Choline Supplements During Pregnancy and Breastfeeding: Supporting Brain Development in Down Syndrome

neurosutton
Jun 20, 2025
6 min read

Updated: Jul 22, 2025

carton of eggs — The simple egg, if you can find it, may be worth its weight in gold for supporting cognitive development.

How to Share This with Other Parents aka TL;DR

“Choline is like a building block for your baby’s brain. In mouse studies modeling Down syndrome, extra choline during pregnancy and nursing helped pups grow stronger brains, with better memory and attention. The improvements stuck around into adulthood. We’re still learning how this translates to people, but making sure you get enough choline could be a gentle, safe, and effective way to support your baby’s brain. As always, check with your doctor before making changes.”

During my time in academic neuroscience research, I had the privilege of rubbing elbows with Drs. Sharon Hunter and Bob Freedman. Their research looks at prenatal supplementation of choline to improve schizophrenia outcomes – not technically related. However, attending their talks, one cannot help but walk away with a deep appreciation of the importance of choline for neurodevelopment, typical or not. So, when I learned that our family might welcome a child with Down syndrome, my first instinct was to ask: could choline supplementation help here, too?

Clinician Sidebar

Though kind, the OB who delivered the NIPT results to us immediately discouraged any supplementation beyond 550mg and reluctantly agreed to 1000mg. Other subsequent practitioners were supportive of exploring supplementation when presented with some of the evidence cited here and and that the Tolerable UL is 3500mg. Please remember that your patient is a mother wanting to do anything reasonable to help her child develop well when you provide clinical guidance. There may not be tons of clinical evidence yet, but if there are few downsides….

What is Choline?

When we talk about building brains, choline is one of the unsung heroes. This nutrient, found in egg yolks, beans, and some veggies, is essential for developing brains, especially during pregnancy and early infancy. There’s growing excitement in the neuroscience community about the potential of extra choline before and after birth to help support cognitive and emotional development for those with Down syndrome (DS; Strupp et al., 2016).

What Have We Learned from Mouse Models?

In the world of neuroscience, the Ts65Dn mouse is one of the useful models for Down syndrome. When pregnant Ts65Dn mice are given 4–5 times the typical amount of dietary choline, their trisomic pups show:

Sharper Thinking: Better memory, attention, and emotional regulation lasting into adulthood, though the benefits may fade a bit with age (Strupp et al., 2016). Some of the changes may be related to permanently altered choline metabolism, if supplemented perinatally, that keeps the supply coming to the brain throughout life.
Brain Circuit Rescue: Choline helps protect and even restore brain regions critical for learning and memory, such as the hippocampus and its connections (Powers et al., 2017).
Gene Expression Tweaks: Choline can “tune” genes involved in brain signaling, especially those using GABA—a neurotransmitter that often runs high in DS brains (Powers et al., 2017).

What About Human Studies?

As the scientific community gathers more evidence, a compelling picture is emerging: increasing maternal choline intake during pregnancy could benefit all developing brains. In fact, some researchers now suggest that recommending higher choline intake to all pregnant women might serve as a universal, early intervention—supporting not only babies with Down syndrome, but also those whose families may not even know about a diagnosis during pregnancy (Strupp et al., 2016).

While we are still in the early days of this research, here’s what we know so far. Studies in typically developing children have shown that higher choline intake during pregnancy is linked to better attention and brain function, with benefits that can last at least through age seven (Caudill et al., 2018). Choline supplements are also considered to be safe, generally well-tolerated during pregnancy, with no major side effects reported in clinical studies (CADTH, 2024). In fact, recent reviews and expert commentaries consistently note that choline supplementation is safe even at levels well above the current recommended daily intake, and may be especially helpful for neurodevelopment in children with Down syndrome (Alasmari et al., 2025).

However, it’s important to recognize that large, long-term studies specifically focused on choline supplementation in families with Down syndrome are still needed. The encouraging results from animal studies offer hope, but more research in humans will help clarify the full potential of this simple, promising intervention.

How Do You Increase Choline?

