TL;DR

• Choline is essential for cell membranes, neurotransmission, methylation and fetal nervous system development. The adequate intake rises to 450 mg a day during pregnancy and 550 mg during breastfeeding.
• Most pregnant women fall well short. In one US analysis, average intake from food was around 321 mg a day, and only 7.7% had an intake above the pregnancy adequate intake.
• Many prenatal vitamins don't help close that gap. A 2022 analysis of 188 US prenatal supplements found that only 40% contained choline, with a median of just 25 mg per serving. South African prenatal vitamins are no different. 
• Small randomised trials suggest higher maternal choline intake may benefit specific aspects of infant attention and processing speed, genuinely promising, but still an early, limited evidence base, not proof that supplementation raises intelligence or prevents developmental problems.
• Lower maternal choline intake is also associated with neural tube defects and preeclampsia in observational studies, an interesting signal, but not the same level of proof that exists for folic acid and neural tube defects specifically.
• Our AM sachet provides 280 mg of choline as choline bitartrate, designed to sit alongside dietary choline, not replace it.

Pregnancy nutrition has a familiar shortlist: folate, iron, iodine, vitamin D, omega-3. Choline rarely makes that list, despite being essential for much the same territory, brain development, cell membranes, placental function, that those other nutrients get credit for. That's starting to change. The American Academy of Pediatrics names choline among the nutrients that matter most for early brain development, and the American Medical Association has called for prenatal vitamins to contain evidence-based amounts of it. The more useful question isn't whether choline matters biologically, it clearly does, it's how much people actually get, what the human research on supplementation shows, and what a reasonable dose looks like.

Most women aren't getting enough

The US adequate intake for choline is 425 mg a day for non-pregnant women, rising to 450 mg during pregnancy and 550 mg during lactation. Worth being precise about what kind of figure that is: it's an adequate intake, not a recommended dietary allowance, meaning there wasn't enough evidence to set a formal RDA. It reflects an established intake target agreed by nutrition scientists, not a number derived from a trial showing 450 mg specifically produces the best infant outcomes.

Most women fall short of it anyway. In an analysis of US NHANES data from 2001 to 2014, pregnant women aged 20 to 40 consumed an average of about 321 mg of choline from food a day, and only 7.7% had an intake above the adequate intake for pregnancy. That doesn't mean the other 92% are clinically deficient, an adequate intake isn't a deficiency threshold, and the body can synthesise some choline on its own, but it does mean typical dietary intake commonly sits well below what's considered adequate for pregnancy.

Why diet can make this difficult

The richest sources of choline, eggs, meat, poultry, fish and dairy, aren't always appealing or tolerable in early pregnancy, when nausea and food aversions are common. Plant foods including soybeans, beans, nuts and cruciferous vegetables contain choline too, but generally in smaller amounts, so reaching the pregnancy target on a plant-based diet takes more deliberate planning rather than being automatically out of reach.

And most prenatals don't provide much

This is where choline becomes a formulation story as much as a nutrition one. A 2022 evaluation of 188 prenatal supplements on the US market, cited by the NIH's Office of Dietary Supplements, found only 40% contained choline at all, and among those that did, the median amount was just 25 mg per serving, a small fraction of the 450 mg target. South African prenatal vitamins are no different. 

One practical formulation challenge, in our own experience, is simply mass: meaningful amounts of choline salts require substantially more capsule or tablet volume than most micronutrients, which is part of why it tends to get left out or added only in token amounts rather than fitting easily alongside everything else in a standard multivitamin. 

What choline actually does

Choline is incorporated into phospholipids like phosphatidylcholine, fundamental components of cell membranes, and is needed to produce acetylcholine, a neurotransmitter involved in nervous system signalling. It also participates in one-carbon metabolism alongside folate and B12. During pregnancy, the placenta actively transports choline to the fetus to support rapid cell division and nervous system development, which is the biological rationale for the higher pregnancy target. Biological plausibility isn't the same as proof that more choline produces better outcomes, though, for that, we need to look at the human trials directly.

What the human trials actually show

The most rigorous evidence comes from a small number of randomised controlled trials run at Cornell over the past decade, and it's worth being precise about both what they found and how limited they still are.

In the best-controlled of these, pregnant women in their third trimester were randomised to consume either 480 mg or 930 mg of choline a day under tightly controlled feeding conditions. Infants in the higher-choline group showed faster information processing speed in their first year. A follow-up of the same children at age seven, this time with about 20 children remaining in the study, found those in the higher-choline group performed better on a task measuring sustained attention.

That's a genuinely interesting, consistently directed body of evidence, but it remains a small one. Sample sizes across these trials have been in the dozens, not hundreds. A 2022 systematic review and meta-analysis of the human evidence reached a similarly measured conclusion: higher maternal choline intake was associated with better neurodevelopmental outcomes across the available studies, but the evidence base is still limited and the studies have real methodological constraints. Promising, not proven. This is evidence that specific measures of attention and processing speed improved in small trials, not evidence that choline supplementation raises intelligence or prevents developmental problems more broadly.

