The Best Choline Supplements for Pregnancy, According to a Prenatal Dietitian

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While choline is not considered a vitamin or a mineral, it is an essential dietary nutrient. It falls into the same family as B vitamins because it performs some similar functions in the body. Choline is needed to support periods of rapid cell division and growth, such as during fetal development and pregnancy.

“Data is showing that this nutrient plays an important role in the development of the spinal cord during early pregnancy, and taking in adequate amounts may support baby's cognitive development,” says Lauren Mannaker MS, RD, LD, author of Fueling Male Fertility. While our bodies produce some choline, they don’t make enough to meet the total needs of the body. Therefore, we must consume choline through food and/or supplements. 

Choline is predominantly found in animal foods. Eggs, beef, and chicken are the largest sources, and some plant foods have small amounts. However, only 5-10% of pregnant people consume the Adequate Intake (AI) amount of dietary choline, and considering they may also be dealing with aversions to foods that are rich in this nutrient, a supplement is a helpful safety measure. When choosing a choline supplement, consider the form and amount of choline, and look for third party certified options.

Verywell Family Approved Choline Supplements

  • Best Overall: Puritan’s Pride Concentrated Ultra Lecithin is a quality choice that provides a well-absorbed form of choline. It’s more affordable, making it easier to take for the duration of your pregnancy.  
  • Best for Brain Health: Bestvite Cognizin, while a touch more costly, provides pregnant people with a high amount of choline that may improve your child’s memory function.

Always speak with a healthcare professional before adding a supplement to your routine to ensure that the supplement is appropriate for your individual needs and which dosage to take.

Are Choline Supplements Beneficial for Pregnant People?

It has largely been agreed upon by the American Medical Association and American Academy of Pediatrics that maternal choline intake is important and supplementation should be routinely recommended for all pregnant people.

Obtaining nutrients from whole foods has many benefits, but for many reasons it can be more challenging to meet one’s needs solely through diet during pregnancy. Pregnant people are encouraged to take a prenatal vitamin to fill in the gaps when nutrition from food is lacking. However, choline is often not included in these supplements.

Who May Not Benefit from Choline

According to Mannaker, “supplementing [with choline] comes with little risk (if any).” However, one thing to highlight about supplemental choline is its connection with trimethylamine-N-oxide (TMAO). 

TMAO is a byproduct of nutrient metabolism in the gut. More specifically, when gut microbes digest certain nutrients, they produce a substance called TMA, which can then be absorbed and converted into TMAO. In humans, high levels of circulating TMAO have been linked with an increased risk for cardiovascular disease.

Some supplement forms of choline are linked to increased levels of TMAO while others are not. Interestingly, food sources of choline do not impact TMAO to the same level as supplements.

Choline is not known to have any interactions with medications, but always speak with a healthcare provider to ensure supplementation is safe for you.

Best Overall: Puritan's Pride Concentrated Ultra Lecithin 1,200 mg

Puritan's Pride Concentrated Ultra Lecithin 1,200 mg

Puritan's Pride

Pros
  • ConsumerLab Approved

  • Provides a well-absorbed form of choline

  • Affordable

Cons
  • Provides low dose of actual choline

Puritan’s Pride Concentrated Ultra Lecithin is our top choice because it is a cost-effective supplement that demonstrates safety and purity, which are especially important during pregnancy. It was given ConsumerLab’s top pick and it’s ours too. 

This supplement provides lecithin sourced from soy and is gluten-free, made without artificial colors, flavors, or preservatives. It’s also a very affordable option compared to choline supplements that provide nearly the same amount of phosphatidylcholine.

One softgel provides you with 420 mg of phosphatidylcholine, which is well absorbed and less likely than some other forms of choline to result in the production of TMAO. 

However, do remember that 420 mg of phosphatidylcholine is really only providing you with about 60 mg of choline. So, it is recommended to take 2 softgels daily for adequate intake.

Form: Softgel | Type: Soy lecithin | Dose: 420 mg phosphatidylcholine | Recommended Use: Twice daily with a meal

Best Budget: Vitacost Choline & Inositol

Vitacost Choline & Inositol

Vitacost

Pros
  • ConsumerLab Approved

  • Inexpensive

  • Provides 50% of the adequate intake (AI) of choline

Cons
  • Uses a less desirable form of choline

  • Inositol may not be appropriate for everyone

Pregnant people are likely already taking a prenatal vitamin, plus other recommended nutrients depending on their unique needs in pregnancy, so a choline supplement that is affordable is incredibly helpful on one’s wallet. 

