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

Abstract Background The impact of maternal diet during pregnancy on child neurodevelopment is of public health and clinical relevance. We evaluated associations of 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 symptoms at 7-10 years of age. Methods Individual participant data for 11,870 mother-child pairs from four European cohorts participating in ALPHABET project were analyzed. Maternal antenatal DASH and E-DII scores were generated from self-completed food frequency questionnaires. Symptoms of depression and anxiety, aggressive behavior, and Attention-Deficit/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 were determined by multivariable logistic regression models and aggregated by the two-level individual participant data meta-analysis method. Results Higher maternal DASH scores (indicating better dietary quality) were associated with lower risk of depressive and anxiety symptoms, aggressive behavior symptoms and ADHD symptoms within the borderline/clinical ranges (OR (95%CI): 0.97 (0.95, 0.99), 0.97 (0.94, 0.99), 0.97 (0.95, 0.98) per one-unit DASH score increase, respectively). 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 symptoms (OR (95%CI): 1.07 (1.03, 1.11), 1.07 (1.02, 1.13), 1.07 (1.01, 1.13) for depression and anxiety, aggressive behavior, and ADHD symptoms, respectively). Conclusions Our findings suggest that maternal low-quality and pro-inflammatory diet may increase risk of emotional and behavioral symptoms in children.