Choline may keep inflammation in check during pregnancy, researchers find

Choline may play an underappreciated role in regulating inflammation during pregnancy, according to researchers looking into deficiencies in Canada. The team at Cornell University, US, reports that higher recent dietary choline intake was associated with lower levels of inflammation in the third trimester. 

The study analyzed data from more than 1,300 pregnant participants enrolled in the Alberta Pregnancy Outcomes and Nutrition cohort, one of the most detailed long-running pregnancy nutrition studies in North America.

“We all have these signaling proteins that can be inflammatory in our blood, but when they go beyond their normal range, we get worried,” says first author Elisabeth Larson, a doctoral student in nutritional sciences.

“Inflammation can be caused by anything from viral infection to chronic disease, such as obesity or cardiovascular disease, and even things like psychological stress.”

Significantly, Larson notes that participants with the highest choline intakes had “dramatically lower” odds of having clinically elevated inflammation than those with the lowest intakes.

Choline’s essential role

Choline supports various biological processes, including cell membrane structure, neurotransmitter production, methylation, immune cell receptor agonism, and fetal brain development. Some of these biochemical processes actively help regulate inflammation.

The essential nutrient is found primarily in eggs, meat, fish, dairy, and some legumes and cruciferous vegetables.

“It’s most abundant in animal-source foods,” details Larson. “If you’re vegetarian or vegan and not taking supplements, I would be concerned that you aren’t consuming enough choline.”

A lead author of the paper stresses that the current recommendation for choline during pregnancy may not be adequate.Despite its role, the researchers note choline remains “something of a nutritional afterthought.” At times, it lacks emphasis in prenatal counseling, and prenatal vitamins often contain little or none of it. 

Unaddressed deficiencies

The study authors cite other research suggesting that most pregnant people fall short of recommended intake levels of 450 mg daily. Their study found an average intake of 365.9 mg per day.

Their paper highlights that inflammation dropped most steeply when choline intake rose from very low levels to moderate and higher ranges. This suggests potential thresholds rather than simply a “more is better” effect.

Specifically, by assessing odds ratios through Fisher’s exact test, the researchers found that those with the highest intakes (above 700 mg/d) had significantly lower odds of clinically elevated inflammation compared to those in the lowest category. 

This sharp decline was anchored to two clinical benchmarks for high-sensitivity C-reactive protein: levels greater than 1 mg/L indicating subacute inflammation and those above 5 mg/L indicating clinically elevated inflammation.

However, Larson cautions: “We had fewer data points at the lower or higher intake ends, so we need to do more research about a potential threshold relationship.”

She underlines that the current recommendation for choline during pregnancy may not be adequate.

The findings pose the question of whether current dietary guidelines adequately reflect choline’s role during pregnancy. It also asks if clinicians should pay closer attention to this alongside more commonly addressed 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 says. “It’s important because mom’s health is very predictive of baby’s future health.”

In research innovation around choline supplementation, Balchem specializes in a bioactive choline-enriched folate, Optifolin+, a patented L-5-methyltetrahydrofolate with 98% active methylating nutrients. The ingredient claims to deliver seven times the methyl groups of other folates for optimal methylation in the body.