We like that the Vitacost Choline & Inositol is ConsumerLab approved and is an easy one capsule dose to remember to take daily. The form of choline in this product is choline bitartrate. It provides 250 mg of active choline, which easily gets you to more than 50% of your daily needs for pregnancy. Bitartrate is widely used in many prenatal and choline supplements because of its high availability of choline, but research cautions against high amounts of this form because of its possible conversion to TMAO in the gut.

Another consideration is that this choline supplement comes packaged with inositol, a sugar that acts similarly to a B vitamin and plays a role in neurotransmitter production, much like choline. Research is preliminary, but inositol may help lower cholesterol and may reduce the risk of gestational diabetes. Because inositol can have effects related to blood sugar in some people, it is best to speak with a healthcare provider before taking it.

Form: Capsule | Type: Choline bitartrate | Dose: 250 mg | Recommended Use: Once daily with food

Best Liquid: Perque Choline Citrate

Perque Choline Citrate

Pure Formulas

Pros
  • ConsumerLab Approved

  • Easy to consume

  • Provides more than 100% of AI for choline

Cons
  • May have a tart taste

This liquid Perque Choline Citrate is a great choice for pregnant people who don’t want any more pills to swallow. There are a few other liquid choline options on the market, but we feel confident recommending Perque for pregnancy because it is ConsumerLab Approved.

Choline citrate is not shown to raise TMAO levels. In just one teaspoon, Perque’s liquid choline provides 650 mg of choline. This amount is above the AI for pregnancy but not considered dangerous, as emerging research suggests that the AI is in fact too low for pregnancy. If a healthcare provider recommends a higher or a lower dose for you, the liquid form makes it easy to adjust the amount you take.

This liquid product needs to be mixed in with water or juice for consumption, and it’s often said that this citrate form can have a sour or tart taste, so something to consider if you’re having aversions to strong smells or tastes in your pregnancy.

Form: Liquid | Type: Choline citrate | Dose: 650 mg | Recommended Use: One teaspoon diluted in water or juice

Best for Brain Health: Bestvite Cognizin

Bestvite Cognizin

Amazon

Pros
  • ConsumerLab Approved

  • Vegetarian

  • Uses a high quality patented form of choline

Cons
  • Expensive

CDP-choline contains a higher percentage of active choline than most other forms of choline found in supplements, and so it’s highly sought after. The patented form of choline, called Cognizin (citicoline), found in this product is recognized as a high quality pure ingredient and is being studied for potential effects on brain health in the aging population in clinical studies. The effect of Cognizin (citicoline) on TMAO levels is still being studied.

Again, due to the caution with supplements in pregnancy, we put a lot of stock in recommending ConsumerLab Approved products, and we also appreciate that this brand is a vegetarian option. This option is a bit more expensive than other supplements, most likely because of its high percentage of active choline.

Form: Capsule | Type: CDP-choline | Dose: 1000mg citicoline | Recommended Use: 2 capsules in the morning with water

Final Verdict

Choline is no doubt an important nutrient for pregnant people to consider supplementing with. Puritan’s Pride Concentrated Ultra Lecithin 1,200 mg is an excellent choice if you are looking to add an inexpensive but effective dose of choline to your prenatal supplement routine. Another option is the Bestvite Cognizin supplement, which is a touch more expensive but provides a larger percentage of the active choline component.

How We Select Supplements

Our team works hard to be transparent about why we recommend certain supplements; you can read more about our dietary supplement methodology here.

We support supplements that are evidence-based and rooted in science. We value certain product attributes that we find to be associated with the highest quality products. We prioritize products that are third-party tested and certified by one of three independent, third party certifiers: USP, NSF, or ConsumerLab. 

It's important to note that the FDA does not review dietary supplements for safety and effectiveness before they go to market. Our team of experts has created a detailed, science-backed methodology to choose the supplements we recommend.

Why Pregnant People May Benefit from Choline Supplementation


Pregnant people may benefit from a choline supplement for a variety of reasons:

Potential Cognitive Function Improvement: Mannaker says, “Choline appears to play a role in self-regulation, processing speed, and attention as the baby gets older.”

