Prenatal Choline Linked to Better Child Behaviour, Cognition in Colorado Trial
10 November 2026, Aurora, US: Children whose mothers took a high-dose choline supplement during pregnancy were far less likely to show social withdrawal problems, and scored higher on cognitive tests by age four, than children whose mothers took a placebo. The results come from a randomized trial at the University of Colorado Anschutz Medical Campus, published on 19 October 2026 in the American Journal of Obstetrics & Gynecology.
The trial enrolled 206 pregnant women. At 16 weeks of pregnancy they were randomly assigned to take either phosphatidylcholine or a placebo every day until delivery. Phosphatidylcholine is a form of choline, an essential nutrient the body uses to build cell membranes and to make acetylcholine, a chemical messenger in the brain. The supplement group received 9,000 milligrams of phosphatidylcholine daily. Women in both groups were encouraged to take standard prenatal vitamins and to eat a diet that included natural food sources of choline.
The research team then followed the children, assessing their behaviour from 18 months to four years of age and their cognitive performance at ages three and four. The university describes the study as the largest randomized clinical trial of prenatal choline supplementation conducted to date.
Among children whose parents completed the behavioural assessments, 4 percent in the supplement group showed elevated social withdrawal problems, compared with 24 percent in the placebo group. On standardized cognitive tests at age four, which measured skills such as working memory and visual-spatial reasoning, children in the choline group scored nearly eight points higher on average. Fewer children in the supplement group showed behaviour profiles and language difficulties commonly associated with autism spectrum disorder, although the study did not diagnose autism.
Not every outcome improved. Attention problems, one of the trial’s primary measures, were not significantly reduced in the supplement group. The researchers reported no significant safety problems linked to the supplement in either mothers or children.
Limits of the findings
The researchers acknowledge several limitations. About one-third of participants did not complete the full four years of assessments, which can bias results if those who dropped out differed from those who stayed. Parents reported the behavioural symptoms rather than having them assessed independently, and the trial was run at a single US academic medical centre. The researchers say larger studies with longer follow-up are needed. The detailed statistical results, including confidence intervals, are in the journal article; the figures above are the ones the university released.
The senior author is Robert Freedman, a professor of psychiatry at CU Anschutz. Co-authors include Sharon Hunter, Camille Hoffman, Amanda Law, Uwe Christians and Angelo D’Alessandro. The study was funded by the US National Institutes of Health, the Institute for Children’s Mental Health and The Anschutz Foundation. The university’s release does not name any supplement manufacturer as a funder or product supplier.
A nutrient tied to livestock and legumes
The trial lands on a known gap in diets. The US National Institutes of Health Office of Dietary Supplements says roughly 90 to 95 percent of pregnant women in the United States get less choline than the adequate intake of 450 milligrams a day set for pregnancy by the Food and Nutrition Board. The same agency notes that prenatal supplements typically contain little if any choline.
That makes food the main route, and the main sources are animal products. The Office of Dietary Supplements identifies meat, poultry, fish, dairy and eggs as the principal dietary sources of choline in the US, with cruciferous vegetables and certain beans also contributing. In its reference table, a three-ounce serving of pan-fried beef liver provides 356 milligrams, one large hard-boiled egg 147 milligrams and half a cup of roasted soybeans 107 milligrams, which ties the nutrient closely to livestock, poultry and oilseed production.
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