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

Introduction: Maternal diet during pregnancy has profound effect on brain and cognitive development of the child and thus an important risk factor in the occurrence of childhood neurodevelopmental disorders. Objectives To our knowledge very few studies examined the association between maternal dietary quality during pregnancy and neurodevelopmental outcomes (ADHD and ASD) posing a need for a comprehensive review of the complex synergies among nutrients and foods and relation with ADHD and ASD to enable evidence-based recommendation on dietary patterns. Method To achieve this, a systematic review and meta-analysis was conducted in accordance with the general recommendations of the PRISMA and MOOSE guidelines with an inverse variance-weighted random-effects model. Results are presented as odds ratio (OR) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Higgins I2 statistic. Interpretation followed Cochrane Handbook guidance and was based on the magnitude of I2 statistics alongside the direction and consistency of the estimates. The review protocol was preregistered on PROSPERO with an ID CRD420251137377. The risk of bias (RoB) for all included studies was independently assessed using the ROBINS-E tool. The GRADE framework was used to assess the overall certainty and accuracy of evidence. Result The study included 9 studies and 22 cohorts studies. On pro-inflammatory dietary patterns for ADHD (8 studies including 17,114 samples), no significant association was observed between higher pro-inflammatory dietary patterns and the risk of offspring ADHD (OR = 1.07, 95% CI 0.96 to 1.20; p = ) with substantial heterogeneity (I² = 79%, Q = 13.87, p = 0.0077) while For ASD (3 studies including 6,511 samples), no significant association was observed (OR 1.55, 95% CI 1.10 to -2.19; p = 0.57), with low heterogeneity (I² = 20%, Q = 7.29, p = 0.12). Anti-inflammatory healthy dietary patterns for ADHD (n = 6, samples 17,028), higher maternal adherence was associated with reduced risk (OR 0.97, 95% CI 0.95 to -0.99; p = 0.002), with low heterogeneity (I² = 21%, Q = 5.87, p = 0.32). For ASD (n = 5, samples 100,908), higher adherence was associated with reduced risk (OR 0.79, 95% CI 0.69 to -0.91; p = 0.003), with no observed heterogeneity (I² = 0%, Q = 4.08, p = 0.54). Conclusion 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 the inflammatory profile and quality of the maternal diet may be relevant to offspring neurodevelopment. Maternal diet at the level of dietary patterns may provide clearer insights than nutrient-specific analyses alone.