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The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: a systematic review and meta-analysis
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OBJECTIVES: This systematic review and meta-analysis provides a quantitative summary of the literature exploring the relationship between maternal diet quality during pregnancy and child cognitive and affective outcomes. We investigate whether there are indications for robust associations and aim to identify methodological strengths and challenges of the current research to provide suggestions of improvement for future research. DESIGN AND PARTICIPANTS: Relevant studies were identified through a systematic literature search in relevant databases. All studies investigating maternal diet quality during pregnancy in relation to child cognitive or affective functioning in children of elementary school age or younger were assessed for inclusion. RESULTS: 18 relevant studies, comprising 63 861 participants were identified. The results indicated a small positive association between better maternal diet quality during pregnancy and child functioning. We observed publication bias and significant heterogeneity between studies, where type of diet classification, publication year and outcome domain together accounted for about 30% of this heterogeneity. Trim and fill analysis substantiated the presence of publication bias for studies in the affective domain and showed an adjusted effect size of Hedge's g=0.088 (p=0.0018) (unadjusted g=0.093 (p=0.03)). We observed no publication bias in the cognitive domain, where results indicated a slightly larger effect size (g=0.14 (p<0.0001)) compared with that of the affective domain. The overall summary effect size was g=0.075 (p<0.0001) adjusted for publication bias (unadjusted g=0.112 (p=0.0001)). Child diet was not systematically controlled for in the majority of the studies. CONCLUSION: The results indicated that a better maternal diet quality during pregnancy has a small positive association with child neurodevelopment, with more reliable results seen for cognitive development. These results warrant further research on the association between maternal diet quality during pregnancy and cognitive and affective aspects of child neurodevelopment, whereby it is crucial that future studies account for child diet in the analysis.
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“and human observational studies also link maternal diet during pregnancy to child emotional and cognitive outcomes (243).”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [243]
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BackgroundVejrup, K., Hillesund, E. R., Agnihotri, N., Helle, C., & Øverby, N. C. (2023) · Nutrients · doi:10.3390/nu15010243 · Cited by 15
“There is a lack of studies with long term follow up, such as up to school age [3,12].”
BackgroundKyozuka, H., Murata, T., Fukuda, T., Yamaguchi, A., Kanno, A., Yasuda, S., Suzuki, D., Takahashi, T., Go, H., Maeda, H., et al. (2022) · Nutrition · doi:10.1016/j.nut.2022.111708 · Cited by 14
Paula, W. O., Gonçalves, V. S. S., Patriota, É. S. O., Franceschini, S. D. C. C., & Pizato, N. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021015 · Cited by 18
Che, X., Gross, S. M., Wang, G., Hong, X., Pearson, C., Bartell, T. R., & Wang, X. (2023) · PubMed Central · doi:10.1097/pn9.0000000000000047 · Cited by 13
“intake, or dietary fiber were used as proxies) during pregnancy had a small association with child neurodevelopment.[44]”
MethodKornatowski, B. M., & Comstock, S. S. (2018) · PeerJ · doi:10.7717/peerj.5526 · Cited by 18
“, 2016) and a meta-analysis concluded maternal diet quality during pregnancy is positively associated with child neurodevelopment and cognitive development (Borge et al., 2017).”
BackgroundAlick, C. L., Maguire, R. L., Murphy, S. K., Fuemmeler, B. F., Hoyo, C., & House, J. S. (2021) · Nutrients · doi:10.3390/nu13093180 · Cited by 12
“An in-depth review and meta-analysis provides evidence for associations between better maternal diet quality and offspring neuro- and cognitive development [5].”
