Choline

Pregnancy

ODS gives an adequate intake (AI) of 450 mg/day during pregnancy. This is a total intake target from food and supplements, not a stated supplement dose. ODS says most pregnant women do not reach the AI, many prenatal products contain little choline, and there are no specific professional or public-agency recommendations for choline supplementation during pregnancy. ACOG also lists 450 mg/day and says choline may help prevent some common birth defects, but this does not establish that a choline supplement prevents neural tube defects (NTDs). Evidence on birth defects is mixed. A 2009 case-control study of 80 NTD-affected pregnancies and 409 controls associated lower mid-pregnancy serum choline with higher NTD odds. A 2014 case-control analysis found no significant difference in maternal plasma total choline between affected pregnancies and controls; its authors said adding choline to folic acid supplements may not further reduce NTD risk. A 2025 case-control study in China (474 cases, 948 controls) found higher dietary choline intake associated with lower odds of some congenital heart defects, but it did not test supplements or establish cause and effect. A small 2018 controlled trial gave 480 or 930 mg/day total choline in the third trimester; 24 infants completed cognitive testing, and mean reaction time was faster in the higher-intake group. A 2025 systematic review included four randomized trials and five observational studies; most neurodevelopment outcomes did not support a benefit, and the authors said evidence was insufficient to support or refute one. Recent observational findings remain mixed: a 2026 cohort of 256 mother-infant pairs linked late-pregnancy dietary choline with some infant scores but stated that no causal inference could be made. A 2026 cross-sectional study of 7,310 women linked dietary choline with higher birth weight and lower odds of low birth weight or small-for-gestational-age birth, while a 988-dyad cohort found no significant association for choline biomarkers. These studies measured diet or blood levels, not the effect of assigning a choline supplement.

Breastfeeding

ODS gives an AI of 550 mg/day during lactation and notes that choline is present in breast milk. CDC's August 2026 page says a breastfeeding woman may benefit from a multivitamin when diet alone may not ensure adequate nutrition, and that health care providers should help determine which supplements are appropriate. In a randomized study, 103 pregnant women received 750 mg/day supplemental choline or placebo from 18 weeks of pregnancy through 45 days postpartum. Supplementation raised several choline compounds in milk; the full paper reported no difference in adverse-event frequency between groups. A 2015 controlled-feeding study randomized 28 lactating women and 21 controls to 480 or 930 mg/day for 10 to 12 weeks and found that higher intake changed some breast-milk choline metabolites. These small studies measured milk composition and short-term reported events, not whether maternal choline supplementation improves infant health or development through breast milk.

What was tested

Human pregnancy evidence includes case-control studies of NTDs, dietary cohorts, and small randomized supplement trials. A 2025 systematic review covered four pregnancy trials and five observational studies, with most child-development outcomes null and important study limits. The newest studies identified through October 2026 are observational and measure dietary intake or blood choline; they do not establish supplement effects. Two small lactation studies assessed maternal intake and milk choline compounds. One also reported short-term adverse events, but long-term infant outcomes from exposure through milk remain unestablished.