. It also concentrates in breast milk.
- 9 out of 10 women (or more) are falling short of dietary choline needs, and even that benchmark for intake is too low.
- Research shows optimal brain development in children of mothers who get 930 mg/day in pregnancy rather than the current recommended level, which is less than half that amount.
- Low maternal choline raises the risk of neural tube defects 36% overall — and up to 2.36-fold in some groups — while higher intakes are linked to better brain development and childhood cognition.
- Women with better choline status have HALF the odds of developing the following complications: gestational diabetes, preeclampsia, preterm delivery, and small for gestational age infants (OR: 0.51).
- Solid choline intake reduces inflammatory markers, like homocysteine, and cuts the risk of fatty liver disease in both mothers and babies.
- The rise in plant-based diets is driving up rates of choline insufficiency. Best food sources are egg yolks, liver, and other animal foods.
Taken together, this reinforces something I’ve emphasized for years: choline is fundamental to baby’s brain development and to your health during pregnancy. Choline also supports efficient methylation [see previous posts on this topic] especially when your intake of B-vitamins is inadequate.
And yet, it’s still one of the most commonly under-consumed nutrients, especially as dietary patterns shift away from choline-rich animal foods.
There are some influencers pushing people to eat “at least 4 eggs a day” in an effort to get enough choline. While I’ve got nothing against 4 eggs a day, that is not necessarily required to hit your choline needs. Choline does also exist in other animal foods, as well as many plant foods (albeit in lower concentrations).
I hear from a lot of women, especially those who are not as tall or not as active (and therefore don’t need as much food) that 4 eggs/day is simply too much for them. The meal plans in Real Food for Pregnancy all surpass the adequate intake level for choline of 450 mg/day, with some of them (like the ones that include liver), exceeding even the 930mg target. So, yes, eat your eggs, but don’t feel like you’re failing if you don’t eat 4 eggs a day.
Lily Nichols has created a great cookbook where you can find lots of healthy foods that provide choline.
However, should you feel that you just can’t manage or feel comfortable knowing what to eat, please contact me here or consult your local fertility qualified naturopath.