An emerging connection with DHA

A newer area of research looks at how choline interacts with DHA. Choline contributes methyl groups to the PEMT pathway, which helps generate phosphatidylcholine species enriched in DHA and supports hepatic DHA export. In a small randomised trial, pregnant women already taking 200 mg of DHA daily were randomised to receive either 550 mg or 25 mg of additional choline from around 12 to 16 weeks of pregnancy until delivery. The higher-choline group showed improvements in several maternal biomarkers of DHA status. This doesn't mean choline replaces DHA, it doesn't, but it suggests the two nutrients may interact in how DHA gets transported and used, an interesting, still-developing area rather than a basis for a new clinical claim.

What about neural tube defects and preeclampsia?

Observational research links lower maternal choline intake to a higher risk of neural tube defects. A meta-analysis pooling five case-control studies found lower maternal choline intake or blood levels was associated with higher odds of an NTD-affected pregnancy, though the authors themselves flagged the small number of studies, inconsistent ways "low choline" was defined across them, and the potential for recall bias in this kind of research. That's an observational signal interesting enough to warrant further study, not proof of prevention, and it isn't the same as folic acid's evidence base. Folic acid has been tested in randomised trials and has an established, direct role in reducing neural tube defects. Choline doesn't yet have that level of proof, so we wouldn't say choline supplementation has been shown to prevent neural tube defects. Choline is therefore worth considering as part of overall prenatal nutrition, but it is not a substitute for folic acid.

A similar pattern shows up with preeclampsia. A 2025 case-control study of nearly 1,000 pregnant women in China found those with higher dietary choline intake had lower odds of preeclampsia. Real and worth knowing, but a case-control study can identify an association, not prove that increasing choline intake prevents the condition, since people who eat more choline-rich food likely differ in other ways too.

How much should you take, and is it safe?

The 450 mg pregnancy target refers to total intake, food, supplements, everything combined, not the amount that specifically needs to come from a capsule. If your diet already supplies a couple of hundred milligrams, a supplement doesn't need to cover the rest on its own. There's also no evidence that everyone should aim for the higher doses used in some research trials, the 930 mg trial is scientifically interesting, not a general recommendation.

The intakes discussed here, 450, 550, 930 mg a day, are well below the US tolerable upper limit of 3,500 mg a day for adults 19 and older, including during pregnancy. Very high choline intakes can cause effects including fishy body odour, gastrointestinal symptoms, excessive sweating and low blood pressure, which is why an upper intake level exists, but that's well above anything discussed in this article.

Where we use it

Our AM sachet includes a separate capsule providing 280 mg of choline as choline bitartrate. That 280 mg contributes a little over 60% of the US pregnancy adequate intake of 450 mg, with the remainder intended to come from diet. It isn't positioned as covering your full daily need on its own, it's a substantial contribution meant to sit alongside whatever choline you're getting from food, which matters given how many prenatal vitamins skip choline altogether or include only a token amount.

We've kept it as its own capsule rather than folding it into the main tablet, for the same reason most brands leave it out: a meaningful dose takes up real space, and compressing it into a single multivitamin tends to come at the cost of tablet size or other ingredients.

This article is for general educational purposes and isn't medical advice. Nutrient requirements vary between individuals, and total choline intake is worth considering across food, prenatal supplements and any additional supplements together. Please speak with your doctor or dietitian about your individual needs, particularly if you follow a vegetarian or vegan diet or are considering an additional choline supplement.

Sources

1. National Institutes of Health, Office of Dietary Supplements. Dietary Supplements and Life Stages: Pregnancy, Health Professional Fact Sheet. https://ods.od.nih.gov/factsheets/Pregnancy-HealthProfessional/ 

2. National Institutes of Health, Office of Dietary Supplements. Choline: Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/ 

3. Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academies Press, 1998.

4. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. The FASEB Journal, 2018;32(4):2172-2180. https://faseb.onlinelibrary.wiley.com/doi/10.1096/fj.201700692RR

5. Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. The FASEB Journal, 2022;36(1):e22054. https://pmc.ncbi.nlm.nih.gov/articles/PMC9303951/

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7. Klatt KC, et al. Prenatal choline supplementation improves biomarkers of maternal docosahexaenoic acid (DHA) status among pregnant participants consuming supplemental DHA: a randomized controlled trial. American Journal of Clinical Nutrition, 2022;116(3):820-832. https://pubmed.ncbi.nlm.nih.gov/35575618/

8. Zhu J, Bo Y, Ma R, Jiang Z, Wang J, Yuan Z, Zhao X, Cao Y, Duan D, Dou W, Liu Y, Lyu Q. Association between dietary choline intake and odds of preeclampsia: a case-control study. Frontiers in Nutrition, 2025;12:1703117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623378/

9. Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. American Journal of Epidemiology, 2004;160(2):102-109.

10. American Medical Association. Proceedings of the 2017 Annual Meeting of the House of Delegates, Resolution 517: Choline Supplementation in Prenatal Vitamins.

11. Schwarzenberg SJ, Georgieff MK, Committee on Nutrition. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018;141(2):e20173716.