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Eur J Epidemiol. 2019 Jul;34(7):661-673. doi: 10.1007/s10654-019-00521-6. Epub 2019 May 7.

Maternal nut intake in pregnancy and child neuropsychological development up to 8 years old: a population-based cohort study in Spain.

Author information

ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, PRBB, C. Doctor Aiguader 88, 08003, Barcelona, Spain.
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
Instituto de Investigación Sanitaria Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain.
Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, France.
Nutritional Epidemiology Unit, Universidad Miguel Hernández, ISABIAL-FISABIO, Alicante, Spain.
Medecine Department, University of Oviedo, Oviedo, Spain.
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago de Compostela, Spain.
Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
Department of Statistics and Computational Research, Universistat de València, Valencia, Spain.
Public Health Division of Gipuzkoa, Department of Health, San Sebastian, Basque Country, Spain.
BioDonostia Research Institute, San Sebastian, Basque Country, Spain.
School of Psychology, University of the Basque Country UPV/EHU, San Sebastian, Basque Country, Spain.
Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, PO Box 2060, 3000 CB, Rotterdam, The Netherlands.
ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, PRBB, C. Doctor Aiguader 88, 08003, Barcelona, Spain.
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.


There is scientific evidence on the protective effects of nut intake against cognitive decline in the elderly; however, this effect has been less explored in child neurodevelopment and no studies have explored the potential longitudinal association with nut intake during pregnancy. We aimed to analyze the association of maternal nut intake during pregnancy with child neuropsychological outcomes. We included 2208 mother-child pairs from a population-based birth cohort in four regions of Spain. The follow up settings were during pregnancy (first and third trimesters), birth, 1.5, 5 and 8 years. Neuropsychological examinations were based on Bayley Scales of Infant Development (1.5 years), McCarthy scales of Children's Abilities (5 year), Attention Network Test (ANT, 8 year) and N-Back test (8 year). Nut intake in pregnancy was reported through a validated food frequency questionnaire during the first and the third trimester. Multivariable regressions analyzed associations after controlling for priori selected confounders notably maternal education, social class, body mass index, energy intake, fish intake, omega-3 supplements, alcohol consumption and smoking habits during pregnancy. Children within the highest tertile of maternal nut consumption during first pregnancy trimester (> 32 g/week) had a decrease of 13.82 ms [95% confidence interval (CI) - 23.40, - 4.23] in the ANT-hit reaction time standard error, compared to the first tertile (median 0 g/w). A similar protective association pattern was observed with the other cognitive scores at the different child ages. After correcting for multiple testing using Bonferroni familywise error rate (FWER), Hochberg FWER and Simes false discovery rate, ANT-hit reaction time standard error remained significant. Final model estimates by inverse probability weighting did not change results. Third pregnancy trimester nut intake showed weaker associations. These data indicate that nut intake during early pregnancy is associated with long-term child neuropsychological development. Future cohort studies and randomized clinical trials are needed to confirm this association pattern in order to further extend nutrition guidelines among pregnant women.


Children; Maternal diet; Neurodevelopment; Nut; Population-based cohort

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