Maternal Dietary Quality During Pregnancy and Risk of Neurodevelopmental Disorders in Offspring: A Systematic Review and Meta-Analysis

Maternal diet during pregnancy may influence fetal brain development and is an important factor in the occurrence of neurodevelopmental disorders including Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). To our knowledge, very few reviews have comprehensively examined the association between maternal dietary quality during pregnancy and offspring ADHD and ASD. This posed the need for a comprehensive synthesis of observational cohort studies investigating maternal dietary quality during pregnancy and offspring ADHD and ASD outcomes. To achieve this, a systematic review and meta-analysis was conducted in accordance with the PRISMA and MOOSE guidelines using an inverse variance-weighted random-effects model. Results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Higgins’ I2 statistic. The review protocol was preregistered on PROSPERO (CRD420251137377). The risk of bias for all included studies was independently assessed using the ROBINS-E tool, and the overall certainty of evidence was assessed using the GRADE framework. The systematic review included 9 studies and 22 cohorts. For pro-inflammatory dietary pattern and offspring ADHD (8 studies including 17,114 samples), no significant association was observed (OR = 1.07, 95% CI 0.96 to 1.20; p = 0.232, I² = 88%). For pro-inflammatory dietary pattern and offspring ASD (3 studies including 6,511 samples), a statistically significant association was observed (OR = 1.55, 95% CI 1.10 to 2.19; p = 0.012, I² = 33%). For anti-inflammatory dietary pattern and offspring ADHD (6 studies including 17,028 samples), higher maternal adherence was associated with reduced risk of ADHD (OR = 0.97, 95% CI 0.95 to 0.99; p = 0.004, I² = 29%). For anti-inflammatory dietary pattern and offspring ASD (5 studies including 100,908 samples), higher adherence was associated with reduced risk (OR 0.79, 95% CI 0.69 to 0.91, p = 0.007, I² = 0%). Across the included studies, anti-inflammatory dietary patterns were associated with lower odds of neurodevelopmental disorders, while pro-inflammatory dietary patterns were associated with increased odds of ASD. These findings suggest that maternal dietary quality during pregnancy may influence offspring neurodevelopment, and dietary pattern-level analyses may provide clearer insights than nutrient-specific analyses alone.