According to the results of a 2020 study in the Journal of Psychiatric Research, the researchers demonstrated that higher prenatal choline levels may help protect and support neurological fetal development, even if the mother contracts a viral respiratory infection in early pregnancy. In light of the current pandemic and according to the study, the Centers for Disease Control and Prevention (CDC) “anticipate that maternal COVID-19 infection will effect fetal development like other respiratory coronaviruses”... as “the maternal inflammatory response to the virus is thought to be the pathogenic mechanism underlying effects on the fetus and its support by the placenta.” 

At 3 months of age, researchers assessed and analyzed infant behavior in those infants whose mothers had contracted a respiratory virus during early gestation by measuring the Infant Behavior Questionnaire (IBQ-R). Maternal C-reactive protein (CRP) and choline levels were measured in both the infected (n = 43) and noninfected (n = 53) mothers at 16-weeks’ gestation. Self-reported symptom severity in infected mothers was also measured to find any correlations between the mothers who were infected with a respiratory virus during the first trimester, choline levels, inflammation and the child’s development. 

 The results showed that infants of mothers who contracted viral infections with choline levels ≥7.5 µM, a level consistent with diets that meet or exceed the minimum requirement for pregnant women, “had significantly increased 3-month IBQ-R scores on the Regulation dimension and specifically the Attention scale … compared to infants of mothers who had viral infections and had choline levels <7.5 µM.” Furthermore, “mothers with respiratory viral infections in early gestation were younger and more likely to be depressed and anxious. Viral infection was associated with increased CRP, 11.0 mg/L in infected women versus 7.5 mg/L in uninfected women.” 

Because endogenous choline is insufficient to meet the physiological demands of the body, even more so during gestation, it is considered an essential nutrient to obtain exogenously, either through diet or supplementation. This study’s researchers concluded that “choline levels sufficient to protect the fetus often require dietary supplements,” suggesting that extra choline supplementation by pregnant women may mitigate the adverse effects that viral infections of the respiratory tract, including novel coronaviruses, can have on their babies. 

Pregnant and lactating women are at particularly high risk for deficiency. Choline requirements are highest in this population, as evidenced by noticeable increases in plasma and serum choline concentrations in pregnant women. Choline is drawn out of the maternal blood to provide for the fetus or infant during pregnancy and lactation. Not only does a deficiency effect the mother’s structural and biological requirements, it greatly impacts the fetus or newborn, particularly with neurological development and information processing speed in infants. 

Not only is it well-established in the scientific literature that choline is a critical nutrient during pregnancy for fetal development, but maintaining adequate choline levels in the body is critical for a variety of biological processes to function optimally. Choline, a member of the B vitamin family, is a precursor to betaine (a methyl donor), acetylcholine (a neurotransmitter involved in memory tasks, attention and mood) and phosphatidylcholine (a primary component of cell membranes), metabolites involved in structural and regulatory roles in the body. Epidemiological studies reveal a positive association between dietary choline intake and serum choline levels and better cognitive performance in adults and the elderly, which is particularly important for the prevention of neurodegenerative conditions. 

Egg yolks are particularly rich dietary sources of choline, providing nearly 126 mg per large egg. Grass-fed beef liver, although not a favorite among many Americans, is the most concentrated and highest source of choline. An average female adult should consume at least 400 mg to 425 mg per day; the adequate intake for pregnant and lactating women is between 450 mg and 550 mg per day, as there is insufficient evidence to develop a Recommended Dietary Allowance (RDA) for choline. Keep in mind that RDA amounts are the minimum amounts required to prevent nutritional deficiency but may not be adequate for optimal biological function. 

Unfortunately, many individual’s diets provide insufficient amounts of choline, leading to widespread deficiencies; choline is one of the top ten underconsumed nutrients by Americans. Choline deficiency is associated with a fourfold increased risk of having an infant with a neural tube defect, organ and muscle dysfunction, and nonalcoholic fatty liver disease, which are common symptoms among adults. Supplementation of this important micronutrient may be essential for those who become pregnant, who are currently pregnant, and who are lactating. Individuals who do not consume adequate choline-rich foods, such as strict vegetarians and vegans, and those who are allergic or sensitive to eggs, would also benefit from supplementation. Glycerylphosphorylcholine, and the metabolites of citicoline, can cross the blood-brain barrier to support brain and nervous system health. Supplementing may help produce more acetylcholine neurotransmitters and phosphatidylcholine in the cell membranes for overall cognitive support and neuroprotection. 

By Caitlin Higgins, MS, CNS, LDN