Choline in pregnant women: a systematic review and meta-analysis

Abstract

Context Choline is a critical nutrient. Inadequate choline intake during pregnancy increases the risk of adverse maternal and offspring health. Objective A systematic review and meta-analysis were conducted to examine the current recommendations for choline intake by pregnant women, estimate the overall prevalence of pregnant women with adequate choline intake, and explore associations between maternal choline level and adverse pregnancy outcomes (APOs). Methods Choline recommendations for pregnant women were assessed from eight nutrient guidelines of the United States, United Kingdom, Canada, Australia, Asia, International Federation of Gynecology and Obstetrics, and World Health Organization. Data on the prevalence of pregnant women with adequate choline intake and the association between maternal choline level and APOs were collected from 5 databases up to May 2023. Meta-analyses with random effects and subgroup analyses were performed for the pooled estimate of prevalence and association. Results Five recent nutrition guidelines from the United States (United States Department of Agriculture), United States (Food and Drug Administration), Canada, Australia, and the International Federation of Gynecology and Obstetrics have emphasized the importance of adequate choline intake for pregnant women. Of 27 publications, 19 articles explored the prevalence and 8 articles explored the association. Meta-analysis of 12 prevalence studies revealed a concerning 11.24% (95% confidence interval, 6.34–17.26) prevalence of pregnant women with adequate choline intake recommendations. A meta-analysis of 6 studies indicated a significant association between high maternal choline levels and a reduced risk of developing APOs, with an odds ratio of 0.51 (95% confidence interval, 0.40–0.65). Conclusion The existing guidelines highlight the importance of choline in supporting maternal health and fetal development during pregnancy. Furthermore, a high maternal choline level was likely to be associated with a lower risk of APOs. However, 88.76% of pregnant women do not achieve the optimal choline intake. Therefore, specific policies and actions may be necessary to improve choline intake in pregnant women’s care and support the well-being of pregnant women. Systematic Review Registration PROSPERO registration no. CDR42023410561.

Choline—An Underappreciated Component of a Mother-to-Be’s Diet

“…In addition to the wealth of scientific evidence demonstrating the role of high levels of choline in the maternal diet for fetal development, there have also been several recent publications that highlight the association of maternal choline intake with adverse pregnancy outcomes. A recent meta-analysis [ 69 ] suggests that an inadequate supply of this component in the diet of pregnant women may be a risk factor for preterm birth, small for gestational age (SGA), preeclampsia (PE) and gestational diabetes mellitus (GDM).…”

“…Women with the AA genotype of the rs7946 polymorphism who consumed less than 255 mg of choline/d during pregnancy had an almost 4-fold higher risk of preterm birth compared to women with the GG genotype who consumed more choline per day. In addition, women with the AA genotype who had low choline levels also had elevated homocysteine levels, which have been shown to be associated with preterm birth [ 69 ].…”