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PEMT and Choline: What Your Genotype Means for Pregnancy and Fertility

Pregnancy increases nutrient needs because the body supports growth and development of the fetus. Choline is a key nutrient for cell membranes, neurotransmitter synthesis, liver health, and methylation reactions that guide fetal brain and neural tube development. The PEMT gene helps the liver make choline. Variants in PEMT can reduce this capacity, increasing dependence on dietary choline. Below we explain how common PEMT genotypes affect choline needs, practical dietary and lifestyle actions, and tests and supplements to consider while emphasizing that PlexusDx provides education about genetic predispositions only and does not provide medical advice. Always consult your healthcare provider before making changes to your diet, supplements, or medical care.

Why choline matters in pregnancy and fertility

  • Supports formation of cell membranes and the neurotransmitter acetylcholine.
  • Plays a role in liver fat metabolism; low choline can contribute to fatty liver.
  • Supplies methyl groups needed for DNA methylation during fetal development, affecting brain and neural tube formation.
  • Needs rise during pregnancy and breastfeeding to support fetal growth and milk production.

General targets and nutrient partners

Recommended choline intake for pregnancy is commonly set around 450 mg daily, but many experts suggest aiming for 550 mg daily during pregnancy to ensure adequate supply for mother and fetus. Choline works closely with folate, vitamin B12, vitamin B6, betaine, and omega-3 DHA. Adequate status of these nutrients supports methylation and neurodevelopment.

Genetic interpretations

2 effect alleles (GG) — Reduced PEMT capacity

Your GG genotype significantly reduces your ability to synthesize choline via PEMT. This increases reliance on dietary choline, especially during pregnancy and lactation. If choline intake is low you are at higher risk for fatty liver and for reduced circulating choline and betaine levels in pregnancy, which can impair methylation processes important for fetal brain and neural tube development.

  • Target choline: aim for at least 550 mg/day during pregnancy; consider similar targets while breastfeeding.
  • Prioritize choline-rich foods: eggs, beef and chicken liver, fish, soybeans and tofu, and milk products.
  • Consider a choline supplement if dietary intake is inadequate; common supplemental forms include choline bitartrate, phosphatidylcholine (lecithin), and CDP-choline. Discuss options and doses with your provider.
  • Include omega-3 DHA and ensure adequate folate, vitamin B12, and B6 to support methylation and fetal neurodevelopment.
  • Limit alcohol intake, which increases choline demand and can worsen liver health.
  • Monitor liver function and consider measuring plasma choline or related biomarkers during pregnancy if recommended by your clinician.
1 effect allele (CG) — Intermediate PEMT capacity

Your CG genotype indicates reduced PEMT-mediated choline synthesis compared with those without the effect allele. You may have increased dietary choline needs during pregnancy and lactation. If intake is insufficient you have higher risk for lowered circulating choline and betaine and potential liver fat accumulation.

  • Target choline: aim for about 550 mg/day during pregnancy.
  • Food-first approach: include eggs, liver (in moderation), oily fish, soy foods, and dairy regularly.
  • Supportive nutrients: confirm adequate folate, vitamin B12, B6, and DHA intake through diet or prenatal supplement.
  • Discuss choline supplementation with your healthcare provider if you cannot reach targets via food.
  • Limit alcohol and avoid crash diets; maintain a balanced calorie and protein intake to reduce fatty liver risk.
  • Consider baseline labs if clinically indicated: liver function tests and nutrient status testing.
0 effect alleles (CC) — Typical PEMT capacity

Your CC genotype is associated with typical PEMT function and a normal capacity to synthesize some choline in the liver. Even so, pregnancy and lactation increase choline needs and dietary intake remains important to support fetal development and maternal health.

  • Target choline: aim for around 550 mg/day during pregnancy.
  • Eat choline-rich foods regularly: eggs, liver, fish, soybeans, and milk products.
  • Ensure sufficient folate, vitamin B12, B6, and DHA to support methylation and brain development.
  • Use prenatal vitamins as recommended by your provider; many prenatal formulas do not contain enough choline so check labels.
  • Maintain liver-friendly lifestyle habits: limit alcohol, avoid unnecessary medications, and follow a balanced diet.

Practical food examples and portion ideas

  • One large egg: about 125 to 150 mg choline
  • 3 ounces cooked beef liver: 300 to 400+ mg choline
  • 3 ounces cooked salmon: 60 to 80 mg choline
  • 1 cup cooked soybeans: roughly 120 to 150 mg choline
  • 1 cup milk: about 40 mg choline

Combining these foods across the day can help reach a 550 mg target. For example, a breakfast with two eggs plus milk, a lunch with soy or fish, and occasional liver servings can meet needs without supplements for many people.

Supplements to discuss with your healthcare provider

  • Choline supplements: choline bitartrate, phosphatidylcholine, or CDP-choline. Dose and form should be individualized.
  • DHA: 200 to 300 mg/day or as recommended in prenatal guidance to support fetal brain development.
  • Standard prenatal vitamin: ensures folate, B12, iron, and other essentials. Verify choline content as many prenatals contain little or none.

Lifestyle and monitoring recommendations

  • Limit alcohol before and during pregnancy; alcohol increases choline requirements and harms fetal development.
  • Maintain a balanced diet with adequate protein and healthy fats to support liver function and nutrient absorption.
  • Avoid restrictive dieting during pregnancy; steady, appropriate weight gain supports nutrient delivery to the fetus.
  • Routine prenatal visits: discuss your PEMT genotype with your care team so they can tailor testing or supplement advice.
  • Consider blood tests if recommended: liver function tests, serum folate, vitamin B12, and, if available, plasma choline or betaine measurements.

Final notes and next steps

If your results show one or two PEMT effect alleles, prioritize dietary choline and the nutrient partners folate, B12, B6, and DHA during preconception, pregnancy, and breastfeeding. Work with your healthcare provider to determine whether a choline supplement is appropriate and to choose dose and form. Even with the CC genotype, pregnancy increases choline needs so review dietary patterns and prenatal supplements with your clinician.

PlexusDx provides education about genetic predispositions only and does not provide medical advice. Always consult your healthcare provider before starting supplements, changing your diet, or making medical decisions based on genetic information.