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Maternal nut intake in pregnancy and child neuropsychological development up to 8 years old: a population-based cohort study in Spain


There is scientific evidence on the protective effects of nut intake against cognitive decline in the elderly; however, this effect has been less explored in child neurodevelopment and no studies have explored the potential longitudinal association with nut intake during pregnancy. We aimed to analyze the association of maternal nut intake during pregnancy with child neuropsychological outcomes. We included 2208 mother–child pairs from a population-based birth cohort in four regions of Spain. The follow up settings were during pregnancy (first and third trimesters), birth, 1.5, 5 and 8 years. Neuropsychological examinations were based on Bayley Scales of Infant Development (1.5 years), McCarthy scales of Children’s Abilities (5 year), Attention Network Test (ANT, 8 year) and N-Back test (8 year). Nut intake in pregnancy was reported through a validated food frequency questionnaire during the first and the third trimester. Multivariable regressions analyzed associations after controlling for priori selected confounders notably maternal education, social class, body mass index, energy intake, fish intake, omega-3 supplements, alcohol consumption and smoking habits during pregnancy. Children within the highest tertile of maternal nut consumption during first pregnancy trimester (> 32 g/week) had a decrease of 13.82 ms [95% confidence interval (CI) − 23.40, − 4.23] in the ANT—hit reaction time standard error, compared to the first tertile (median 0 g/w). A similar protective association pattern was observed with the other cognitive scores at the different child ages. After correcting for multiple testing using Bonferroni familywise error rate (FWER), Hochberg FWER and Simes false discovery rate, ANT—hit reaction time standard error remained significant. Final model estimates by inverse probability weighting did not change results. Third pregnancy trimester nut intake showed weaker associations. These data indicate that nut intake during early pregnancy is associated with long-term child neuropsychological development. Future cohort studies and randomized clinical trials are needed to confirm this association pattern in order to further extend nutrition guidelines among pregnant women.

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Fig. 1



Alpha-linolenic acid


Attention Network Test


Brain-derived neurotrophic factor


Body mass index


Bayley Scales of Infant Development


Confidence interval


Directed Acyclic Graph


Disability adjusted life-years


Docosahexaenoic acid


Eicosapentaenoic acid


False discovery rate


Food frequency questionnaire


Familywise error rate


Hit reaction time standard error


Intelligence quotient


Infancia y Medio Ambiente (Environment and Childhood)


Interquartile range


Inverse probability weighting


McCarthy Scales of Children’s Abilities


Prevention with Mediterranean Diet


Polyunsaturated fatty acids


Relative Mediterranean diet score


Standard deviation


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We would like to thank all the participants of the INMA Project for their collaboration as well as the project investigators at each cohort center as well as the coordination centers. A full roster of the INMA Project investigator can be found at We would like to thank also Nuria Sebastian-Galles and her team who have designed the N-Back and ANT tests.


This study was funded by Grants from Spanish Institute of Health Carlos III-Ministry of Economy and Competitiveness (INMA Network G03/176, CB06/02/0041, and FIS-FEDER: PI03/1615, PI04/1436, PI08/1151, PI04/2018, PI04/1509, PI04/1112, PI04/1931, PI05/1079, PI05/1052, PI06/1213, PI06/0867, PI07/0314, PI09/02647, PS09/00090, PI09/02311, MS11/0178, PI13/1944, PI13/2032, PI13/02429, PI16/1288, and PI17/00663), Generalitat de Catalunya-CIRIT 1999SGR 00241, JCI-2011–09771–MICINN, Generalitat Valenciana (Conselleria de Sanitat-048/2010 and 060/2010 and FISABIO-UGP 15-230, 15-244, and 15-249), Alicia Koplowitz Foundation, Universidad de Oviedo, Fundación Cajastur-Liberbank, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and the Fundación Roger Torné. This study has been funded by Instituto de Salud Carlos III through the projects “CP14/00108 & PI16/00261” (Co-funded by European Regional Development Fund “A way to make Europe”). Jordi Julvez, Mònica Guxens and Maria-Jose Lopez-Espinosa hold a Miguel Servet contract (MS14/00108, MS13/00054 and MSII16/00051, respectively) awarded by the Spanish Institute of Health Carlos III (Ministry of Economy and Competitiveness). Funding sources played no role in the design and conduct of the study, including: collection, management, analysis and interpretation of the data; or the preparation, review, and approval of the manuscript. The authors would also like to acknowledge all the study participants for their generous collaboration, and the interviewers for their assistance in contacting the families and administering the questionnaires.

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DR, JS and JJ designed research. FG analyzed data, wrote the paper and is responsible for final content. CP, JJ, DR, SFB, RGE supported and revised the statistical analyses. JJ coordinated and supervised data collection. JJ and DR supervised the interpretation of the results. All authors critically reviewed the manuscript and approved the final version of the manuscript.

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Correspondence to Jordi Julvez.

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Gignac, F., Romaguera, D., Fernández-Barrés, S. et al. Maternal nut intake in pregnancy and child neuropsychological development up to 8 years old: a population-based cohort study in Spain. Eur J Epidemiol 34, 661–673 (2019).

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  • Nut
  • Maternal diet
  • Children
  • Neurodevelopment
  • Population-based cohort