Choline: the often-overlooked crucial nutrient for pregnant mums

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When talking about essential nutrients during pregnancy, folate, calcium and iron often take the limelight. But did you know that choline can be just as important?

Pregnant mums often think that taking a prenatal supplement provides them with all the nutrients a growing baby needs. But that may not be the case when it comes to one critical nutrient: choline.

Pregnancy is a time when demand for choline is high. Most prenatal supplements contain a low amount of choline,1 leaving many pregnant women without enough of it. In fact, choline still remains important after pregnancy, during lactation – and even then, lactating mums might miss out of getting enough of this nutrient. This can have a critical effect on your health and your child’s development.

Why is choline so important? And how can you get enough of this this essential nutrient during pregnancy and when breastfeeding? We’ll tell you why here – and what you can do about it.

What Is Choline?

Choline is an essential nutrient which is grouped together with B-vitamins due to their similar functions.2 Like folic acid, it protects growing babies against neural tube defects and supports brain development.3 This influences lifelong memory and learning functions.

Your liver can make small amounts of choline.3 However, intake from food is necessary to meet your body’s – and your developing baby’s – demand for the nutrient.

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Why You Need Choline During Pregnancy

1. To replenish choline stores

Choline demand is high during pregnancy because mums deliver a large amount of choline across the placenta to the foetus.

The placenta is unique as it is one of the few non-nervous tissues to store large amounts of choline as acetylcholine. Some experts believe that this is a reserve storage pool that ensures delivery of choline to the fetus. Incredibly, choline concentration in amniotic fluid is ten times greater than that in maternal blood.4

2. For proper placental function

Did you know that pregnant moms grow a whole new organ in pregnancy – the placenta – that is essential for a healthy pregnancy? Dietary choline is one crucial nutrient needed for proper placental development and function, a process known as placental angiogenesis. Specifically, higher dietary intake of choline may improve signaling mechanisms responsible for placental angiogenesis – ensuring that exchanges between mother and foetus are at their best.5

3. To prevent preeclampsia

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Choline may also alleviate cases of preeclampsia, a condition in pregnancy characterized by high blood pressure. If preeclampsia is not diagnosed or controlled, it could severely affect the health of both mummy and developing baby.6

4. For DNA formation and stress regulation

In pregnant women, choline plays a critical role in two important fetal development areas. Higher maternal choline intake alters gene methylation (a process that is crucial in forming DNA) and the expression of placental corticotropin-releasing hormone, a key regulator in stress response. This suggests that low levels of maternal choline intake may have an adverse effect on maternal and foetal responses to stress1.

5. Vital role in foetal brain development

You may have heard of the brain building benefits of DHA in milk. Choline too plays an important role in foetal brain development – in fact, it works in synergy with DHA. Studies have found that these benefits are enhanced with combined choline and DHA supplements during normal pregnancy.  Together, they help develop foetal hippocampal neurodevelopment (responsible for enhanced memory function and development) better than choline or DHA alone.7

Choline Intake Beyond Pregnancy

The importance of choline continues post-pregnancy. Large amount of choline is transferred during lactation and this means that breastfeeding mums too need choline in their diet to replenish their body stores1.

Do You Have Choline Deficiency?

Mums, now that you are aware of the high demand of choline during pregnancy and lactation, how much choline do you actually need?

As pregnant women are at greatest risk of choline inadequacy, with 90-95% consuming less than the recommended adequate intake (AI)8, the US Institute of Medicine recommends that pregnant women consume 450mg of choline per day. The demand for choline is even higher for breastfeeding moms at 550mg per day9.

What could happen when you don’t get enough choline? In cases of choline deficiency, fat accumulates in the liver and may lead to liver disease. This may show up as elevated ALT (alanine aminotransferase) and reduced VLDL (very low density lipoprotein) levels in the blood. A choline deficiency can also cause elevated levels of the amino acid homocysteine – linked to early development of heart disease10.

Sources of Choline

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In a nutshell, pregnant and lactating mums need to bank more choline to ensure they have sufficient stores of this essential nutrient.

Here are some examples of how much choline-rich food11 you should eat to meet your AIs of this important nutrient:

  • BOILED EGGS (1 boiled egg, 50g = 146.9mg choline)

Eggs have always been unbeatable when it comes to breakfast recipes. To fulfill your daily choline needs, take three eggs per day during pregnancy and four eggs per day if you are breastfeeding.

