Maternal diet quality during pregnancy and child cognition and behavior in a US cohort

Am J Clin Nutr. 2022 Jan 11;115(1):128-141. doi: 10.1093/ajcn/nqab325.


Background: Maternal intake of several nutrients during pregnancy is linked to offspring cognition. The relation between maternal dietary patterns and offspring cognition is less established.

Objectives: We aimed to examine associations of maternal diet quality during pregnancy with child cognition and behavior.

Methods: Among 1580 mother-child pairs in Project Viva, a prospective prebirth cohort, we assessed maternal diet during pregnancy using FFQs and evaluated diet quality using versions modified for pregnancy of the Mediterranean Diet Score (MDS-P) and Alternate Healthy Eating Index (AHEI-P). Child cognitive and behavioral outcomes were assessed using standardized tests and questionnaires at infancy and in early and mid-childhood. We conducted multivariable linear regression analyses.

Results: Mothers were predominantly white, college-educated, and nonsmokers. After adjustment for child age and sex and maternal sociodemographic and lifestyle characteristics, maternal high (6-9) compared with low (0-3) MDS-P during pregnancy was associated with higher child Kaufman Brief Intelligence Test (KBIT-II) nonverbal (mean difference for first trimester: 4.54; 95% CI: 1.53, 7.56) and verbal scores (3.78; 95% CI: 1.37, 6.19) and lower Behavioral Rating Inventory of Executive Function (BRIEF) Metacognition Index (-1.76; 95% CI: -3.25, -0.27), indicating better intelligence and fewer metacognition problems in mid-childhood. Maternal Q4 compared with Q1 AHEI-P during pregnancy was associated with higher Wide Range Assessment of Visual Motor Abilities matching scores in early childhood (mean difference for first trimester: 2.79; 95% CI: 0.55, 5.04) and higher KBIT-II verbal scores (2.59; 95% CI: 0.13, 5.04) and lower BRIEF Global Executive Composite scores in mid-childhood (-1.61; 95% CI: -3.20, -0.01), indicating better visual spatial skills, verbal intelligence, and executive function.

Conclusions: Maternal intake of a better-quality diet during pregnancy was associated with better visual spatial skills in the offspring at early childhood and with better intelligence and executive function in the offspring at mid-childhood.

Keywords: Alternate Healthy Eating Index; Mediterranean diet; birth cohort; childhood cognition; cognitive development; early development; early-life nutrition; maternal diet during pregnancy; prenatal nutrition; programming.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Child
  • Child Behavior
  • Child Development
  • Child, Preschool
  • Cognition
  • Diet Surveys
  • Diet, Healthy / statistics & numerical data*
  • Executive Function
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intelligence
  • Linear Models
  • Male
  • Maternal Nutritional Physiological Phenomena*
  • Mothers / statistics & numerical data*
  • Neuropsychological Tests
  • Pregnancy
  • Prenatal Exposure Delayed Effects / psychology*
  • Prospective Studies
  • United States