BackgroundFernando, K. K., Craig, J. M., & Dawson, S. L. (2023) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174423000211 · Cited by 12
Gestational weight gain and offspring’s cognitive skills: a systematic review and meta-analysis
Martínez‐Hortelano, J. A., Álvarez‐Bueno, C., Cavero‐Redondo, I., Herráiz-Adillo, Á., Berlanga‐Macías, C., & Martínez‐Vizcaíno, V. (2020) · BMC Pediatrics · doi:10.1186/s12887-020-02429-7 · Cited by 12
Mou, Y., Jansen, P. W., Sun, H. J., White, T. J. H., & Voortman, T. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.08.018 · Cited by 16
“…studies suggested that a better diet quality during pregnancy has a small positive association with neurodevelopment in early childhood [10], with more consistent fi ndings within cognitive domains [11 – 18], although the majority of the studies used fi sh intake as a marker for diet…”
Rimawi, I., Ornoy, A., & Yanai, J. (2021) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2021.05.026 · Cited by 11
Solberg, B. S., Kvalvik, L. G., Instanes, J. T., Hartman, C. A., Klungsøyr, K., Li, L., Larsson, H., Magnus, P. M., Njølstad, P. R., Johansson, S., et al. (2023) · Biological Psychiatry · doi:10.1016/j.biopsych.2023.12.017 · Cited by 11
Diet quality indexes for use during pregnancy: a scoping review
Robb, L., Joubert, G., & Walsh, C. M. (2023) · Nutrition Reviews · doi:10.1093/nutrit/nuad138 · Cited by 11
Lamsal, R., Yeh, E. A., Pullenayegum, E., & Ungar, W. J. (2024) · PharmacoEconomics · doi:10.1007/s40273-024-01397-5 · Cited by 12
Vejrup, K., Brantsæter, A. L., Meltzer, H. M., Mohebbi, M., Knutsen, H. K., Alexander, J., Haugen, M. A., & Jacka, F. N. (2022) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2021-000412 · Cited by 10
“16 The meta-analysis by Borge et al , 16 which included data from a large pregnancy cohort in Norway, found relatively small effect sizes and indicated a slightly larger effect size for the cognitive than for the affective domain.”
Myers, A. M., Bowen, S. E., & Brummelte, S. (2023) · Developmental Psychobiology · doi:10.1002/dev.22433 · Cited by 10
Bliznashka, L., Nwabuikwu, O., Ahun, M. N., Becker, K., Nnensa, T., Roschnik, N., Kachinjika, M., Mvula, P., Munthali, A., Ndolo, V., et al. (2024) · Maternal and Child Nutrition · doi:10.1111/mcn.13698 · Cited by 8
Nutrition in Early Life and Its Impact Through the Life Course
Ren, H., Zhou, Y., & Liu, J. (2025) · Nutrients · doi:10.3390/nu17040632 · Cited by 9
“A better diet quality during pregnancy and lactation is associated with greater white matter development in the offspring’s brain [25], higher intelligence, and better executive functioning skills in childhood [26,27].”
Pull, K., Folk, R. W., Kang, J., Jackson, S., Gusek, B., Esfandiarei, M., & Jadavji, N. M. (2023) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00502.2023 · Cited by 9
van Rooij, D., Mou, Y., White, T. J. H., Voortman, T., Jansen, P. W., & Buitelaar, J. K. (2025) · Nutrients · doi:10.3390/nu17182979 · Cited by 8
Rajagopalan, K., Alexander, M., Naik, S., Patil, N. U., Mehta, S., Leu, C., Bhosale, R. A., Mathad, J. S., Caulfield, L. E., Gupta, A., et al. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520005188 · Cited by 8
“In addition to birth outcomes and fetal growth, diet quality during pregnancy also influences fetal neurodevelopment and cognitive development in children(10).”
BackgroundPannu, P. K., Scherini, A. J. J., Silva, D. T., & Whalan, S. (2024) · Nutrients · doi:10.3390/nu16152571 · Cited by 7
“Conversely, a healthier diet during pregnancy may promote more favourable cognitive development in the child, including age-appropriate language abilities, reading and writing skills, and fewer affective problems in the child [17,20].”
BackgroundCaro, C. V., Trow, S., Bell, Z., Flynn, A. C., & Lavelle, F. (2025) · Sports Medicine · doi:10.1007/s40279-025-02191-9 · Cited by 7
“Pregnancy is associated with significant physical, mental, and emotional health changes [7–9].”
Midwives’ perspectives on women's dietary intake during pregnancy: A systems thinking approach
O’Halloran, S., Sunder, P., Cusworth, R., Hutchinson, A. M., Alston, L. V., Vasilevski, V., Sweet, L. P., Olive, E. C., Sominsky, L., Vuillermin, P., et al. (2025) · Midwifery · doi:10.1016/j.midw.2025.104396 · Cited by 7
The Application of Salutogenesis in Birth, Neonatal, and Infant Care Settings
Downe, S. M., Magistretti, C. M., Shorey, S., & Lindström, B. (2022) · Springer eBooks · doi:10.1007/978-3-030-79515-3_43 · Cited by 8
Huang, X., Sun, W., Wang, R., Wu, H., Yu, S., Fang, X., Liu, Y., Akinwunmi, B. O., Huang, J. V., & Ming, W. (2022) · Journal of Medical Internet Research · doi:10.2196/28637 · Cited by 7
“Besides, better quality of maternal diet during pregnancy is positively associated with general maternal health, reproductive outcomes, and child neurodevelopment [24,30].”
