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Pre-pregnancy diet quality and its association with offspring behavioral problems

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The maternal diet has a critical role in epigenetic changes in the fetus, which has been associated with fetal brain tissue development and later onset of behavioral disorder. However, pre-pregnancy diet quality has not been examined in relation to offspring behavioral problems.


1554 mother–child dyads with mothers from the Australian longitudinal study on women’s health (ALSWH) and children from the mothers and their children’s health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariable logistic regression was used.


211 children experienced a greater SDQ-score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI 0.32, 0.85) at p = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with lower odds of offspring externalizing problems (AOR = 0.64, 95% CI 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI 0.47, 0.96) and (AOR = 0.63, 95% CI 0.42, 0.96), respectively.


We found that adherence to a diet of better quality in pre-pregnancy was associated with a lower risk of behavioral disorders in the offspring. Large prospective studies are warranted to confirm the findings.

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Australian longitudinal study on women’s health


Analysis of variance


Adjusted odds ratio


Children’s dietary questionnaire


Crude odds ratio


Food frequency questionary


Gestational diabetes mellitus


Goodness of fit


Hypertensive disorder in pregnancy


Healthy eating index


Low birth weight


Metabolic equivalent


Mothers’ and their children’s health


Strengths and difficulties questionnaire


Total energy intake


  1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56:345–365

    Article  Google Scholar 

  2. World Health Organization. Child and adolescent mental health. Accessed September 2019.

  3. Australian Institute of Health and Welfare (2019) Mental health services in Australia. Accessed April 2019.

  4. Ogundele MO (2018) Behavioural and emotional disorders in childhood: a brief overview for pediatricians. World Jo Clin Pediatr 7:9–26

    Article  Google Scholar 

  5. Georgieff MK (2007) Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr 85:614S–620S

    CAS  PubMed  Google Scholar 

  6. Vucetic Z, Kimmel J, Totoki K, Hollenbeck E, Reyes TM (2010) Maternal high-fat diet alters methylation and gene expression of dopamine and opioid-related genes. Endocrinology 151:4756–4764

    Article  CAS  Google Scholar 

  7. Arnsten AF, Rubia K (2012) Neurobiological circuits regulating attention, cognitive control, motivation, and emotion: disruptions in neurodevelopmental psychiatric disorders. J Am Acad Child Adolesc Psychiatry 51:356–367

    Article  Google Scholar 

  8. Wu A, Ying Z, Gomez-Pinilla F (2004) The interplay between oxidative stress and brain-derived neurotrophic factor modulates the outcome of a saturated fat diet on synaptic plasticity and cognition. Eur J Neurosci 19:1699–1707

    Article  Google Scholar 

  9. Sullivan EL, Riper KM, Lockard R, Valleau JC (2015) Maternal high-fat diet programming of the neuroendocrine system and behavior. Horm Behav 76:153–161.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Steenweg-de Graaff J, Tiemeier H, Steegers-Theunissen RP, Hofman A, Jaddoe VW, Verhulst FC, Roza SJ (2014) Maternal dietary patterns during pregnancy and child internalising and externalising problems. The Generation R Study Clinical nutrition 33:115–121

    PubMed  Google Scholar 

  11. Borge TC, Brantsæter AL, Caspersen IH, Meltzer HM, Brandlistuen RE, Aase H, Biele G (2019) Estimating the Strength of Associations Between Prenatal Diet Quality and Child Developmental Outcomes: Results From a Large Prospective Pregnancy Cohort Study. Am J Epidemiol 188:1902–1912

    Article  Google Scholar 

  12. Borge TC, Aase H, Brantsæter AL, Biele G (2017) The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: a systematic review and meta-analysis. BMJ open 7:e016777

    Article  Google Scholar 

  13. Oddy WH, Robinson M, Ambrosini GL, Therese A, de Klerk NH, Beilin LJ, Silburn SR, Zubrick SR, Stanley FJ (2009) The association between dietary patterns and mental health in early adolescence. Prev Med 49:39–44

    Article  Google Scholar 

  14. American Congress of Obstetricians and Gynecologists (2018) Prenatal development: How your baby grows during pregnancy: Women's Health Care Physicians: (cited December, 2018).

  15. Stephenson J, Heslehurst N, Hall J, Schoenaker DA, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet 391:1830–1841

    Article  Google Scholar 

  16. National Research Council (1989) Diet and health: implications for reducing chronic disease risk: National Academies Press

  17. Sacks FM, Obarzanek E, Windhauser MM, Svetkey LP, Vollmer WM, McCullough M, Karanja N, Lin P-H, Steele P, Proschan MA (1995) Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH): a multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol 5:108–118

    Article  CAS  Google Scholar 

  18. Dobson AJ, Hockey R, Brown WJ, Byles JE, Loxton DJ, McLaughlin D, Tooth LR, Mishra GD (1547f) Cohort profile update: Australian longitudinal study on women's health. Int J Epidemiol 44(1547):1547a–1547f.

