Adaptive changes in multiple aspects of emotion regulation in the offspring of pregnant persons receiving a diet-and-exercise intervention relative to usual pregnancy care: a randomized controlled trial.

Background: Human studies examining the influence of prenatal diet and/or exercise interventions on offspring neurodevelopment are mixed. Interventions that include the provision of whole foods, nutritional counseling, address exercise behaviors, and that utilize multimethod assessments of offspring emotion regulation (ER) may better reveal the impact of these interventions on neurodevelopment.

Objectives: To explore whether the Be Healthy in Pregnancy (BHIP) prenatal diet-and-exercise intervention improves ER in 22-mo-old offspring.

Methods: Pregnant persons (>18 y, singleton pregnancy) were recruited between 12 and 17 wk gestation and randomly assigned to the intervention [high protein energy-controlled diet via the provision of cottage cheese, Greek yogurt, low-fat milk, individualized biweekly nutritional counseling, a controlled walking program, and usual pregnancy care (UPC)] or control (UPC alone) groups. ER in offspring [m = 22.2 (SD = 4.04); 50.9% female; intervention: n = 29, control: n = 28] was assessed using reports from pregnant persons and their partners on the Child Behavior Checklist, and the Behavior Rating Inventory of Executive Function-Preschool Version, laboratory observational tasks examining inhibitory control, attention, and empathy, and high-frequency heart rate variability (HF-HRV).

Results: Children exposed to the BHIP intervention exhibited medium to large effect size reductions in pregnant person and partner reported externalizing [effect size ƞp = 0.08, 95% confidence interval of the difference (0.05, 7.14); ƞp = 0.17 (1.68, 9.65)], internalizing [ƞp = 0.08 (0.09, 5.32); ƞp = 0.13 (0.84, 8.88)], and total behavior problems [ƞp = 0.09 (0.72, 11.87); ƞp = 0.17 (3.17, 17.88)] relative to control participants' children. Pregnant persons, but not partners, reported fewer problems with inhibitory control [ƞp = 0.13 (1.40, 8.55)], cognitive flexibility [ƞp = 0.08 (0.18, 4.85)], emergent metacognition [ƞp = 0.14 (2.00, 11.59)], and global executive function [ƞp = 0.14 (3.37, 20.12)]. Intervention children displayed fewer impulsive behaviors [ƞp = 0.11 (0.16, 1.77)] and a longer attention span [ƞp = 0.08 (0.30, 13.34)]. Finally, intervention children exhibited greater baseline HF-HRV [ƞp = 0.10 (0.16, 2.01)], and adaptive HF-HRV reactivity during the impulsivity [ƞp = 0.12 (0.20, 2.19)], and attention tasks [ƞp = 0.21 (0.74, 2.77)].

Conclusions: This intervention was associated with medium/large effect size improvements in offspring ER. Larger trials are needed to confirm the potential of these interventions on offspring neurodevelopment.

Trial Registration Number: This trial was registered at www.

Clinicaltrials: gov as NCT01689961 (21 September, 2012).