During pregnancy, two nutrients called folate and choline play crucial roles in helping a baby’s brain and nervous system develop properly. This research review looks at what doctors recommend for pregnant women and those planning to get pregnant. Scientists found that taking folate supplements can prevent serious birth defects, while choline supports brain development. The study explains the difference between regular folic acid and newer forms called active folates, which work better for some women. The findings suggest that getting enough of both nutrients before and during pregnancy is important for giving babies the best start in life.

The Quick Take

  • What they studied: What nutrients pregnant women need to take and how much, specifically looking at folate and choline and their effects on baby’s brain development
  • Who participated: This wasn’t a study with participants—instead, researchers reviewed existing studies and guidelines from major medical organizations around the world to summarize what we know
  • Key finding: Folate supplements (0.4-0.8 mg daily) are proven to prevent serious birth defects of the brain and spine, and choline helps with brain development. Some women benefit from a special type of folate called 5-MTHF instead of regular folic acid
  • What it means for you: If you’re pregnant or planning to get pregnant, talk to your doctor about taking folate supplements. If you have a genetic variation (MTHFR mutation), you may need a different type of folate. Getting enough choline through food or supplements may also help your baby’s brain development, though more research is needed

The Research Details

This is a review article, which means researchers didn’t conduct their own experiment. Instead, they carefully read and summarized hundreds of scientific studies and official guidelines from major medical organizations in Poland, Europe, and the United States. They looked at different types of research, including large studies that tested folate and choline on many people, smaller studies that followed pregnant women over time, and clinical trials where some women received supplements while others didn’t. By combining all this information, the researchers created a comprehensive guide about what doctors should recommend to their pregnant patients.

Review articles like this are important because they help doctors stay up-to-date with the latest science. Instead of reading hundreds of individual studies, doctors can read one clear summary that explains what we know and what we still need to learn. This helps ensure that pregnant women everywhere get consistent, evidence-based advice about supplements

This review was published in a respected medical journal and includes information from the most trusted health organizations in the world. However, because it’s a review rather than a new study, the strength of the findings depends on the quality of the studies it reviewed. The authors note that more research is still needed, especially about the best amount of choline to take and its long-term effects on children’s thinking and learning

What the Results Show

Folate supplementation is recommended for all women who might become pregnant or are already pregnant. The standard dose is 0.4 to 0.8 milligrams per day, and this amount has been proven to reduce the risk of serious birth defects called neural tube defects (which affect the brain and spine) by about 50-70%. This is one of the most important discoveries in pregnancy medicine because these defects can be largely prevented with a simple, inexpensive supplement.

The research also found that not all folate supplements work the same way for everyone. Regular folic acid (the synthetic form) works well for most women. However, some women have a genetic variation called an MTHFR mutation that makes it harder for their bodies to convert folic acid into the active form their cells can use. For these women, taking a special type of folate called 5-MTHF (methyltetrahydrofolate) may work better.

Choline, another important nutrient, supports the development of the baby’s brain and may help with memory and learning abilities later in childhood. The European health authorities recommend 400-480 mg of choline daily for pregnant women, though other medical organizations suggest getting it mainly from food sources like eggs, fish, and beans. Unlike folate, choline recommendations are less consistent across different countries.

The review found that starting folate supplementation before pregnancy (during the preconception period) is just as important as taking it during pregnancy. This is because the baby’s brain and nervous system start developing very early, sometimes before a woman even knows she’s pregnant. The research also suggests that adequate choline intake may have long-lasting benefits for children’s brain function, though scientists need more studies to confirm the best amounts and long-term effects

This research confirms what doctors have known for decades: folate prevents birth defects. However, it adds new information about active folates like 5-MTHF being better for certain women, and it highlights choline as an equally important nutrient that hasn’t always received as much attention. The review brings together recommendations from different countries and shows that while folate guidelines are fairly consistent worldwide, choline recommendations still vary, suggesting this is an area where science is still evolving

This is a review of other studies, not a new experiment, so its findings are only as strong as the studies it reviewed. The authors note that more research is needed to determine the best amount of choline for pregnant women and to understand how these nutrients affect children’s brain development over many years. Additionally, most of the research has been done in developed countries, so the findings may not apply equally to all populations worldwide. The review also doesn’t address how individual factors like diet, genetics, or other health conditions might change what each woman needs

The Bottom Line

All women who could become pregnant should take a folate supplement of 0.4-0.8 mg daily, starting before pregnancy if possible and continuing throughout pregnancy (HIGH CONFIDENCE). Women with MTHFR mutations or those who don’t respond well to regular folic acid should ask their doctor about 5-MTHF supplements (MODERATE CONFIDENCE). Pregnant women should aim for adequate choline intake through food sources like eggs, fish, chicken, and beans, with supplementation considered if dietary intake is low (MODERATE CONFIDENCE). These recommendations should be discussed with your healthcare provider, as individual needs may vary

These findings are most important for women who are pregnant, planning to become pregnant, or could become pregnant. Women with a family history of birth defects, those with MTHFR mutations, and women with certain genetic conditions should especially discuss these nutrients with their doctors. Men don’t need to take these supplements, though getting adequate folate and choline in their diet is still healthy. Women who have already had children with neural tube defects should definitely talk to their doctor about higher doses of folate before their next pregnancy

Folate’s protective effect against birth defects happens during the first few weeks of pregnancy, which is why starting supplementation before pregnancy is so important. The benefits of adequate choline for brain development happen throughout pregnancy and may continue affecting brain function throughout childhood, but these long-term effects take years to measure and observe

Want to Apply This Research?

  • Track daily folate and choline intake by logging supplements taken and major food sources (eggs, fish, beans, chicken). Set a daily reminder to take your folate supplement at the same time each day and log it in the app
  • Set up a daily supplement reminder for your folate vitamin. Add choline-rich foods to your meal planning: aim for 2-3 servings per week of eggs, fish, or chicken. Use the app to track which foods you’re eating and whether you’re meeting choline goals through diet
  • Weekly check-in: review whether you took your folate supplement every day. Monthly review: assess your choline intake from food sources and determine if you need supplementation. Share your tracking data with your healthcare provider at prenatal appointments to ensure you’re meeting nutritional goals

This article summarizes medical research but is not a substitute for professional medical advice. Folate and choline supplementation during pregnancy should be discussed with and recommended by your healthcare provider, as individual needs vary based on genetics, diet, health history, and other factors. Women with specific health conditions, those taking certain medications, or those with a history of birth defects should receive personalized guidance from their doctor. This information is current as of the publication date but medical recommendations may change as new research emerges. Always consult your obstetrician, midwife, or primary care doctor before starting, stopping, or changing any supplements during pregnancy or when planning to become pregnant.