    Article  Google Scholar 

  19. Mishra GD, Moss K, Loos C, Dobson AJ, Davies PS, Loxton D, Hesketh KD, Koupil I, Bower C, Sly P (2018) MatCH (Mothers and their Children's Health) profile: offspring of the 1973–78 Cohort of the Australian Longitudinal Study on Women's Health. Long Life Course Stud 9:351–375

    Article  Google Scholar 

  20. Ireland P, Jolley D, Giles G, O'Dea K, Powles J, Rutishauser I, Wahlqvist ML, Williams J (1994) Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pac J Clin Nutr 3:19–31

    CAS  PubMed  Google Scholar 

  21. Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G (2000) The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust N Z J Public Health 24:576–583

    Article  CAS  Google Scholar 

  22. Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL, Tooze JA, Wilson MM, Reedy J (2018) Update of the healthy eating index: HEI-2015. J Acad Nutr Diet 118:1591–1602.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Reedy J, Lerman JL, Krebs-Smith SM, Kirkpatrick SI, Pannucci TE, Wilson MM, Subar AF, Kahle LL, Tooze JA (2018) Evaluation of the healthy eating index-2015. J Acad Nutr Diet 118:1622–1633.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586.

    Article  CAS  Google Scholar 

  25. Goodman A, Lamping DL, Ploubidis GB (2010) When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. J Abnorm Child Psychol 38:1179–1191

    Article  Google Scholar 

  26. Cheng S, Keyes KM, Bitfoi A, Carta MG, Koç C, Goelitz D, Otten R, Lesinskiene S, Mihova Z, Pez O (2018) Understanding parent–teacher agreement of the strengths and difficulties questionnaire (SDQ): comparison across seven European countries. Int J Methods Psychiatric Res 27:e1589

    Article  Google Scholar 

  27. Department of Health and Aged Care (GISCA) (2001) Measuring Remoteness Accessibility/Remoteness Index of Australia (ARIA), Revised edn. In: Canberra, 2001.

  28. National Health and Medical Research Council (2001) Australian alcohol guidelines: health risks and benefits, 2001. Accessed June 2019.

  29. Brown WJ, Burton NW, Marshall AL, Miller YD (2008) Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women. Aust N Z J Public Health 32:535–541.

    Article  PubMed  Google Scholar 

  30. Magarey A, Golley R, Spurrier N, Goodwin E, Ong F (2009) Reliability and validity of the Children's Dietary Questionnaire; a new tool to measure children's dietary patterns. Int J Pediatr Obes 4:257–265.

    Article  PubMed  Google Scholar 

  31. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    Article  CAS  Google Scholar 

  32. Pina-Camacho L, Jensen S, Gaysina D, Barker E (2015) Maternal depression symptoms, unhealthy diet and child emotional–behavioural dysregulation. Psychol Med 45:1851–1860

    Article  CAS  Google Scholar 

  33. Mesirow MS, Cecil C, Maughan B, Barker ED (2017) Associations between prenatal and early childhood fish and processed food intake, conduct problems, and co-occurring difficulties. J Abnorm Child Psychol 45:1039–1049.

    Article  PubMed  Google Scholar 

  34. Petronis A (2001) Epigenetics: influence on behavioral disorders. e LS 2001. Accessed June 2019.

  35. Jaclyn Chasse ND (2018) Epigenetics and Preconception: The Ultimate Preventive Medicine. 8f92dcd09563a0a9b79fa51c3f00.pdf. Accessed June 2019.

  36. Johnston RB (2009) Folic acid: preventive nutrition for preconception, the fetus, and the newborn. NeoReviews 10:e10–e19

    Article  Google Scholar 

  37. King JC (1444S) A summary of pathways or mechanisms linking preconception maternal nutrition with birth outcomes–3. J Nutr 146:1437S–1444S

    Article  CAS  Google Scholar 

  38. Anderson OS, Sant KE, Dolinoy DC (2012) Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation. J Nutr Biochem 23:853–859

    Article  CAS  Google Scholar 

  39. Khulan B, Cooper WN, Skinner BM, Bauer J, Owens S, Prentice AM, Belteki G, Constancia M, Dunger D, Affara NA (2012) Periconceptional maternal micronutrient supplementation is associated with widespread gender related changes in the epigenome: a study of a unique resource in the Gambia. Hum Mol Genet 21:2086–2101

    Article  CAS  Google Scholar 

  40. Rodríguez-Bernal CL, Rebagliato M, Iñiguez C, Vioque J, Navarrete-Muñoz EM, Murcia M, Bolumar F, Marco A, Ballester F (2010) Diet quality in early pregnancy and its effects on fetal growth outcomes: the Infancia y Medio Ambiente (Childhood and Environment) Mother and Child Cohort Study in Spain–. Am J Clin Nutr 91:1659–1666

