The potential influence of children's sex on the association between prenatal Mediterranean diet and offspring behavior.

Introduction: Maternal nutrition during pregnancy is crucial for fetal brain development and is linked to the offspring’s behavioral development. This study investigated the impact of the adherence to a plant-based dietary pattern, namely the Mediterranean diet (MedDiet), during pregnancy on children's behavioral problems at age 4. We also sought to evaluate whether there was a sex-specific influence.

Methods: This study involved 220 mother–child pairs from a randomized clinical trial in Tarragona. Maternal adherence to the MedDiet was scored based on the consumption of the following nine food items: fruits, vegetables, legumes, cereals, fish, olive oil, meat, dairy products, and alcohol. Positive scores were given for the first six items and negative for the last three, with higher scores indicating a greater adherence. The final score ranged from 0 to 18. The children's behavior was assessed using the Child Behavior Checklist 1½-5 (CBCL 1½-5), a parent-reported questionnaire with 99 items on emotional, behavioral, and social problems. Higher scores indicated greater behavioral problems. Multivariable analyses accounting for potential influential factors during pregnancy were fitted to assess the association between the MedDiet and the children’s behavioral problems.

Results: A greater adherence to the Mediterranean diet during pregnancy was associated with lower scores for externalizing problems, such as attention problems, aggressive behavior, and attention-deficit/hyperactivity problems, as well as for depressive problems in children. Sex-stratified analyses showed a beneficial association with externalizing problems in both girls and boys. However, regarding depression problems, a beneficial association was only observed in boys.

Conclusion: Adhering to a plant-based diet, such as the MedDiet, during pregnancy may mitigate future behavioral problems in offspring. This study underscores the importance of this dietary pattern as a healthy pattern to provide a favorable fetal nutritional environment, ensuring proper development.