“As maternal dietary choline intake increased, the neurobehavioral development scores and developmental indices of the offspring also improved,” wrote researchers from Nantong University in China, noting that the observational nature of the study meant that no causal relationship could be inferred.
The prospective cohort study, published in the European Journal of Nutrition, included 256 mother-infant pairs. A food frequency questionnaire was employed to assess dietary choline and other nutrient intakes during late pregnancy.
The researchers evaluated the infants at one, three and six months using developmental scales and analyzed the relationships between maternal choline intake and infant intelligence, motor score, mental development index (MDI) and psychomotor development index (PDI).
They found that only 1.56% of the pregnant women met the adequate intake (AI) for choline.
Maternal dietary choline intake was significantly associated with the infant intelligence scores, MDI and PDI.
“These results are in line with the current body of evidence that shows that higher maternal choline intake is associated with better neurodevelopment,” Michael VanderDrift, senior marketing communications manager at choline supplier Balchem Human Nutrition and Health, told NutraIngredients.
“More specifically, maternal choline supplementation during pregnancy has been shown to provide lasting benefits for offspring cognition, observed as early as the first year of life and persisting even up to age seven,” he added.
An essential nutrient
Choline is an essential micronutrient that people must consume through dietary sources such as egg yolks, liver, and legumes or supplements. The liver synthesizes a limited amount of choline but not enough to meet the body’s requirements.
As a source of methyl groups, choline is needed for the synthesis of phosphatidylcholine and acetylcholine, and it plays a key role in nervous system function and early brain development.
Choline can serve as a primary methyl donor when the diet is deficient in folate or vitamin B12, or when an individual has a variant in enzymes involved in methylation. According to experts, pregnant women, particularly those with low B12 status or who are not taking folic acid, may be at risk of inadequate choline.
“Despite its importance in supporting a healthy pregnancy, very few pregnant women meet the adequate intake for choline (450 mg/day in the US), 480 mg/day in Europe),” VanderDrift said.
Food vs supplements
VanderDrift explained that meeting the recommended intake of choline without supplements is “extremely difficult”. He said that choline is typically found in calorie-rich foods such as eggs, beef, dairy, pasta and fast food, making it challenging for pregnant women to get enough from their diets alone.
“If you’re someone who is trying to follow a healthy diet (where “healthy” is meeting the USDA Healthy U.S. Style Food Pattern), or if you’re a vegan/vegetarian, there is virtually no way you can meet your choline requirements while staying within your caloric limits,” he said.
“Prenatal supplements are a great way to fill that nutrient gap, but sadly many prenatal supplements do not contain choline, or only contain small amounts inadequate to meet recommendations, something recognized by multiple medical societies and expert groups.”
VanderDrift recommended that consumers look for prenatal supplements that contain adequate amounts of clinically tested forms of choline to support the health of the mother and infant.
Although there is a lack of long-term studies into choline dosage and safety, VanderDrift noted that the supplement has been evaluated within normal limits.
“The current Tolerable Upper Intake Limit (UL) in the US is 3,500 mg/day—more than 7x higher than the current intake recommendation of 450 mg/day," he said. “The safety of choline has been evaluated multiple times, most recently in 2025 by the Council for Responsible Nutrition which reaffirmed the UL, a strong recognition of the safety of this critical nutrient."
Source: European Journal of Nutrition (2026) 65:23. doi: 10.1007/s00394-025-03880-x. “Association of dietary choline intake in late pregnancy with the early neurobehavioral development of offspring”. Authors: Y. Weng et al.
