A randomized controlled trial depicted that prenatal choline supplementation substantially alters the choline metabolome, thus favoring pregnancy-linked metabolic adaptations and disclosing biomarkers for usage in nutritional evaluation and monitoring during pregnancy. Investigators aimed to determine the influence of supplementation with choline on fetal and maternal biomarkers of choline metabolism in pregnant women.

Free-living pregnant females consuming self-selected diets were randomly segregated to (i) Interventional group: Received supplemental choline (as choline chloride) intakes of 550 mg/d (500 mg/d d0-choline + 50 mg/d methyl-d9-choline), and (ii) Control group: Received 25 mg/d d9-choline from gestational week 12-16 until delivery. The fasting blood and 24-hour urine samples were procured at study visit 1 (gestational week 12-16), visit 2 (gestational week 20-24), and visit 3 (gestational week 28-32).

Collection of placental tissue samples and maternal and cord blood was done at the time of childbirth. At 1 or more timepoints of the trial, raised plasma concentration of free choline, dimethylglycine, sphingomyelin, phosphatidylcholine, and betaine was noted in the interventional group. Notably, betaine was found to be most responsive to prenatal supplementation of choline with elevation in maternal plasma noted at visit 2-delivery (with respect to visit 1 and control), along with in the cord plasma and placenta.

Compared to the control group, the intervention group exhibited greater plasma enrichments of d3- phosphatidylcholine and low-density lipoprotein-cholesterol. This implied an elevated synthesis of phosphatidylcholine through lipid export and de novo phosphatidylethanolamine N-methyltransferase pathway.