  • BROCCOLI (1 bunch broccoli, 608g = 113.7mg choline)

Broccoli is a great source of choline, and you can munch on this healthy vegetable during mealtimes or as a snack. To get the recommended choline levels, take four to five heads of broccoli if you are pregnant or lactating.

  • TOFU (1 piece, 13g = 13.8mg choline)

Yes, that’s right: You have to eat at least a plate of 33 pieces tofu to meet your daily dose of choline during pregnancy and 40 pieces tofu while breastfeeding.

However, if you are unable to eat these foods in the recommended quantities, or you do not eat a diet containing milk, meat, eggs, or other choline-rich foods, then, you should consider a dietary supplement that is enriched with choline, to help meet your increased needs of this nutrient.

Replenish Your Choline Needs

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Enfamama A+ is an everyday nutritional milk supplement scientifically formulated to support the increased nutritional needs of both mum and developing baby during pregnancy and lactation. Compared to other maternal & lactating milk supplements, Enfamama A+ contains the highest level of choline.

When it comes to replenishing your choline needs, only Enfamama A+ meets more than 100% of the required choline intake for pregnant and lactating mums.

Enfamama A+ also helps provide these essential nutrients while supporting appropriate weight gain:

  • 100mg DHA in 2 servings/day to help meet expert recommended daily DHA intake
  • High in folic acid that is essential for growth and division of cells
  • Calcium aids in the development of strong bones and teeth
  • Iron is a factor in red blood cell formation
  • Prebiotic (inulin) helps increase intestinal bifidobacteria and helps maintain a good intestinal environment
  • Lower in fat: 80-82%* less fat than full cream milk

Including Enfamama A+ in your diet is a great way to help meet your choline requirements, plus you’ll also be receiving a host of other nutritional benefits.

For more information about Enfamama A+, visit the Enfamama A+ website.

 

References:

1 Zeisel SH. 2013. Nutrition in pregnancy: the argument for including a source of choline. Int J Womens Health. 5:193-199

2 Bonetti F et al. 2017. Nutrition and functional foods for healthy aging. Academic Press:139-158

3 Wikipedia. 2018. Choline. Available on en.wikipedia.org/wiki/Choline

4 Steven H Zeisel. 21 August 2006. Choline: Critical Role During Fetal Development and Dietary Requirements in Adults. Annual Review of Nutrition, Vol. 26:229-250. https://doi.org/10.1146/annurev.nutr.26.061505.111156, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441939/

5 Xinyin Jiang, Sara Jones, Benjamin Y. Andrew, Anita Ganti, Olga V. Malysheva, Natasa Giallourou, Patsy M. Brannon, Mark S. Roberson, Marie A. Caudill. 16 December 2013. Choline inadequacy impairs trophoblast function and vascularization in cultured human placental trophoblasts. Journal of Cellular Physiology.

6 Xinyin J et al. 2013. A higher maternal choline intake among third-trimester pregnant women lowers placental and circulating concentrations of the antiangiogenic factor fms-like tyrosine kinase-1 (sFLT1). The FASEB Journal. 27(3):1245-53. Doi 10.1096/fj.12-221648 https://www.ncbi.nlm.nih.gov/pubmed/23195033

7 Rajarethnem et al. 2018. Combined Supplementation of Choline and Docosahexaenoic Acid during Pregnancy Enhances Neurodevelopment of Fetal Hippocampus. https://www.ncbi.nlm.nih.gov/pubmed/28210506

8 Chetham CL. 2014. Mechanisms and correlates of a healthy brain: A commentary in Monographs of the society for research in child development. 79(4):153-65

9 Institute of Medicine. Food and Nutrition Board. 1998. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press.

10 Sha w et al. 2010. Metabolomic profiling can predict which humans will develop liver dysfunction when deprived of dietary choline. FASEB J. 24(8): 2692-2975

11 U.S. Department of Agriculture, Agricultural Research Service. 2018. USDA National Nutrient Database for Standard Reference. Available on ndb.nal.usda.gov/ndb/

For adult pregnant and lactating females, the minimum intake for optimal adult health and for fetal and child development is 300mg/d EPA+DHA, of which at least 200mg should be DHA. FAO 2010. Fats and fatty acid in human nutrition. Report of an expert consultation. FAO Food and Nutrition Paper no. 91. FAO:Rome.

Compared to other key maternal milk brands in the market as of Sept 2017. Enfamama A+ Choline levels: 560mg per 100g powder

*80% (Chocolate) – 82% (Vanilla) less fat than full cream milk

MYS-01/11P16/18351

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