    Article  Google Scholar 

  41. De‐Regil LM, Peña‐Rosas JP, Fernández‐Gaxiola AC, Rayco‐Solon P (2015) Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev

  42. Rao R, Tkac I, Townsend EL, Gruetter R, Georgieff MK (2003) Perinatal iron deficiency alters the neurochemical profile of the developing rat hippocampus. The Journal of nutrition 133:3215–3221

    Article  CAS  Google Scholar 

  43. Tian X, Anthony K, Neuberger T, Diaz FJ (2014) Preconception zinc deficiency disrupts postimplantation fetal and placental development in mice. Biol Reprod 90(83):81–12

    Google Scholar 

  44. Akbaraly TN, Shipley MJ, Ferrie JE, Virtanen M, Lowe G, Hamer M, Kivimaki M (2015) Long-term adherence to healthy dietary guidelines and chronic inflammation in the prospective Whitehall II study. Am J Med 128(152–160):e154

    Google Scholar 

  45. Kim Y-J, Hong Y-C, Lee K-H, Park HJ, Park EA, Moon H-S, Ha E-H (2005) Oxidative stress in pregnant women and birth weight reduction. Reprod Toxicol 19:487–492

    Article  CAS  Google Scholar 

  46. Sen S, Rifas-Shiman SL, Shivappa N, Wirth MD, Hébert JR, Gold DR, Gillman MW, Oken E (2015) Dietary inflammatory potential during pregnancy is associated with lower fetal growth and breastfeeding failure: results from project viva–3. J Nutr 146:728–736

    Article  Google Scholar 

  47. Kim H, Hwang J, Ha E, Park H, Ha M, Lee S, Hong Y-C, Chang N (2011) Fruit and vegetable intake influences the association between exposure to polycyclic aromatic hydrocarbons and a marker of oxidative stress in pregnant women. Eur J Clin Nutr 65:1118

    Article  CAS  Google Scholar 

  48. Sagiv SK, Thurston SW, Bellinger DC, Amarasiriwardena C, Korrick SA (2012) Prenatal exposure to mercury and fish consumption during pregnancy and attention-deficit/hyperactivity disorder–related behavior in children. Arch Pediatr Adolesc Med 166:1123–1131

    Article  Google Scholar 

  49. Braun JM, Yolton K, Dietrich KN, Hornung R, Ye X, Calafat AM, Lanphear BP (2009) Prenatal bisphenol A exposure and early childhood behavior. Environ Health Perspect 117:1945–1952

    Article  CAS  Google Scholar 

  50. Engel SM, Miodovnik A, Canfield RL, Zhu C, Silva MJ, Calafat AM, Wolff MS (2010) Prenatal phthalate exposure is associated with childhood behavior and executive functioning. Environ Health Perspect 118:565–571

    Article  CAS  Google Scholar 

  51. Chin EH, Schmidt KL, Martel KM, Wong CK, Hamden JE, Gibson WT, Soma KK, Christians JK (2017) A maternal high-fat, high-sucrose diet has sex-specific effects on fetal glucocorticoids with little consequence for offspring metabolism and voluntary locomotor activity in mice. PLoS ONE 12:e0174030

    Article  Google Scholar 

  52. Weiss B (2011) Same sex, no sex, and unaware sex in neurotoxicology. Neurotoxicology 32:509–517

    Article  Google Scholar 

  53. Kermani MP, Nematy M (2018) Maternal Nutrition and the Child’s Sex: A Review. Int J Womens Health Reprod Sci 6:394–399

    Article  Google Scholar 

  54. Rosenfeld CS (2015) Sex-specific placental responses in fetal development. Endocrinology 156:3422–3434

    Article  CAS  Google Scholar 

  55. Clifton V (2010) Sex and the human placenta: mediating differential strategies of fetal growth and survival. Placenta 31:S33–S39

    Article  Google Scholar 

  56. Crozier SR, Robinson SM, Godfrey KM, Cooper C, Inskip HM (2009) Women's dietary patterns change little from before to during pregnancy. J Nutr 139:1956–1963

    Article  CAS  Google Scholar 

  57. Cuco G, Fernandez-Ballart J, Sala J, Viladrich C, Iranzo R, Vila J, Arija V (2006) Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. Eur J Clin Nutr 60:364

    Article  CAS  Google Scholar 

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The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data.


DGG is supported by the UQ Research Training Scholarship. GDM holds the Australian Health and Medical Research Council Principal Research Fellowship APP1121844.

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The authors’ contributions were as follows: DGG, MW, and GDM designed the study; DGG analyzed the data and wrote the manuscript; GDM and MW critically reviewed the manuscript.

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Correspondence to Dereje G. Gete.

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All authors read and approved the final manuscript. The authors declare no competing interests.

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Gete, D.G., Waller, M. & Mishra, G.D. Pre-pregnancy diet quality and its association with offspring behavioral problems. Eur J Nutr 60, 503–515 (2021).

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