Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

Introduction

Choline is a water-soluble nutrient that serves as a structural component of cell membranes, a precursor to the neurotransmitter acetylcholine, and a methyl donor through its metabolite betaine. (Zeisel 2009) These functions make choline integral to phospholipid synthesis, epigenetic regulation, lipid transport, and one-carbon metabolism. (Derbyshire 2025) During pregnancy, physiological demands for choline increase to support rapid cellular proliferation, fetal central nervous system development, and placental function. (Jaiswal 2023)(Mujica-Coopman 2024) Results from human observational studies and randomized controlled trials (RCTs) suggest that adequate maternal choline intake may reduce the risk of neural tube defects (NTDs) and support favorable neurocognitive outcomes in children. (Obeid 2022) Research also suggests that higher maternal choline levels are associated with a reduced risk of adverse pregnancy outcomes (APOs), including gestational diabetes, preeclampsia, preterm delivery, and small-for-gestational-age infants. (Nguyen 2025) 

Despite choline’s importance, surveys demonstrate that most pregnant individuals do not meet the current adequate intake (AI) of 450 mg per day established for pregnancy. (Beluska-Turkan 2019) Rich dietary sources include egg yolks, liver, wheat germ, red meat, fish, and poultry. Smaller amounts are found in plant sources like legumes, nuts, cruciferous vegetables, and whole grains. Individuals following plant-based dietary patterns or those with limited dietary diversity may be at higher risk of insufficiency. (Derbyshire 2025) In such cases, supplementation may be considered to help individuals meet recommended intake levels during pregnancy.

Ingredients

Choline

Dosing: 450 mg per day during the first 12 weeks of pregnancy. 550 mg per day during the second and third trimesters of pregnancy. (Jaiswal 2023)

Supporting evidence:

  • Choline is an essential nutrient that plays a role in cell membrane structure, brain function, and lipid metabolism. Choline nutritional demands increase in pregnancy to support fetal neural tube formation and brain development. (Jaiswal 2023)
  • A 2025 systematic review and meta-analysis of 27 studies concluded that 88.76% of pregnant women do not achieve the optimal daily choline intake. In the meta-analysis of six studies, high maternal choline levels were associated with about half the odds of APOs compared with lower levels. (Nguyen 2025)
  • A 2022 systematic review and meta-analysis, which included over 5,000 mothers, demonstrated that low maternal choline intake during pregnancy was associated with a higher risk of NTDs, with the odds increasing by more than double in some populations. Another finding was that higher maternal choline intake during the second half of pregnancy and the early postpartum period was associated with better child neurocognitive outcomes, such as memory, attention, and visuospatial learning. (Obeid 2022)
  • Two reports from a small randomized feeding trial indicate that infants of mothers who consumed higher choline intakes during their third trimester show faster information processing in infancy and better sustained attention into childhood. (Bahnfleth 2022)(Caudill 2018)

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

View protocol on Fullscript
References
  1. Bahnfleth, C. L., Strupp, B. J., Caudill, M. A., & Canfield, R. L. (2022). Prenatal choline supplementation improves child sustained attention: A 7‐year follow‐up of a randomized controlled feeding trial. The FASEB Journal, 36(1), e22054. https://doi.org/10.1096/fj.202101217r
  2. Beluska-Turkan, K., Korczak, R., Hartell, B., Moskal, K., Maukonen, J., Alexander, D. E., Salem, N., Harkness, L., Ayad, W., Szaro, J., Zhang, K., & Siriwardhana, N. (2019). Nutritional gaps and supplementation in the first 1000 Days. Nutrients, 11(12), 2891. https://doi.org/10.3390/nu11122891
  3. Caudill, M. A., Strupp, B. J., Muscalu, L., Nevins, J. E. H., & Canfield, R. L. (2018). Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: A randomized, double‐blind, controlled feeding study. The FASEB Journal, 32(4), 2172–2180. https://doi.org/10.1096/fj.201700692rr
  4. Derbyshire, E. J. (2025). Choline in pregnancy and lactation: Essential knowledge for clinical practice. Nutrients, 17(9), 1558. https://doi.org/10.3390/nu17091558
  5. Jaiswal, A., Dewani, D., Reddy, L. S., & Patel, A. (2023). Choline supplementation in pregnancy: Current evidence and implications. Cureus, 15(11), e48538. https://doi.org/10.7759/cureus.48538
  6. Mujica-Coopman, M. F., Paules, E. M., & Trujillo-Gonzalez, I. (2024). The role of prenatal choline and its impact on neurodevelopmental disorders. Frontiers in Nutrition, 11, 1463983. https://doi.org/10.3389/fnut.2024.1463983
  7. Nguyen, H. T., Oktayani, P. P. I., Lee, S.-D., & Huang, L.-C. (2025). Choline in pregnant women: A systematic review and meta-analysis. Nutrition Reviews, 83(2), e273–e289. https://doi.org/10.1093/nutrit/nuae026
  8. Obeid, R., Derbyshire, E., & Schön, C. (2022). Association between maternal choline, fetal brain development, and child neurocognition: Systematic review and meta-analysis of human studies. Advances in Nutrition, 13(6), 2445–2457. https://doi.org/10.1093/advances/nmac082
  9. Zeisel, S. H., & da Costa, K.-A. (2009). Choline: An essential nutrient for public health. Nutrition Reviews, 67(11), 615–623. https://doi.org/10.1111/j.1753-4887.2009.00246.x