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Choline - A Neglected Nutrient Vital for Healthy Brains - BOOK HERE

Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies

Obeid R, Derbyshire E, Schön C (2022) Adv Nutr 13(6) 2445-2457. doi: 10.1093/advances/nmac082. 

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We studied associations between prenatal and early postnatal choline intake, brain development, and neurocognitive function of children. We conducted a systematic review followed by a meta-analysis and critical appraisal of human studies published from 1997 to 2021.

Thirty publications were identified. The meta-analysis included 5 of 7 case-control studies studying neural tube defects (NTDs) in relation to maternal choline intakes/circulating concentrations. Low maternal choline intake/circulating concentrations were associated with a higher OR for NTDs among 1131 mothers of newborns with NTDs and 4439 control mothers (pooled estimate = 1.36; 95% CI: 1.11, 1.67). The 95% prediction intervals were 0.78, 2.36.

Findings and critical evaluation of 10 publications with interventional designs showed that higher maternal choline intakes during the second half of pregnancy and early postnatal period (550 mg up to 1 g/d on top of the diet) or a child intake of 513 to 625 mg/d from supplements were safe and likely to demonstrate favorable effects on several domains of child neurocognition, such as memory, attention, and visuospatial learning versus the comparators.

Findings from observational studies (n = 13) partly supported the association between maternal choline intake/serum concentrations and child neurocognition, but there was low confidence in the use of plasma choline concentrations as a choline intake marker.

In conclusion, low maternal choline intakes were associated with a higher OR for NTDs. The risk could be up to 2.36-fold in some populations. Despite limitations of available trials and observational studies, higher maternal choline intake was likely to be associated with better child neurocognition/neurodevelopment.

The results should be used to guide choline intake recommendations in pregnancy and lactation, especially because most young women are not achieving the reference intake of choline.

This meta-analysis is registered at PROSPERO as CRD42021233790.


Because some choline can be made within the body, this vital nutrient has still not been properly recognised as the dietary essential that it is - particularly during pregnancy and early life, when the brain and nervous system are developing.

Diet and nutrition surveys consistently show that over recent decades, most women of childbearing age in the US, UK and Europe have been failing to reach the recommended daily intake of choline, owing to changing dietary patterns (by far the main dietary sources of choline are animal foods - particularly liver and other organ meats, and eggs). 

This systematic review examined the evidence from human studies that low choline intakes may negatively affect child neurodevelopmental outcomes (as already firmly establised in animals), including both observational studies of maternal choline intakes or status during pregnancy, and clinical trials involving choline supplementation during pregnancy.

While acknowledging the limitations of plasma choline concentrations as a reliable biomarker of choline status, the reviewers concluded that
  • Low maternal choline intakes and/or status in pregancy are associated with significantly increased risks for neural tube defects
  • dietary supplementation with choline of mothers during pregnancy can significantly improve children's cognitive development
As they note, given that most women of childbearing age have suboptimal choline intakes, there appears to be a strong case for public health authorities to do more to raise both awareness, and intakes of choline during pregnancy.

See also:

And for more information on the importance of choline for brain development and function across the lifespan, see: