Choline is an important supplement for pregnancy, but are you getting enough? Learn how to spot choline deficiency symptoms. 


By OBGYN and fertility expert Dr. Kenosha Gleaton

Choline benefits include improved cognition, cardiovascular health, metabolism, reproductive health, and more. Some groups are at a higher risk of deficiency and while this is rare, it may lead to organ dysfunction. Read on to find out more about how to prevent deficiency and support your health. 

What is choline?

Choline is a vital nutrient necessary for muscle, liver, and brain functions. It also plays an important role in lipid metabolism and cellular membranes. The Food and Nutrition Board of The National Academies of Medicine recognized choline as an essential nutrient in 1998. Choline is produced naturally by the body in small doses, but larger amounts must be consumed in the diet to prevent deficiency. 

Both animal and plant sources contain choline; however, animal source foods typically contain more choline per gram of product. Foods high in choline include beef, eggs, chicken, fish, pork, nuts, legumes, and cruciferous vegetables. 

Choline and fertility

An animal study on female infertility and choline supplemented different groups with choline, Omega 3, and choline + Omega 3. They found that the percentage of antral follicles in the choline + Omega 3 group were higher compared to the control group. To better understand this finding of choline's influence on ovarian function in vivo, scientists analyzed the expression of various genes and ultimately determined insights into the mechanisms behind choline’s positive effect on ovarian development phenotype.

A different study on genotyping found that deletion of a choline related enzyme in males led to diminished sperm motility, abnormal sperm morphology, and diminished function. These findings suggest that choline may be extremely effective for supporting ovarian function, sperm health, and overall reproductive health.

In addition to choline, many other supplements have been linked to improvements in sperm parameters. Looking for a high-quality, antioxidant-rich multivitamin formulated for male fertility? Consider our prenatal supplement for men

Choline and pregnancy

Choline is one of many vitamins and minerals necessary for a healthy pregnancy and has even been called the “brain-building” nutrient by the American Academy of Pediatrics. Prenatal processes involving membrane biosynthesis, tissue expansion, brain development, and gene expression require ample choline levels in the maternal diet. Studies have shown that supplementing the diet with choline improves pregnancy outcomes and reduces the risk of negative outcomes such as neural tube defects and preeclampsia (read more on preeclampsia here). 

Choline is so necessary for a growing fetus that maternal plasma choline can become depleted if there is not adequate supplementation. Choline is found in large amounts in the placenta, amniotic fluid, and breast milk. It’s been found that most pregnant women in the U.S. are not achieving adequate choline intake recommendations of 450 mg/day and would likely benefit from boosting their choline intakes through dietary and/or supplemental approaches, such as Natalist Prenatal Daily Packets

What causes choline deficiency?

Some groups are at a higher risk of choline deficiency. These groups include:

  • Pregnant women: Around 90% of pregnant women do not consume the recommended amount of choline per day (450 mg)
  • People with certain genetic alterations: Anyone with variations in the DNA sequences responsible for choline, folate, and methionine metabolism are more likely to have inadequate choline levels.
  • Patients receiving parenteral nutrition (liquid nutrients): Currently, choline is not added to parenteral solutions for infants or adults. If you or a loved one are receiving most or all of your nutrition through parenteral solutions, you may want to talk to your doctor about choline supplementation. 

Research also shows that men and postmenopausal women are more likely than premenopausal women to develop signs of organ dysfunction due to dietary choline deficiency. 

Low choline symptoms

It’s important for overall health and especially for those pregnant or breastfeeding that adequate choline levels are reached through diet or supplementation. If choline levels are too low, serious symptoms and effects of deficiency may arise, including liver and muscle disorders or dysfunction, lymphocyte disorders, and dysfunction of the kidney, pancreas, brain, and nervous system.

Before you get too worried, note that it’s very difficult to reach a choline level low enough for deficiency. Talk to your doctor about potential signs and symptoms of low choline you should be looking out for. A great way to avoid nutrient deficiency is by taking a daily vitamin, such as the Prenatal Daily Packets!

Ways to treat low choline

  • Diet and choline rich foods:  Following the federal government’s 2020-2025 Dietary Guidelines for Americans  will include a substantial amount of choline-rich foods and help you maintain a balanced diet. If you’re looking for foods packed with higher levels of choline, try adding in fish, beef, poultry, eggs, some beans and nuts, as well as many vegetables, fruits, whole grains, and dairy products.
  • Supplements: Choline is also available in dietary supplements by itself, or in combination with B-complex vitamins and multivitamins. There are various forms of choline in supplements including choline bitartrate, phosphatidylcholine, and lecithin. So far, there are no studies indicating if one form is more effective or beneficial than the others. 

Choline upper limits 

It’s important to note that there are upper limits for most vitamins and minerals that you should research before adding any supplements to your diet. According to the NIH, the upper limits for choline are:

  • Birth to 12 months: no dosage established
  • 1-8 years: 1,000 mg
  • 9-13 years: 2,000 mg
  • 14-18 years (includes pregnant and lactating females): 3,000mg
  • 19+ years (includes pregnant and lactating females): 3,500mg

Choline toxicity

If choline levels surpass tolerable upper intake recommendations, choline toxicity may occur. Extremely high intake of choline is associated with a fishy body odor, excessive sweating and salivation, vomiting, hypotension, and liver toxicity. High choline consumption has also been linked to the production of TMAO, a substance linked to a higher risk of cardiovascular disease. 


  • Choline is an essential nutrient that can benefit your memory, heart, and many other organ functions.
  • Choline is found in some dietary sources such as meat, eggs, and dairy, as well as some fruits and vegetables. 
  • Choline has positive effects on reproductive health by increasing ovarian function and is vital for sperm health.
  • Improved pregnancy outcomes are also associated with choline supplementation.
  • While hard to reach, dangerously low choline levels may result in organ dysfunction and other disorders.

For more information on nutrition, fertility, and more, visit the Natalist homepage


Featured Image by Nataliya Vaitkevich