Overview

In this episode, we explore two questions. First, we break down the role of choline in pregnancy, including its benefits for fetal brain development. We review the current evidence and provide practical tips on how to ensure you’re getting enough choline from your diet or supplements. Next, we dive into precipitous labor, when labor progresses rapidly—and discuss what you can do to prepare for a fast labor.

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Transcript and Resources

This week’s questions come from Danielle:

Hi Vanessa! 

First off I want to say thank you! I listened to every episode available at least once when I was pregnant with my first in 2020/2021 and as a first time mom during that time, your podcast was so incredibly helpful! I am now pregnant with my second, and joined premium so I can refresh on everything. 🙂 

I have two questions or requests for episodes: 

First off, I have seen some suggestions that extra choline supplementation during pregnancy may increase childhood attention span, processing speed, and maybe even reduce the risk of autism spectrum disorder. I would love it if you could confirm or debunk this! I took extra choline with my daughter and am again, so I have my own anecdotal assumptions, but I’d love a review of the studies. 

Second, I would love it if you would do an episode on precipitous labor! My first was born in about 3.5 hours from start of active to in arms, and how fast my second may come is a big anxiety source for me. I’d love some more info and data on birth length of subsequent births for those of us with quick labors, and ways to prepare. With my first I felt so prepared for birth – I had my birth plan and back up hospital transfer plan and cesarean plan, I thought I was ready for any outcome. Boy was I wrong! It all happened so fast I was left feeling pretty traumatized, and the knee jerk of people to say “you’re so lucky she came fast” was so hard at the time, especially as a first time mom. This time I’m keeping my fingers crossed that I don’t end up with a car baby, but I would love some info and resources on how to appropriately prepare for another fast and furious labor experience.

Thank you so much again! I really appreciate the time and detail you put into each podcast episode. I recommend it to everyone! 

The Evidence on Choline

Choline is an essential nutrient that is involved in many processes. Choline is required for many steps in metabolism. The body needs choline to preserve the structural integrity of all cell membranes. Choline is needed to produce acetylcholine, which is an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions. Choline also plays important roles in modulating gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development.

There is a lot of evidence supporting the need to ensure that you have adequate choline during pregnancy. We talk a lot about folate or folic acid to prevent neural tube defects; choline also plays a role. Choline is essential for fetal brain development, and evidence suggests that insufficient choline intake could increase the child’s susceptibility to neurodevelopmental disorders. Choline plays a crucial role in maintaining liver health. A deficiency can lead to the development of fatty liver disease, and liver dysfunction could negatively affect you and your developing baby. Some research also shows children exposed to lower choline levels in utero may be at greater risk of experiencing challenges in learning, memory, and overall behavior. You can read more in this in-depth review.

Humans can produce choline endogenously in the liver, but not enough to meet their needs. As a result, they must obtain some choline from their diet or a supplement. The Food and Nutrition Board (FNB) of the Institute of Medicine has set the adequate intake for choline at 450 mg/day for pregnant women. One study found that 95% of pregnant women had suboptimal intakes of choline.

The highest sources of choline are animal products, including meat, poultry, fish, dairy, and eggs. If you eat a primarily plant-based diet, you can also get choline from cruciferous vegetables like broccoli and Brussels sprouts. Soybeans and peanuts contain choline, and you can also get some choline from whole grains like quinoa. You can see a list of foods high in choline here. Choline is also present in breast milk and is added to most commercial infant formulas.

Danielle, I can confirm that choline is a critical nutrient during pregnancy. There is a lot of evidence that you should ensure you get adequate choline from your diet or a supplement. With that being said, it is so easy to go down rabbit holes and start assessing everything you eat or start buying more supplements. Looking into one specific nutrient can open the door to looking into everything else, and it can quickly become overwhelming.

Step one is to ensure you are eating a wide variety of foods, ideally healthy whole foods, and limiting processed foods. Next, it is critical that you are taking a prenatal vitamin. Not all prenatal vitamins will contain choline. My recommendation is the Zahler Prenatal + DHA. This is a very high-quality vitamin, and Zahler goes above and beyond in examining up-to-date research. As a result, their formula does contain choline. There is always a promo code for the Zahler prenatal on this page.

Lastly, you could take an additional supplement or increase the foods in your diet that have high levels of choline. Your diet should be your primary source for nutrients. An easy solution is eating eggs; an egg has about 147 milligrams of choline.

If you are eating a wide variety of foods and taking a prenatal that includes choline, I wouldn’t stress out whether you are getting enough of this nutrient. While you do not want to overdo it, there isn’t a downside to increasing your choline intake, provided it is under the Tolerable Upper Intake Level, which is set at 3,500 milligrams. To quantify that, 3,500 milligrams would be the choline in about 23 eggs. It would be hard to overdo it unless you took high amounts of a choline supplement. Most choline supplements contain around 500mg.

Precipitous Labor

There is an episode of the podcast on precipitous labor that goes into more detail. Let’s cover the key points. Typically, “normal” labor for a first-time mother is between 3 and 30 hours. Less than three hours is considered precipitous, and more than 30 hours is considered prolonged. Some references consider a birth under five hours as precipitous. While many people may think a very short labor is ideal, three and a half hours is not a lot of time for your body to go through everything, and it can definitely be a stressful whirlwind to have a baby that quickly.

There are some risks that come along with a precipitous labor. If you plan to have your baby in the hospital with an epidural, it can be very scary to end up going into labor so quickly that you don’t even make it to the hospital, which also means you wouldn’t have access to pain relief. In the United States and most countries 0.1-3% of births are considered precipitous, so this is not extremely common. Second labors tend to be shorter than first, and if you had a previous precipitous labor, you are more likely to have one again. On the bright side, you can prepare for this scenario.

You should know what the signs of the start of labor are so you can keep an eye out for an indication that your baby is coming. There is a complete episode on Labor Signs and the Start of Labor. Your water breaking or contractions are the obvious signs, but there may be other indicators, like losing your mucus plug or nausea, that you should keep an eye out for.

Most expecting moms don’t head to the hospital as soon as labor starts. In your case, I would consider heading in as soon as your labor starts. Have your hospital bag packed and everything ready to go weeks before your due date. You and your partner should have your doctor’s phone number stored in your phones so you can notify them when you go into labor. Your partner should know the quickest route to the hospital, where to park, and all of the details before you arrive.

This is your second baby, which means that you need a plan in place for someone to care for your child when you go into labor. You may even want to consider a backup or alternative plan, depending on your situation. For example, if your mother-in-law is watching your child but they live an hour away, can a neighbor take your child until your mother-in-law can pick them up?

I am sure that you are discussing your previous pregnancy with your current doctor or midwife. Because of your history of very short labor, they may change how they respond to this labor. Typically, doctors don’t show up the minute you arrive at the hospital; in your case, they should be there fairly quickly. I would ask them the same questions you are asking here. They may have additional advice for how you can best prepare.

Danielle, I completely understand that this is a significant source of anxiety for you, and I don’t blame you one bit for being nervous about another quick birth. The best thing you can do is keep an open conversation with your doctor or midwife about your concerns, and as your due date gets closer, keep communicating and discussing your options.

Thank you to the amazing companies that have supported this episode.

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