  • Not only is choline an important structural component for the rapidly developing baby, but it may also have an impact on the neurodevelopment of the baby farther into their future.
  • Data from observational studies are somewhat mixed. However, there is evidence that higher maternal intake of choline—at levels as high as 930 mg—is linked to faster processing speed and reaction time in infants 4 to 13 months of age and even up through age seven. 

Possible Neural Tube Defect Prevention: Research is now looking at the link between other nutrients, such as choline, and the possible reduction in NTDs.

  • Folate gets most of the press when it comes to preventing neural tube defects (NTDs) for babies, and while folic acid supplementation does help reduce the risk of NTDs, these birth defects do still occur.
  • It seems that studies are mixed, and while some show a strong link between higher choline intakes and fewer NTDs, other studies are less conclusive.

Possible Placental Health Improvement: All of the nutrients that the baby needs and receives are passed through the placenta, so the health and functioning of this unique organ is vital.

  • While the research has mostly been conducted in animals, there appears to be a link between high level choline supplementation and enhanced nutrient transport, specifically improved transport of DHA, a fatty acid crucial for baby’s brain and nervous system development.
  • A small study in pregnant women, which provided 930 mg of choline per day for 12 weeks, showed improved placental vascular function and a likely benefit to modifying preeclampsia risk.

What to Look for in a Choline Supplement for Pregnancy

Third-Party Testing

Supplements that are third-party tested are sent to a lab where they are tested to ensure they contain what they say they contain and are not contaminated with specific high-risk, common contaminants. However, it’s important to note:

  • Third party testing does not test to see if a product is effective or safe for everyone, and it does not ensure the supplement will not interact with other supplements or medications.
  • Not all third-party testing is created equal. It is not uncommon for supplement companies to pay labs for certificates after conducting minimal to no testing. 
  • The third party certifications we can trust are: ConsumerLab, NSF, and USP. However, these certifications are difficult to obtain and/or expensive for manufacturers, so many companies choose not to get their products tested by one of these three organizations. 
  • Sometimes products tested by these three companies are more expensive to try to offset the cost they pay for certification.
  • Just because a supplement is not tested by one of these three companies, it does not mean it’s a bad product. We recommend doing some research on the reputability of the manufacturer, and calling up the manufacturer and their testing lab to determine their protocols and decide if you feel comfortable consuming the supplement.

Form

Choline supplements can be found in a variety of forms.One important consideration is that each supplement form actually provides a different amount of the active choline compound. Supplement labels commonly only list the amount of the ingredient, but not the amount of active choline, which can be confusing.

More specifically, the CDP-choline, choline citrate, alpha-GPC, bitartrate, and chloride forms have much greater concentrations of choline per gram. This means you can take less of the supplement to obtain the same amount of the active choline. However, as we will discuss below, some of these forms are not necessarily “better.” 

Forms of Choline We Recommend

  • Phosphatidylcholine is the form predominantly found in food, the most abundant form of phospholipid in the body, and is commonly found in supplement form. Research has shown that phosphatidylcholine may be better absorbed than other sources, which leaves less choline in the gut to be potentially turned into potentially harmful TMAO.
  • Choline citrate is less commonly found as a supplement, and it is worth noting that it’s often found to have a very sour taste. This form is not shown to significantly raise TMAO levels, and one study showed that high dose supplementation with this form decreased asthma symptoms and need for medication.
  • Citicoline (CDP-choline) is a more expensive form, but it is highly sought after due to the two-in-one benefit of choline and cytidine, which is a precursor for uridine—a compound studied for neuroprotection and cognition. In a small study of pregnant animals, supplementation of citicoline showed decreased brain inflammation and improved memory function in offspring.
  • Alpha-GPC choline contains about 40% choline and has been shown to modestly improve cognition in elderly people with Alzheimer’s.
  • Lecithin is another form you will find as a choline supplement. This is usually derived from soybean, sunflower, and rapeseed and so could be found as a food-based supplement, or as a pill. Lecithin is actually a purified form of phosphatidylcholine, but the true amount of choline is only 2-3%. 

Forms of Choline We Recommend with Caution

Choline bitartrate contains quite a high percentage of active choline, but it has been demonstrated that this type possibly raises TMAO levels in the body more so than other forms. However, this risk may only be for high doses of the supplement as it was documented in findings from a 2021 study that provided subjects with 1000 mg of choline bitartrate daily, which is well above the recommended amount for pregnancy.

