A recently published study by Klatt and colleagues examined the impact of choline supplementation alongside DHA supplementation, versus DHA supplementation alone, on DHA status in pregnancy. It is known that DHA is a critical nutrient at this time for healthy development of the child. And through a number of mechanisms discussed later, it has been hypothesized that choline could lead to greater DHA status. We discuss:

• What is the connection between choline and DHA? What is the PEMT pathway?
• Study design for the choline + DHA trial
• Are there risks of high-dose choline?
• Main findings of the trial
• How DHA status is not just a function of DHA intake, but also methyl metabolism too
• Issues with omega-3 trials; e.g. not taking baseline status into account
• Pragmatic recommendations for health professionals and patients
• Different forms of choline supplements
• Choline supplementation vs. food-derived choline

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