Pregnancy is, biologically speaking, a state of controlled upheaval. The immune system recalibrates, blood volume surges, and sometimes, inflammation rises to unsafe levels, posing potential health risks for both parent and child. A new study suggests that choline, a nutrient often under-consumed during pregnancy, may play a crucial role in mitigating inflammation.
Researchers analyzed data from over 1,300 pregnant participants enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort, one of North America’s most comprehensive long-term studies on pregnancy nutrition. Their findings indicate that higher dietary choline intake is associated with lower inflammation levels in the third trimester.
Understanding Choline’s Impact
“We all have these signaling proteins that can be inflammatory in our blood, but when they go beyond their normal range, we get worried,” said Elisabeth Larson, the study’s first author and a doctoral student in nutritional sciences at the College of Human Ecology. “Inflammation can be caused by anything from viral infections to chronic diseases, such as obesity or cardiovascular disease, and even psychological stress.”
Most notably, Larson discovered that participants with the highest choline intakes had significantly lower odds of experiencing clinically elevated inflammation compared to those with the lowest intakes.
The Biological Role of Choline
Choline is an essential nutrient involved in numerous biological processes, including cell membrane structure, neurotransmitter production, methylation, immune cell receptor activation, and fetal brain development. Some of these processes are integral to inflammation regulation. Choline is primarily found in eggs, meat, fish, dairy, and certain legumes and cruciferous vegetables.
“It’s most abundant in animal-source foods,” Larson noted. “If you’re vegetarian or vegan and not taking supplements, I would be concerned that you aren’t consuming enough choline.”
Choline: The Overlooked Nutrient
Despite its importance, choline is often overlooked in prenatal counseling, and many prenatal vitamins contain little or none of it. Surveys suggest that most pregnant individuals do not meet the recommended intake levels, making the new findings particularly compelling.
Using detailed 24-hour dietary recalls collected during the third trimester, the researchers estimated participants’ recent choline intake and compared it with blood levels measured by high-sensitivity C-reactive protein (hs-CRP), a common biomarker of low-grade systemic inflammation. The association between choline intake and CRP levels persisted even after accounting for factors known to influence inflammation, such as body mass index, gestational age, total energy intake, omega-3 fats, and other related nutrients.
“The relationship was not linear. Instead, inflammation dropped most steeply as intake rose from very low levels into moderate and higher ranges, suggesting potential thresholds rather than a simple ‘more is better’ effect,” Larson explained.
Choline in Context
The researchers did not examine choline in isolation. It works alongside other methyl donor nutrients, including folate, vitamin B12, and betaine, all of which participate in overlapping biochemical cycles. To account for this complexity, the study tested whether choline’s association with inflammation depended on the intake of these other nutrients. Despite the intertwined biological pathways, the inverse relationship between choline and hs-CRP remained robust, suggesting an independent contribution.
The findings align with experimental studies in nonpregnant adults and rodents showing that higher choline intake can lower inflammatory markers. Until now, evidence in pregnancy has been limited.
Implications for Dietary Guidelines
“This helps fill a meaningful gap because pregnancy has historically been excluded from interventional trials, even though it’s a period of enormous physiological importance,” Larson said. The current recommendation for choline during pregnancy is 450 mg, but there’s some evidence that this may not be sufficient.
The study’s findings raise questions about whether current dietary guidelines adequately reflect choline’s role during pregnancy and whether clinicians should pay closer attention to it alongside better-known nutrients like folate and iron.
“There really isn’t enough work on these under-appreciated nutrients that might be predictive of health for mother and child,” Larson emphasized. “It’s important because Mom’s health is very predictive of Baby’s future health.”
As research continues, the potential for choline to play a significant role in prenatal health could lead to revised dietary recommendations and increased awareness among healthcare providers and expectant parents.
