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Prenatal choline supplementation improves biomarkers of maternal docosahexaenoic acid status among pregnant participants consuming supplemental DHA: a randomized controlled trial

Klatt K, McDougall M, Malysheva O, Taesuwan S, Loinard-González A, Nevins J, Beckman K, Bhawal R, Anderson E, Zhang S, Bender E, Jackson K, King J, Dyer R, Devapatla S, Vidavalur R, Brenna T, Caudill M (2022) The American Journal of Clinical Nutrition May 16 doi: 10.1093/ajcn/nqac147 

Web URL: Read this and related articles on PubMed


Background: Dietary methyl donors (e.g., choline) support the activity of the phosphatidylethanolamine N-methyltransferase (PEMT) pathway, which generates phosphatidylcholine (PC) molecules enriched in docosahexaenoic acid (DHA) that are exported from the liver and made available to extrahepatic tissues.

Objective: This study investigated the effect of prenatal choline supplementation on biomarkers of DHA status among pregnant participants consuming supplemental DHA.

Design: Pregnant participants (N=30) were randomized to supplemental choline intakes of 550 mg/d (500 mg/d d0-choline + 50 mg/d deuterium labeled-choline [d9-choline]; intervention) or 25 mg/d (25 mg/d d9-choline; control) from gestational week (GW) 12-16 until delivery. All participants received a daily 200-mg DHA supplement and consumed self-selected diets. Fasting blood samples were obtained at baseline, GW 20-24, and GW 28-32; maternal/cord blood was obtained at Delivery. Mixed effects linear models were used to assess the impact of prenatal choline supplementation on maternal and newborn DHA status.

Results: Choline supplementation (550 vs 25 mg/d) did not achieve a statistically significant intervention-x-time interaction for RBC PC-DHA (P=0.11); a significant interaction was observed for plasma PC-DHA and RBC total DHA, with choline supplementation yielding higher levels (+32-38% and +8-11%, respectively) at GW28-32 (P<0.05) and Delivery (P<0.005). A main effect of choline supplementation on plasma total DHA was also observed (P=0.018); its interaction with time was not significant (P=0.068). Compared with controls, the intervention group exhibited higher (P=0.007); main effect) plasma enrichment of d3-PC (d3-PC/total PC). Moreover, the ratio of d3-PC:d9-PC was higher (+50-67%, P<0.001) in the choline intervention arm (vs control) at GW 20-24, GW 28-32 and Delivery.



This new study of women during pregnancy confirms that choline increases the availability of he long-chain omega 3 fatty acid DHA - which is essential for normal vision, cognition and brain development and function, but seriously lacking from modern, western-type diets.

DHA is a major structural component of brain and nerve cell membranes, and its many derviatives also play numerous functional roles in the brain and nervous system, as well as other vital organs and body systems.  Adequate supplies of DHA are therefore needed for normal brain development, plasticity and cell signalling.  

As the current findings confirm, choline is needed to transport DHA across the placenta to the unborn child, and other evidence shows it also helps transport DHA across the blood-brain barrier.  

These effects of choline in boosting DHA availability may help to explain the long-term benefits for children's cognitive development from maternal supplementation during pregnancy that have been shown in human clinical trials. See:

For the related news article please see:

For a summary overview of how DHA and choline work together to promote brain health – and the best dietary sources of each - as well as the clinical trials showing maternal supplementation can benefit children’s cognitive development, see:  

See also: