October 2019 Hot Topic: New Study Sheds Light on the Importance of Diet Quality During Pregnancy


“For many centuries people have believed that there is continuity between the individual in utero and the individual in the world; now there is solid evidence that this ancient belief is correct, albeit in a far more complex and nuanced way than our ancestors ever imagined.”Annie Murphy Paul, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives

Accumulating evidence points to a hypothesis long held by scientists and thought leaders alike: environmental factors from before birth may have long-term effects on later health outcomes. As Oliver J. Rando et al eloquently point out in a 2015 publication of Cell, “The period from conception to birth is a time of rapid growth, cellular replication and differentiation, and functional maturation of organ systems. These processes are very sensitive to alterations in nutrient availability, and an abnormal intrauterine metabolic milieu can thus have long-lasting effects on the offspring.”1 A new study published in PLOS Medicine sheds some light on the validity of these postulations.

Using data from a national birth cohort study of 19,582 mother-child pairs, researchers found that maternal diet quality during pregnancy was associated with the diet quality of children at age 14 years.2 This is the first large prospective cohort with extensive concurrently collected information on dietary habits from both pregnancy and adolescence, and it helps underscore earlier evidence that dietary exposures during fetal life can affect susceptibility to disease.2 “One such factor is the offspring’s own dietary habits,” write the study’s authors.2

In this study, children’s diet quality was positively associated with their mother’s antenatal diet quality, despite the fact that the two dietary assessments were completed 15 years apart.2 Furthermore, this association was observed at an age when the children became more independent; it was also robust after adjustment for a number of different sociodemographic factors and consistently observed across strata of the children’s gender, maternal BMI, and education status.2

A similar study also published this year in the journal Nutrients looked at whether maternal pregnancy nutrition influences fetal growth.3 Researchers examined associations between maternal diet quality during pregnancy and lactation with offspring growth and body composition from birth to six months. They found that higher maternal diet quality during pregnancy through three months postpartum was associated with lower infant weight and adiposity in early postnatal life.3

Maternal Over-Nutrition & Obesity

Conversely, can the issue of maternal over-nutrition and obesity also affect a child’s health trajectory? This topic has been the subject of investigation for years, and most animal studies report that offspring exposed to a high fat diet during gestation and lactation have increased body weight and adiposity at weaning.4,5 A 2009 study in Wistar rats suggests that a lifetime of high-fat consumption during pregnancy and lactation results in a significantly increased risk of obesity in offspring.5 This observation and others like it6,7 underscore the importance of considering the early life environment as a contributor to later life metabolic health.5 (However, it is prudent to note that since this research was done in rats, we cannot draw any conclusions about the connection in humans).

Another interesting study in rats found that offspring of mothers fed a high-fat diet were heavier in body weight, had increased circulating triglyceride levels, and consumed more alcohol and high fat food in adulthood.8 In humans, a 2011 multiethnic cohort study of 82 children and 379 youth found that exposure to maternal gestational diabetes is associated with increased overall and abdominal adiposity.9

Eating For Two

What foods or dietary patterns are beneficial for pregnant mothers and their children? An observational study in 2018 looked at the macronutrient intake of over 1,000 women during pregnancy associated with their children’s birth weight.10 The researchers found that each additional 10g of carbohydrates consumed by the mother per day was associated with an increase of approximately 4g in the birth weight of her baby. Interestingly, each additional 10g of fats consumed per day was associated with a birth weight decreased by 8g.10

A similarly interesting review published in a 2019 edition of Nutrients looked at whether vegetarian and vegan diets could be considered safe for the pregnant mother’s health and for offspring during pregnancy and lactation.11 Vegan and vegetarian diets have become popular worldwide, in part due to some research suggesting that plant-based dietary patterns may reduce the risk of coronary heart disease, high blood pressure, and type 2 diabetes. However, pregnant women with unbalanced dietary patterns may lack macro- and micronutrients, increasing the risk of fetal impairment. The review posits that plant-based diets during pregnancy and lactation can be healthy for mothers and children alike but require a strong awareness for a complete intake of essential key nutrients and vitamin supplements.11


The research summarized here suggests that efforts to decrease chronic disease and obesity should also focus on the diet of pregnant women and women who may become pregnant. As well, it underscores the need for clinicians to acknowledge that some patients may have long-held dietary patterns that predate their own birth, which may make changing these patterns more difficult. Careful and empathetic lifestyle counseling for balanced nutrition and weight gain during pregnancy may have a long-term effect on the health of generations to come.


  1. Rando OJ, Simmons RA. I’m eating for two: parental dietary effects on offspring metabolism. Cell. 2015;161(1):93-105. doi:1016/j.cell.2015.02.021
  2. Ahrendt Bjerregaard A, Halldorsson TI, Tetens I, Frodi Olsen S. Mother’s dietary quality during pregnancy and offspring’s dietary quality in adolescence: follow-up from a national birth cohort study of 19,582 mother-offspring pairs. PLoS Med. 2019;16(9):e1002911. doi:10.1371/journal.pmed.1002911
  3. Tahir MJ, Haapala JL, Foster LP, et al. Higher maternal diet quality during pregnancy and lactation is associated with lower infant weight-for-length, body fat percent, and fat mass in early postnatal life. Nutrients. 2019;11(3):E632. doi:3390/nu11030632
  4. Sullivan EL, Smith MS, Grove KL. Perinatal exposure to high-fat diet programs energy balance, metabolism, and behavior in adulthood. Neuroendocrinology. 2011;93(1):1-8. doi:1159/000322038
  5. Howie GJ, Sloboda DM, Kamal T, Vickers MH. Maternal nutritional history predicts obesity in adult offspring independent of postnatal diet. J Physiol. 2009;587:(Pt 4):905-915. doi:1113/jphysiol.2008.163477
  6. Armitage JA, Khan IY, Taylor PD, Nathanielsz PW, Poston L. Developmental programming of the metabolic syndrome by maternal nutritional imbalance: how strong is the evidence from experimental models in mammals? J Physiol. 2004;561(Pt 2):355-377. doi:1113/jphysiol.2004.072009
  7. Vickers MH, Krechowec SO, Breier BH. Is later obesity programmed in utero? Curr Drug Targets.2007;8(8):923-934. doi:2174/138945007781386857
  8. Bocarsly ME, Barson JR, Hauca JM, Hoebel BG, Leibowitz SF, Avena NM. Effects of perinatal exposure to palatable diets on body weight and sensitivity to drugs of abuse in rats. Physiol Behav. 2012;107(4):568-575. doi:1016/j.physbeh.2012.04.024
  9. Crume TL, Ogden L, West NA, et al. Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the Exploring Perinatal Outcomes Among Children (EPOCH) study. Diabetologia. 2011;54(1):87-92. doi:1007/s00125-010-1925-3
  10. Sharma SS, Greenwood DC, Simpson NAB, Cade JE. Is dietary macronutrient composition during pregnancy associated with offspring birth weight? An observational study. Br J Nutr. 2018;119(3):330-339. doi:1017/S0007114517003609
  11. Sebastiani G, Herranz Barbero A, Borrás-Novell C, et al. The effects of vegetarian and vegan diet during pregnancy on the health of mothers and offspring. Nutrients. 2019;11(3):E557. doi:3390/nu11030557