BackgroundWaselewski, M. E., Plegue, M. A., Sonneville, K. R., Resnicow, K., Ghumman, A., Ebbeling, C. B., Mahmoudi, E., Sen, A., Wolfson, J. A., & Chang, T. (2022) · JMIR Research Protocols · doi:10.2196/40568 · Cited by 7
“A healthy diet during pregnancy promotes healthy weight gain among mothers [22] and impacts permanent fetal epigenetic programming that determines future risk for chronic disease among infants [23,24].”
Polanek, E., Karai, A., Molnár, R., Németh, G., Orvos, H., Balogh, P., & Paulik, E. (2022) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15364 · Cited by 7
“mellitus can also be correlated with maternal eating patterns.(13,14) Dietary supplementation may be considered in order to achieve higher micronutrient intake levels during pregnancy.”
BackgroundNutrition and Dietary Patterns: Effects on Brain Function
Granero, R., & Guillazo‐Blanch, G. (2025) · Nutrients · doi:10.3390/nu17071169 · Cited by 6
Faa, G., Ziranu, P., Pretta, A., Cau, R., Coghe, F., Cau, F., Fraschini, M., Castagnola, M., Saba, L., & Scartozzi, M. (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70224 · Cited by 7
Sketch of a Dynamic Common Pathways, Epigenetic Theory of Psychopathology with Hypotheses
Nigg, J. T. (2026) · Studies in systems, decision and control · doi:10.1007/978-3-032-17029-3_3 · Cited by 6
Diet and Depression: From Epidemiology to Novel Therapeutics
Marx, W., Hoare, E., & Jacka, F. N. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813333-0.00025-1 · Cited by 6
Ni, Y., Szpiro, A. A., Loftus, C. T., Tylavsky, F. A., Kratz, M., Bush, N. R., LeWinn, K. Z., Sathyanarayana, S., Enquobahrie, D. A., Davis, R. L., et al. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa395 · Cited by 6
Lai, J. S., Colega, M., Godfrey, K. M., Tan, K. H., Yap, F. K. P., Chong, Y. S., Lee, Y. S., Eriksson, J. G., Chan, S., & Chong, M. F. (2023) · Nutrients · doi:10.3390/nu15081870 · Cited by 8
“There is evidence that adopting a healthy diet during pregnancy is associated with better pregnancy outcomes such as lower risks of gestational diabetes [1] and preterm birth [2], as well as better offspring metabolic and cognitive health [3,4].”
BackgroundLong-Term Vitamin K Antagonists and Cancer Risk
Shurrab, M., Quinn, K. L., Kitchlu, A., Jackevicius, C. A., & Ko, D. T. (2019) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000000571 · Cited by 6
Evidence review: The primary prevention of mental health conditions
VicHealth (2020) · doi:10.37309/2020.po906 · Cited by 6
Metadata
- Authors
- Borge, T. C., Aase, H., Brantsæter, A. L., & Biele, G.
- Affiliations
- Norwegian Institute of Public Health (NO)
- Corresponding author
- Borge, Tiril Cecilie
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-09
- Volume
- 7
- Issue
- 9
- Pages
- e016777
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5623570
- OpenAlex
- W2758182105
- Cited by
- 186
- References
- 85
- Citations by year
- 2026: 7 · 2025: 24 · 2024: 22 · 2023: 24 · 2022: 30 · 2021: 30 · 2020: 22 · 2019: 17 · 2018: 10
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- NevSom; National Centre for Neurodevelopmental Disorders and Hypersomnia - ADHD, Autism, Tourette’s syndrome and Hypersomnia
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- maternal diet quality, pregnancy, child cognitive development, child neurodevelopment, maternal nutrition, publication bias, children's diet, diet classification
- MeSH terms
- Affect, Child, Child Development, Cognition, Diet, Female, Humans, Pregnancy, Pregnancy Outcome, Publication Bias, Food Quality
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