When it comes to supporting healthy brain development during pregnancy and breastfeeding, starting with the diet can make a world of difference. Eggs, especially the yolks, are among the richest sources of choline. Lean meats such as chicken and turkey, as well as fish, also provide generous amounts of choline. For families who prefer plant-based options, beans, lentils, and cruciferous vegetables like broccoli and cauliflower offer a valuable, if somewhat smaller, contribution to daily choline needs.

For many expecting and new mothers, however, meeting the recommended choline intake through diet alone can be challenging. The current guidelines suggest a daily intake of 450 mg during pregnancy and 550 mg while breastfeeding. Yet, a growing chorus of experts in nutrition and neuroscience believe these recommendations may be set too low—particularly when it comes to optimizing brain development in children with Down syndrome (Zeisel & da Costa, 2009). Emerging research suggests that higher choline intake (minimum of 930mg) could offer additional neuroprotective benefits, potentially supporting memory, attention, and emotional regulation in developing brains.

Supplements can help bridge the gap when dietary sources fall short. Choline supplements are available in various forms, such as choline bitartrate or phosphatidylcholine (sunflower lecithin being a simple source), each with slightly different properties and absorption profiles. While supplementation is generally considered safe and well-tolerated, especially within the recommended upper intake levels (3500mg), it’s always wise to consult with a healthcare provider before making any changes to your supplement routine. This is especially important during pregnancy and breastfeeding, when nutritional needs are heightened and individualized care is essential.

Conclusion

I’ll be the first to admit that this is a semi-biased post. I was grasping for any way to intervene, when we received the news. I know some of the researchers. In full disclosure, I chose the path of supplementation. I have no clue if it has or will help. I have no way of knowing what my child’s development may have looked like without it. But I do know that adding massive amounts of choline was the best choice that I could make based on my understanding of the science, low risks, and in conjunction with our physician’s oversight. Before making any changes to your diet or adding supplements, always consult your healthcare provider. Every family’s situation is unique, but if you are looking for ways to support your child from the earliest days (even if DS is not suspected), please look into choline further and embrace curiosity….

What has this post made you curious about? Drop a comment below!

Disclaimer:This post is for informational purposes only and is not medical advice. Always consult your healthcare provider before making changes to your or your child’s diet or supplement routine.

References

Alasmari F, Ahmad A, Alsanea S, Hammad AM, Al-Qerem W. Current insights and prospects for the pathogenesis and treatment of clinical manifestations associated with Down syndrome through neurotransmitter, inflammatory, and oxidative stress pathways. Front Pharmacol. 2025 Apr 28;16:1592277. doi: 10.3389/fphar.2025.1592277. PMID: 40356974; PMCID: PMC12066560.

CADTH Health Technology Review. (2024). Choline supplementation for neurodevelopmental outcomes: A review of clinical effectiveness and guidelines.

Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. 2018 Apr;32(4):2172-2180. doi: 10.1096/fj.201700692RR. Epub 2018 Jan 5. PMID: 29217669; PMCID: PMC6988845.

Powers BE, Velazquez R, Strawderman MS, Ginsberg SD, Mufson EJ, Strupp BJ. Maternal Choline Supplementation as a Potential Therapy for Down Syndrome: Assessment of Effects Throughout the Lifespan. Front Aging Neurosci. 2021 Oct 6;13:723046. doi: 10.3389/fnagi.2021.723046. PMID: 34690739; PMCID: PMC8527982.

Strupp BJ, Powers BE, Velazquez R, Ash JA, Kelley CM, Alldred MJ, Strawderman M, Caudill MA, Mufson EJ, Ginsberg SD. Maternal Choline Supplementation: A Potential Prenatal Treatment for Down Syndrome and Alzheimer's Disease. Curr Alzheimer Res. 2016;13(1):97-106. doi: 10.2174/1567205012666150921100311. PMID: 26391046; PMCID: PMC4733524.

Zeisel SH, da Costa KA. Choline: an essential nutrient for public health. Nutr Rev. 2009 Nov;67(11):615-23. doi: 10.1111/j.1753-4887.2009.00246.x. PMID: 19906248; PMCID: PMC2782876.