Association of Prenatal Healthy and Unhealthy Plant-Based Diets with Behavioral Outcomes in Preschool Children

Abstract

Background/objectives: Dietary patterns rich in plant-based foods during pregnancy have been associated with neurodevelopmental outcomes in offspring. However, not all components of these diets are healthy, and the impact of their quality on behavioral outcomes remains unexplored. Therefore, this study aimed to examine the association between healthy and unhealthy plant-based diets and offspring behavioral problems at the age of four.

Methods: This research involved 201 mother-child pairs from the ECLIPSES study. Maternal diet during pregnancy was assessed using a validated food frequency questionnaire, from which the healthy plant-based diet index (hPDI) was calculated, emphasizing the consumption of fruits, vegetables, legumes and nuts, along with the unhealthy plant-based diet index (uPDI), highlighting the intake of sugary drinks and refined grains. Children's behavior was evaluated using the Child Behavior Checklist 1.5-5. Multivariable logistic regression analyses were conducted to estimated odds ratios (ORs) and their 95% confidence intervals (CIs).

Results: Greater adherence to the uPDI during pregnancy was associated with higher odds for externalizing problems, including attention-deficit/hyperactivity problems (OR = 1.08; 95%CI from 1.01 to 1.16) and oppositional defiant behavior (OR = 1.09; 95%CI from 1.00 to 1.19) in offspring, particularly girls. Higher adherence to the hPDI was not associated with children's behavior.

Conclusions: The consumption of unhealthy components of a plant-based dietary pattern during gestation has been associated with adverse behavioral outcomes in children at age four. These findings underscore the importance of discerning between the healthy and unhealthy components of plant-based diets when assessing their impact on child development.

Keywords: child; child behavior; maternal diet; neurodevelopment; plant-based diets; pregnancy.

Figure 1

Flowchart of the study population.

Figure 2

Multivariable-adjusted odds ratio of behavioral problems of children and maternal adherence to healthy (hPDI) and unhealthy (uPDI) plant-based diet indices. CBCL 1.5-5, Child Behavior Checklist 1.5-5; CI, confidence interval. Models were adjusted for maternal age, maternal first trimester body mass index, socioeconomic status, maternal smoking, anxiety during gestation, energy intake during gestation, physical activity, intervention group, gestational age, breastfeeding duration, maternal and child attachment, maternal anxiety or depression at the 4-year visit, child’s sex, and child’s diet quality. The diamonds indicate the odds ratios, while the whisker plots represent the 95% CIs. * p-value < 0.05.

Figure 2

Multivariable-adjusted odds ratio of behavioral problems of children and maternal adherence to healthy (hPDI) and unhealthy (uPDI) plant-based diet indices. CBCL 1.5-5, Child Behavior Checklist 1.5-5; CI, confidence interval. Models were adjusted for maternal age, maternal first trimester body mass index, socioeconomic status, maternal smoking, anxiety during gestation, energy intake during gestation, physical activity, intervention group, gestational age, breastfeeding duration, maternal and child attachment, maternal anxiety or depression at the 4-year visit, child’s sex, and child’s diet quality. The diamonds indicate the odds ratios, while the whisker plots represent the 95% CIs. * p-value < 0.05.