# Maternal adherence to the EAT-Lancet diet recommendations among pregnant women in Ireland and associations with offspring birth outcomes and childhood adiposity

## TL;DR

This study examines how well pregnant women in Ireland follow a plant-based EAT-Lancet diet and its effects on their children's birth and growth outcomes.

## Contribution

The study is the first to examine EAT-Lancet diet adherence during pregnancy in relation to maternal-child health outcomes.

## Key findings

- Higher EAT-Lancet diet adherence was linked to better birth outcomes like higher birth weight and length.
- The diet was not associated with adverse effects on offspring health in the short or long term.
- Adherence showed lower micronutrient intake for retinol, riboflavin, vitamin B12, and calcium.

## Abstract

Pregnancy is a critical period during which maternal diet may impact offspring growth and future health. The EAT-Lancet commission promotes a plant-based diet pattern for meeting environmental and health challenges. EAT-Lancet diet scores have been developed however, thus far they have not been examined in the context of maternal-child health. We investigated adherence to EAT-Lancet diet recommendations during pregnancy and associations with offspring birth outcomes and childhood adiposity. The hypothesis tested was that greater adherence is not related to adverse outcomes.

This study included mother–child pairs (n = 1,052) from the Lifeways Cross-generational cohort, in Ireland. Maternal EAT-Lancet diet score was derived from an early pregnancy validated food frequency questionnaire. Correlation analysis examined relationships with other diet scores (Healthy Eating Index (HEI-2015), Dietary Approach to Stop Hypertension (DASH) score, and energy adjusted-Dietary Inflammatory Index (E-DII). Logistic and linear regression analyses examined associations with offspring birth outcomes and childhood adiposity and weight status at age 5 and 9 years, with adjustment for energy intake and potential confounders.

The EAT-Lancet diet score (mean ± SD 21.0 ± 4.1) was moderately positively correlated with HEI-2015 and DASH scores (ρ > 0.5) and negatively correlated with dietary inflammation (E-DII (ρ < − 0.5, all p-value < 0.001)). Greater adherence to the EAT-Lancet diet recommendations was associated with higher intake of most micronutrients (except for retinol, riboflavin, vitamin B12 and calcium which were significantly lower). In energy-adjusted models, maternal EAT-Lancet diet score was positively associated with offspring birth weight (β 8.77, 95% CI 0.35–17.19, p = 0.04), length (β 0.06, 95% CI 0.01–0.1, p = 0.01), head circumference (β 0.04, 95% CI 0.01–0.07, p = 0.01) and lower likelihood of having a low birth weight (Odds ratio 0.91, 95% CI 0.85–0.99, p = 0.01). These associations did not withstand adjustment for additional confounders.

Adherence to EAT-Lancet diet recommendations during pregnancy was not associated with adverse short or long-term offspring outcomes. Further examination in other cohorts with more diverse diets, and with additional health outcomes, is warranted.

The online version contains supplementary material available at 10.1007/s00394-025-03756-0.