The impact of maternal nutrition on offspring's risk of non-communicable diseases in adulthood: a systematic review

A growing body of evidence suggests the impact of maternal nutrition plays a role in determining offspring's risk of non-communicable diseases (NCDs), including heart disease (CVD), type 2 diabetes (T2DM), cancer and chronic obstructive pulmonary diseases (COPD). We conducted a systematic review to investigate this relationship. We systematically searched CINAHL, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, Database of Abstracts of Reviews of Effects, MEDLINE, EMBASE, Web of Science Core Collection and Global Health for papers published before May 2016 (PROSPERO: CRD42016039244, CRD42016039247). Included studies examined the impact of maternal nutrition (diet, vitamin status and weight) on adult offspring's NCD outcomes. Of 23 501 identified citations, 20 met our inclusion criteria. Heterogeneity of papers required narrative synthesis. Included studies involved 1 939 786 participants. CVD: Four papers examined maternal exposure to famine during gestation, 3 identified a resulting increased risk of CVD in offspring. Five identified an increased risk of offspring CVD with increasing maternal weight. T2DM: Six studies investigated maternal exposure to famine during gestation; three identified an increase in offspring's T2DM risk. Three found no increased risk; two of these were in circumstances where famine states persisted beyond pregnancy. Three papers found an increased risk of T2DM in offspring with increasing maternal BMI. CANCER: Four papers investigated maternal famine exposure during pregnancy - two identified a reduced risk of cancer in male offspring, and two an increased risk in female offspring. COPD: One study found low maternal vitamin D status was associated with reduced use of asthma medication. While there are indications that exposure to both famine (particularly when coupled with exposure to nutritional excess after birth) and maternal overweight during pregnancy is associated with offspring's risk of CVD, T2DM and cancer, currently there is a lack of evidence to confirm this relationship. Despite the lack of conclusive evidence, these finding hold important research and policy implications for a lifecycle approach to the prevention of NCDs.