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Maternal protein intake in early pregnancy and child development at age 3 years



The current study aimed to assess the association between low maternal protein intake during pregnancy and child developmental delay at age 3 years.


This research used data obtained from the Japan Environment and Children’s Study. In total, we analyzed 77,237 mother–child pairs. Dietary intake was assessed using the Food Frequency Questionnaire. Developmental outcomes at age 3 years were evaluated with the Japanese version of the Ages and Stages Questionnaire, Third Edition. A multivariate logistic regression analysis was performed to assess the association between maternal protein intake during pregnancy and child development delays at age 3 years.


Based on the protein-to-total energy intake ratio during early pregnancy, the participants were categorized into three groups: <9.39% (>2 standard deviation below the mean), the severely low protein (SLP) group; 9.39–<13%, the low protein group; and ≥13%, the normal protein group. After adjusting for potential confounding factors, SLP intake was found to be significantly correlated with a higher risk of developmental delay according to the communication, fine motor and problem-solving skill domains.


SLP intake caused by inadequate diet during early pregnancy was associated with a higher risk of child developmental delay at age 3 years.


  • Animal studies have shown that maternal protein restriction during pregnancy and lactation causes abnormal brain development among offspring.

  • Birth cohort studies to date have not assessed the effects of maternal low protein exposure during pregnancy on child development.

  • Severely low protein intake during early pregnancy was associated with a higher risk of child developmental delay at age 3 years.

  • Since nutritional imbalance in early pregnancy affects not only fetal growth but also postnatal neurodevelopment, nutritional management before pregnancy is considered important.

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Fig. 1
Fig. 2: Comparison of breakfast intake frequency before and in early pregnancy among the three groups.

Data availability

Data are unsuitable for public deposition due to ethical restrictions and legal framework of Japan. It is prohibited by the Act on the Protection of Personal Information (Act No. 57 of May 30, 2003, amendment in September 9, 2015) to publicly deposit the data containing personal information. Ethical Guidelines for Medical and Health Research Involving Human Subjects enforced by the Japan Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare also restrict the open sharing of epidemiologic data. All inquiries about access to data should be sent to: The person responsible for handling enquiries sent to this e-mail address is Dr Shoji F. Nakayama, JECS Programme Office, National Institute for Environmental Studies.


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We thank all the participants and co-operating healthcare providers for their contribution to the JECS.


This study was funded by the Ministry of the Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the above government.

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Authors and Affiliations




K.M. conceived and designed the study, drafted the initial manuscript, and revised the manuscript. K.Mo. designed the study and reviewed and revised the manuscript. R.S., S.H., M.K., S.O., Z.Y., and the JECS group collected data and critically reviewed and revised the manuscript. Y.A., T.O., R.K., and H.Y. critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Kunio Miyake.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The Japan Environment and Children’s Study (JECS) protocol was reviewed and approved by the Ministry of the Environment’s Institutional Review Board on Epidemiological Studies and the Ethics Committees of all participating institutions. The JECS was conducted in accordance with the Declaration of Helsinki, and written informed consent was obtained.

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Miyake, K., Mochizuki, K., Kushima, M. et al. Maternal protein intake in early pregnancy and child development at age 3 years. Pediatr Res 94, 392–399 (2023).

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