To assess the longitudinal associations between maternal diet during pregnancy and child adiposity between ages 2 and 12 years.
Methods:
Repeated measures linear regression models with autoregressive covariance were used to assess the association between maternal diet and child body mass index (BMI) trajectories between ages 2 and 12 years. Logistic regression models were used to assess the associations between maternal diet and likelihood of child BMI greater than the 85th percentile, as well as the association between age at adiposity rebound and the likelihood of subsequent overweight/obesity. Additionally, multiple linear regression was used to assess the association between maternal diet and child age at adiposity rebound. Interactions with race/ethnicity were explored.
Results:
There was no association between maternal diet during pregnancy and child adiposity, but race-ethnic specific analyses revealed that compared to a high maternal adherence to a Mediterranean-style diet, a low adherence was associated with a higher BMI trajectory among White children (β = −0.67; p = 0.01).
Conclusions:
Maternal diet during pregnancy may influence child BMI trajectories in race/ethnic-specific ways that likely stem from cultural and socioeconomic factors that should be considered when designing interventions.
ChungST, OnuzuruikeAU, MaggeSN. Cardiometabolic risk in obese children. Ann N Y Acad Sci, 2018; 1411(1):166–183.
2.
StiermanB, AffulJ, CarrollMD, et al.National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. Hyattsville, MD; doi: 10.15620/cdc:106273;2021
PattonGC, CoffeyC, CarlinJB, et al.Overweight and obesity between adolescence and young adulthood: A 10-year prospective cohort study. J Adolesc Health, 2011; 48(3):275–280.
5.
Rolland-CacheraMF, DeheegerM, BellisleF, et al.Adiposity rebound in children: A simple indicator for predicting obesity. Am J Clin Nutr, 1984; 39(1):129–135.
6.
ZhouJ, ZhangF, QinX, et al.Age at adiposity rebound and the relevance for obesity: A systematic review and meta-analysis. Int J Obes (Lond), 2022; 46(8):1413–1424.
7.
MartínezJA, CorderoP, CampiónJ, MilagroFI. Interplay of early-life nutritional programming on obesity, inflammation and epigenetic outcomes. Proc Nutr Soc, 2012; 71(2):276–283.
8.
Langley-EvansSC. Early life programming of health and disease: The long-term consequences of obesity in pregnancy. J Hum Nutr Diet, 2022; 35(5):816–832.
9.
PhelanS, CardelMI, LeeAM, et al.Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program. Obesity (Silver Spring), 2023; 31(11):2709–2719.
10.
Gonzalez-NahmS, MarchesoniJ, MaityA, et al.Maternal Mediterranean diet adherence and its associations with maternal prenatal stressors and child growth. Curr Dev Nutr, 2022; 6(11):nzac146.
11.
Monthe-DrezeC, Rifas-ShimanSL, ArisIM, et al.Maternal diet in pregnancy is associated with differences in child body mass index trajectories from birth to adolescence. Am J Clin Nutr, 2021; 113(4):895–904.
12.
HarmanciogluB, KabaranS. Maternal high fat diets: Impacts on offspring obesity and epigenetic hypothalamic programming. Front Genet, 2023; 14:1158089.
13.
ZhangQ, XiaoX, ZhengJ, et al.A Maternal High-Fat Diet Induces DNA Methylation Changes That Contribute to Glucose Intolerance in Offspring. Front Endocrinol (Lausanne), 2019; 10:871.
14.
EscalonaR, LarqueC, CortesD, et al.High-fat diet impairs glucose homeostasis by increased p16 beta-cell expression and alters glucose homeostasis of the progeny in a parental-sex dependent manner. Front Endocrinol (Lausanne), 2023; 14:1246194.
15.
GuntherJ, HoffmannJ, SpiesM, et al.Associations between the Prenatal Diet and Neonatal Outcomes-A Secondary Analysis of the Cluster-Randomised GeliS Trial. Nutrients, 2019; 11(8):1889.
16.
YisahakSF, MumfordSL, GrewalJ, et al.Maternal diet patterns during early pregnancy in relation to neonatal outcomes. Am J Clin Nutr, 2021; 114(1):358–367.
17.
RheeDK, JiY, HongX, et al.Mediterranean-Style Diet and Birth Outcomes in an Urban, Multiethnic, and Low-Income US Population. Nutrients, 2021; 13(4):1188.
18.
StrohmaierS, BoglLH, EliassenAH, et al.Maternal healthful dietary patterns during peripregnancy and long-term overweight risk in their offspring. Eur J Epidemiol, 2020; 35(3):283–293.
19.
MitrouPN, KipnisV, ThiebautACM, et al.Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Arch Intern Med, 2007; 167(22):2461–2468.
20.
LaffondA, Rivera-PicónC, Rodríguez-MuñozPM, et al.Mediterranean diet for primary and secondary prevention of cardiovascular disease and mortality: An updated systematic review. Nutrients, 2023; 15(15):3356.