Interestingly, many prenatal vitamin companies use choline bitartrate in their products, but often well below 500 mg. These supplements commonly provide VitaCholine, which is manufactured from a supplement chemical company, Balchem (the same brand that is used in many research studies as well).

It is very likely that in low doses, choline bitartrate is safe, but more research needs to be done on the benefit and/or harm of this source of choline for pregnancy and the general population.

Ingredients & Potential Interactions

It is essential to carefully read the ingredient list and nutrition facts panel of a supplement to know which ingredients and how much of each ingredient is included, relative to the recommended daily value of that ingredient. Please bring the supplement label to a healthcare provider to review the different ingredients contained in the supplement and any potential interactions between these ingredients and other supplements and medications you are taking.

Choline supplements are, in general, fairly straightforward, but some products will contain additional nutrients. You may find B vitamins paired with choline because these nutrients work together in the body.

Choline Dosage

Always speak with a healthcare professional before adding a supplement to your routine to ensure that the supplement is appropriate for your individual needs and to understand which dosage to take.

According to the Institute of Medicine (IOM), there was not enough evidence to establish an Estimated Average Requirement (EAR) for choline, and so an Adequate Intake (AI) level was determined and for pregnancy is as follows:

  • 4-18 years- 450 mg for pregnancy
  • 19+ years- 450 mg for pregnancy

It is also important to note that the amount of choline that you need is influenced by the amount of methionine, betaine, and folate in your diet, your body’s ability to produce choline, and possible genetic mutations.

How Much is Too Much?

The IOM established the Tolerable Upper Intake Level (UL), meaning the maximum amount that can be safely taken on a daily basis, for choline as 3500 mg for adults, including during pregnancy and lactation.

Consuming excessive choline can cause a fishy body odor in some people, excessive sweating and salivation, vomiting and gastrointestinal upset, hypotension (low blood pressure), and liver toxicity.

Again, one concern that is being discussed more is the connection between choline and the production of TMAO, a compound that has been linked to a higher risk of cardiovascular disease in adults, depending on the dose. It does not appear that food sources of choline significantly impact TMAO, but choline supplements, particularly choline bitartrate, have been shown to raise TMAO levels. The choline-TMAO connection is not well-established, however, and many other factors such as genetics and gut microbiota may also influence TMAO production.

No matter whether you get your choline from food or supplements, you should not exceed 3500 mg per day.

Frequently Asked Questions

  • Should non pregnant people take choline supplements?

    Choline is an important nutrient even for non-pregnant people. One of the major functions of choline is that it acts as a precursor for a critical neurotransmitter, acetylcholine, which aids in memory, muscle function, mood, and overall brain and nervous system functioning.

    Choline has been studied in relation to cardiovascular health and peripheral artery disease in adults, but the findings are mixed. More studies are also needed to clarify the relationship between choline intakes and cognition, as well as diseases like Alzheimers. There is also a possible benefit to consuming sufficient choline and treatment or prevention of liver disease, but, again, more research needs to be done.

  • Are there risks to pregnancy of taking choline supplements?

    Aside from potential gastrointestinal upset, the fishy body odor, and excessive sweating and salivation, which are mostly only present at very high doses, there is likely little risk to taking choline during pregnancy. In fact, the research is building to support taking double the AI of choline during pregnancy.

  • How should I take a choline supplement?

    There is no strong evidence or recommendations to say when or how you should take a choline supplement. Generally, supplements are better tolerated when taken with food, so consider consuming your choline with a meal.

  • What are the side effects of choline supplements?

    If choline doses exceed the UL of 3500mg, some people might start to notice a fish body odor, excessive sweating and salivation, vomiting and gastrointestinal upset, or hypotension (low blood pressure). More serious side effects of excessive choline supplementation are liver toxicity and the concern over TMAO production, depending on the type of choline supplement taken.

Why Trust Verywell Family

Casey Seiden, MS, RDN, CDN, CDCES is a registered dietitian nutritionist and certified diabetes care and education specialist based out of New York City. Casey works at Maternal Fetal Medicine Associates, the premier maternal fetal medicine practice in Manhattan, where she provides nutrition therapy and counseling to women with high risk pregnancies. She is also the founder of Casey Seiden Nutrition, a virtual private practice specializing in a non-diet approach to diabetes care and women’s health.

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