Journal Article

Maternal Dietary Pattern in Pregnancy and Behavioral Outcomes at 4 Years of Age in the Piccolipiù Cohort: Potential Sex-Related Differences

Nisticò, Lorenza, Culasso, Martina, Lastrucci, Vieri, Gagliardi, Luigi, Pizzi, Costanza, Brescianini, Sonia, Leccese, Letizia

2025

Overview

Background: The fetal period is critical for neurodevelopment, with maternal diet emerging as a key environmental factor influencing long-term child health. This study investigated the associations between maternal dietary patterns during pregnancy and neurocognitive and behavioral outcomes in 4-year-old children, with a particular focus on sex-related differences. Methods: We used data from the Piccolipiù Italian birth cohort, including 2006 mother/child pairs. Maternal dietary intake during pregnancy was assessed via a questionnaire and categorized into distinct patterns using Principal Component Analysis (PCA). Child neurodevelopment was evaluated at age 4 using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and the Child Behavior Checklist (CBCL 1.5–5). Linear and logistic regression models were employed, adjusting for potential confounders and stratifying by child sex. Results: Two major maternal dietary patterns were identified: “Processed and high-fat foods” and “Fresh foods and fish”. Higher maternal adherence to the “Processed and high-fat foods” pattern was associated with increased externalizing behaviors in offspring (β = 0.88; 95%CI 0.28–1.49; p = 0.004). In males, this pattern was associated with an increased clinical risk of Attention Deficit Hyperactivity Disorder (ADHD) (OR (Odds Ratio) = 1.13; 95%CI: 1.02–1.26; p = 0.021). Conclusions: Our findings indicate that maternal consumption of a diet rich in processed and high-fat foods during pregnancy is associated with increased behavioral problems in children, with sex-specific vulnerabilities: slightly higher externalizing behaviors in girls and an increased risk of ADHD in boys. These results underscore the importance of promoting healthy maternal dietary patterns during pregnancy as a targeted early prevention strategy for supporting child neurodevelopment.

• Publisher: MDPI AG
• Subject: Adult / Age / Aggressiveness / Analysis / Attention deficit hyperactivity disorder / Behavior / Child Behavior / Child Development / Child, Preschool / Childhood / Children / Children & youth / Childrens health / Cognitive development / Cohort Studies / Diet / Diet - adverse effects / DNA methylation / Fatty acids / Feeding Behavior / Female / Food habits / Gender differences / Gene expression / Health aspects / Humans / Italy - epidemiology / Male / Maternal Nutritional Physiological Phenomena / Metabolism / Metabolites / Nutrition research / Pregnancy / Pregnant women / Prenatal Exposure Delayed Effects / Questionnaires / Sex Factors