21.
AmatiF, HassounahS, SwakaA. The impact of Mediterranean dietary patterns during pregnancy on maternal and offspring health. Nutrients, 2019; 11(5):1098.
22.
Fernandez-BarresS, VrijheidM, Manzano-SalgadoCB, et al.The association of Mediterranean diet during pregnancy with longitudinal body mass index trajectories and cardiometabolic risk in early childhood. J Pediatr, 2019; 206:119–127 e116.
23.
Díaz-LópezA, Rodríguez EspeltL, AbajoS, ArijaV. Close Adherence to a Mediterranean Diet during Pregnancy Decreases Childhood Overweight/Obesity: A Prospective Study. Nutrients, 2024; 16(4):532.
24.
HoyoC, MurthaAP, SchildkrautJM, et al.Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST). BMC Public Health, 2011; 11(1):46.
25.
HoyoC, DaltveitAK, IversenE, et al.Erythrocyte folate concentrations, CpG methylation at genomically imprinted domains, and birth weight in a multiethnic newborn cohort. Epigenetics: official Journal of the DNA Methylation Society, 2014; 9(8):1120–1130.
26.
TrichopoulouA, Kouris-BlazosA, WahlqvistML, et al.Diet and overall survival in elderly people. BMJ, 1995; 311(7018):1457–1460.
27.
ChatziL, Rifas-ShimanSL, GeorgiouV, et al.Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood. Pediatr Obes, 2017; 12(Suppl 1):47–56.
SAS [computer program]. Version 9.4. Cary, NC. 2016.
30.
Fernández-BarrésS, RomagueraD, ValviD, et al.; INMA Project. Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: The INMA birth cohort study. Pediatr Obes, 2016; 11(6):491–499.
31.
SharmaS, EspositoS, Di CastelnuovoA, et al.Impact of Mediterranean diet adherence during pregnancy on preeclampsia, gestational diabetes mellitus, and excessive gestational weight gain: A systematic review of observational studies and randomized controlled trials. Nutrients, 2025; 17(10):1723.
32.
AntasourasG, PapadopoulouSK, AlexatouO, et al.Adherence to the Mediterranean Diet during Pregnancy: Associations with Sociodemographic and Anthropometric Parameters, Perinatal Outcomes, and Breastfeeding Practices. Medicina (Kaunas), 2023; 59(9):1547.
33.
BarreaL, VerdeL, Simancas-RacinesD, et al.Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype. J Transl Med, 2023; 21(1):675.
34.
ScaglioneS, Di ChiaraT, DaidoneM, TuttolomondoA. Effects of the Mediterranean diet on the components of metabolic syndrome concerning the cardiometabolic risk. Nutrients, 2025; 17(2):358.
35.
Gonzalez-NahmS, MendezMA, RobinsonWR, et al.Low maternal adherence to a Mediterranean diet is associated with increase in methylation at the MEG3-IG differentially methylated region in female infants. Environ Epigenet, 2017; 3(2):dvx007.
36.
McCulloughLE, MillerEE, CalderwoodLE, et al.Maternal inflammatory diet and adverse pregnancy outcomes: Circulating cytokines and genomic imprinting as potential regulators? Epigenetics, 2017; 12(8):688–697.
37.
Martinez-GonzalezMA, HersheyMS, ZazpeI, TrichopoulouA. Transferability of the Mediterranean diet to non-Mediterranean countries. What is and what is not the mediterranean diet. Nutrients, 2017; 9(11):1226.
38.
HoffmanR, GerberM. Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: A critical appraisal. Nutr Rev, 2013; 71(9):573–584.
39.
NagataJM, BashirA, WeinsteinS, et al.Social epidemiology of the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay (MIND) diet among early adolescents: The Adolescent Brain Cognitive Development Study. Pediatr Res, 2024; 96(1):230–236.
40.
LipskyLM, WrightB, LinTC, et al.Diet quality from early pregnancy through 1-y postpartum: A prospective cohort study. Am J Clin Nutr, 2024; 120(5):1284–1293.
41.
Sotres-AlvarezD, HerringAH, Siega-RizAM. Latent transition models to study women’s changing of dietary patterns from pregnancy to 1 year postpartum. Am J Epidemiol, 2013; 177(8):852–861.
42.
FreedmanLS, ComminsJM, MolerJE, et al.Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake. Am J Epidemiol, 2014; 180(2):172–188.
43.
Bach-FaigA, GelevaD, CarrascoJL, et al.Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Public Health Nutr, 2006; 9(8A):1110–1117.
44.
Morales-Suarez-VarelaM, Rocha-VelascoOA. Impact of ultra-processed food consumption during pregnancy on maternal and child health outcomes: A comprehensive narrative review of the past five years. Clin Nutr ESPEN, 2025; 65:288–304.
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