Dietary quality and dietary inflammatory potential during pregnancy and offspring emotional and behavioral problems in childhood: an individual participant data meta-analysis of four European cohorts

Abstract

Background/Aim: The impact of maternal diet during pregnancy on child neurodevelopment is of scientific interest and public health and clinical relevance. We evaluated associations of maternal dietary quality (based on Dietary Approaches to Stop Hypertension (DASH) score) and dietary inflammatory potential (based on energy-adjusted Dietary Inflammatory Index (E-DII) score) during pregnancy with offspring emotional and behavioral problems at 7-10 years of age. Methods: Individual participant data for 11,870 mother-child pairs from four European cohorts, participating in the ALPHABET consortium, were analyzed. Maternal antenatal DASH and E-DII scores were generated from self-completed food frequency questionnaires (FFQ). Symptoms of depression and anxiety, aggression and attention deficit and hyperactivity disorder (ADHD) in children were assessed using mother reported tests and classified within the normal or borderline/clinical ranges using validated cut-offs. Adjusted odds ratios (OR) were determined by multivariable logistic regression models and aggregated by the two-stage individual participant data meta-analysis method. Results: After adjustment for sociodemographic and lifestyle factors, higher maternal DASH scores (indicating better dietary quality) were associated with lower risk of depressive and anxiety symptoms (OR (95% CI) per 1 unit DASH score increase: 0.97 (0.95, 0.99)), aggressive symptoms (0.97 (0.95, 0.99)) and ADHD symptoms (0.97 (0.95, 0.98)) within the borderline/clinical ranges. A one-unit increase in E-DII scores (more pro-inflammatory diet) was associated with a 7% increased risk of all three analyzed emotional and behavioral problems (OR (95% CI): 1.07 (1.03, 1.11), 1.07 (1.02, 1.13) and (1.07 (1.00, 1.13) for symptoms of depression and anxiety, aggression and ADHD, respectively). Conclusions: Overall higher dietary quality during pregnancy is associated with lower risk of offspring emotional and behavioral problems during childhood, while higher dietary inflammatory potential with higher risk of that problems. Educational programs and interventions focused on healthy diet recommendations during pregnancy may improve offspring neurodevelopmental outcomes.