Introduction

Childhood cognitive development is a dynamic process that begins in utero and continues throughout early life. Neurodevelopmental disorders affect roughly 17% of children ages 3–17 years, contributing to long-term challenges in learning, behavior, and social functioning. (CDC 2025)

Nutrition is one of many determinants of early cognitive development. (Cohen Kadosh 2021) Despite choline’s importance in brain development and neurological function, average pregnancy intakes reach only about 70% of the established adequate intake (AI) level. (Bahnfleth 2022) This is particularly concerning given that evidence suggests prenatal maternal intakes as high as 930 mg per day—more than twice the AI—are associated with improved infant cognitive function. (Caudill 2018) These findings underscore the importance of nutritional strategies that go beyond minimum recommendations to better support maternal and early-life neurodevelopment.

This protocol provides clinicians with an evidence-based framework, grounded in the Council for Responsible Nutrition’s (CRN’s) Supplements to Savings report, to support childhood cognitive development.

Ingredients

Choline

Dosing: 900 mg, total per day, during pregnancy and lactation. (Ross 2016)(Caudill 2018)(Bahnfleth 2022) Continued infant supplementation throughout the first two years of life continues to support optimal neurodevelopment. The pediatric AIs for choline established by the Institute of Medicine are as follows: 

• Infants aged 0–6 months: 125 mg per day
• Infants aged 7–12 months: 150 mg per day
• Infants aged 1–2 years: 200 mg per day (Bragg 2021)

Supporting evidence:

• Prenatal choline supplements (550 mg per day) significantly improved choline metabolism and plasma concentrations of choline and its metabolites, particularly betaine, in the placenta and umbilical cord. (Taesuwan 2021)
• A systematic review of eight animal and 16 human studies concluded that a substantial pool of evidence favors choline’s role in child neurodevelopment. The evidence suggests that supplementing the mother’s or child’s diet with choline over the first 1,000 days (two years) of life supports normal brain development, helps protect against neurological damage (e.g., fetal alcohol syndrome), and improves neural and cognitive functioning through adulthood. (Derbyshire 2020)
• Results from a randomized, double-blind, controlled feeding trial suggest that maternal choline intake at approximately twice the recommended amount during late pregnancy improves early cognitive processing in offspring. Healthy pregnant women in their third trimester (n=26) took 930 or 480 mg of choline daily until delivery. Infants of mothers receiving 930 mg of choline per day during the third trimester had faster reaction times (at four, seven, ten, and 13 months of age) compared to those whose mothers consumed 480 mg per day. Infants of mothers in the 480 mg group showed faster reaction times with prolonged exposure, indicating that even modest increases in maternal choline during pregnancy may enhance cognitive outcomes. (Caudill 2018)
• In a follow-up to Caudill et al., 20 children were assessed at age seven for sustained attention using a signal detection task. Those whose mothers consumed 930 mg per day of choline during the third trimester demonstrated superior sustained attention compared to the 480 mg per day group, reflected in higher Sustained Attention Task (SAT) scores and more stable performance over 12 minutes. For very brief signals (17 ms), the lower-dose group’s performance declined by 22.9%, while the higher-dose group improved slightly by 1.5%. No differences were observed for longer signals, errors, or off-task behavior, suggesting the advantage stemmed from enhanced perceptual processing rather than behavioral factors. (Bahnfleth 2022)
• Increased maternal choline intake may enhance fetal cerebral inhibition and reduce early childhood behavioral problems linked to later neuropsychiatric illness. In a randomized, double-blind, placebo-controlled trial, maternal phosphatidylcholine supplementation (providing ~900 mg of choline per day) beginning at or before 16 weeks of gestation and continuing through delivery, followed by infant supplementation (600 mg per day) until 52 weeks after the mother’s last menstrual period, was associated with fewer attention problems and less social withdrawal at 40 months. These behavioral improvements were linked to earlier measures of improved brain inhibition in infancy and influenced by the child’s CHRNA7 genotype, a gene associated with increased risk for schizophrenia, ASD, and ADHD. (Ross 2016)
• This prospective cohort study enrolled 154 healthy pregnant women and followed their full-term, singleton infants. Maternal blood samples were collected at 16 and 36 weeks of gestation to measure plasma concentrations of choline, betaine, and related metabolites. Infant neurodevelopment was assessed at 18 months of age using the Bayley Scales of Infant Development-III. Higher maternal plasma free choline and betaine concentrations at 16 weeks of gestation were significantly associated with higher cognitive scores in infants at 18 months. The study also noted that the average maternal choline intake was below the recommended dietary intake for pregnancy. (Wu 2012)
• In another prospective study with 808 mother-infant pairs, higher choline intake during the second trimester of pregnancy was associated with better visual memory scores in children at seven years old. Children of mothers in the highest choline intake group (364–806 mg per day) scored 1.4 points higher on visual memory tests than those in the lowest group (141–288 mg per day). Choline intake in the first trimester showed a similar but weaker trend. (Boeke 2013)

Choline in the Fullscript catalog