Food and Behaviour Research

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Maternal intake of choline during pregnancy impacts children's sustained attention

Cornell University


Findings from a new study suggest population-wide benefits of adding choline to a standard prenatal vitamin regimen


Choline is still not classed as an 'essential nutrient' (as vitamins are), because we can make some choline for ourselves - albeit not enough to meet our needs. In this way, it resembles the key long-chain omega-3 DHA.

Furthermore, adequate choline is essential for the effective transport of DHA into the brain, and during pregnancy for the delivery of DHA from the mother to the developing child.  Choline plays key roles in brain development and function, and adequate supplies are vital for normal lipid metabolism, liver function, and gene expression and regulation.

Substantial evidence already shows that most people in the UK, US and other developed countries fail to meet even the minimal dietary recommendations - including 9 in every 10 pregnant women. 

This new study adds powerful evidence that current recommended intakes are themselves too low to support optimal brain development.

In a randomised controlled clinical trial, the placebo group were given the recommended 'Adequate Intake' of choline (i.e. more choline than 70-90% of pregnant women usually get from their diets), while the active group received twice that level during the 3rd trimester of pregnancy.

An earlier report on this trial showed significantly better visual and cognitive development over the first year of life in the infants of mothers who received the high-dose choline supplementation.  See:

This new study found that even 7 years later, the children whose mothers received the high-dose choline suppementation showed significantly better cognitive function than the placebo group.

For details of this new research see:

For further information on this topic please see also:

And the related news article: Suggested move to plant-based diets risks worsening brain health nutrient deficiency

This open-access article provides an excellent overview of why we need to consume choline, the main dietary sources (which are primarily animal-derived foods), and the implications of deficiencies.  It also emphasises why the ongoing failure of regulatory authorities to do more to recognise and raise awareness of the essentiality of choline - particularly in the face of low and declining intakes - is potentially a serious public health problem.

In this freely available online presentation, FAB's Dr Alex Richardson provides a summary overview of choline, with a particular focus on how DHA and choline work together for normal brain development. 

This talk also includes advance coverage of key findings from this newly published study (provided in advance by the authors), as well as its background and rationale.

See also:

03/01/2022 - Medical Xpress

Seven-year-old children performed better on a challenging task requiring sustained attention if their mothers consumed twice the recommended amount of choline during their pregnancy, a new Cornell study has found.

The study, which compared these children with those whose mothers had consumed the recommended amount of choline, suggests that the recommended choline intake for expectant mothers does not fully meet the needs of the fetal brain.

"Our findings suggest population-wide benefits of adding choline to a standard prenatal vitamin regimen," said Barbara Strupp, professor in the Cornell Division of Nutritional Sciences (DNS) and Department of Psychology, and co-senior author of the study:

First author of the study is Charlotte Bahnfleth, Ph.D., a former graduate student in the Strupp Laboratory. Co-senior author is Richard Canfield, senior research associate in DNS. Marie Caudill, professor in DNS, was also a co-author.

Choline—found in egg yolks, lean red meat, fish, poultry, legumes, nuts and cruciferous vegetables—is absent from most prenatal vitamins, and more than 90% of expectant mothers consume less than the recommended amount.

Several decades of research using rodent models has shown that adding extra choline to the maternal diet produces long term cognitive benefits for the offspring. In addition to improving offspring attention and memory throughout life, maternal choline supplementation in rodents has proven to be neuroprotective for the offspring by mitigating the cognitive adversities caused by prenatal stress, fetal alcohol exposure, autism, epilepsy, Down syndrome and Alzheimer's disease.

In the Cornell study, all women consumed a prepared diet with a specified amount of choline throughout the third trimester of pregnancy. One half of these women consumed 480 mg choline per day, which slightly exceeds the recommended adequate intake (AI) level of 450 mg/day. The other half consumed a total intake of 930 mg choline per day, approximately double the AI level.

When tested at 7 years of age, the children of women in the 480 mg/day group showed a decline in accuracy from the beginning to the end of a sustained attention task, while those from the 930 mg/day group maintained a high level of accuracy throughout the task. These findings parallel the effects of maternal choline supplementation and deprivation in rodents, using a closely analogous sustained attention task.

"By demonstrating that maternal choline supplementation in humans produces offspring attentional benefits that are similar to those seen in animals," Strupp said, "our findings suggest that the full range of cognitive and neuroprotective benefits demonstrated in rodents may also be seen in humans."

The new findings build on a previous study from this research group describing benefits during infancy. That study demonstrated that maternal choline supplementation improved information processing speed throughout the first year of life in these same children.

Few studies with human subjects have evaluated the effect of maternal choline supplementation and this is the first study to follow the children to school age.

"By showing that the beneficial effects of prenatal supplementation endure into childhood, these findings illustrate a role for prenatal choline in programming the course of child cognitive development," Canfield said. "And because the ability to sustain attention in challenging situations is critical to nearly all areas of cognitive performance, the cumulative impact of improving sustained attention is likely to be substantial."

Current recommendations—including those for pregnant women—were set in 1998 and are based on the amount of choline needed to prevent liver dysfunction in men, studies have shown.