||Background & aims: The prenatal environment, including availability of critical nutrients, has a profound
impact on offspring development. The present study examined the association between maternal longchain polyunsaturated fatty acid (LC-PUFA) status during pregnancy and later child behavioral problems
at the age of 5e6 years. In light of evidence of autonomic nervous system (ANS) dysregulation in some
behavioral problems, study further tested if the above association is statistically mediated by cardiac ANS
Methods: Data was collected as part of the Amsterdam Born Children and their Development-study and
complete data were available for 1717 mothers and their offspring. Maternal LC-PUFA status was assessed
during early pregnancy (mean gestation ¼ 12.7, SD ¼ 2.5 weeks) and quantified as levels of docosahexenoic acid (DHA), arachidonic acid (AA), eicosapentaenoic acid (EPA), as well as the ratio of n-6:n-3
fatty acids. Child emotional problems and peer problems (internalizing problems), as well as conduct
problems and inattention/hyperactivity (externalizing problems), were assessed using the Strengths and
Difficulties Questionnaire as rated by the mother and teacher at 5e6 years. Child cardiac respiratory sinus
arrhythmia (RSA), pre-ejection period (PEP), and heart rate (HR) were utilized as measures of ANS activity at 5e6 years.
Results: The results confirmed an association between maternal LC-PUFA status and internalizing
behavioral problems as rated by the mother, as shown for DHA (b ¼ 0.11;p < 0.01), EPA (b ¼ -
0.22;p < 0.05), and n-6:n-3 LC-PUFA (b ¼ 0.17;p < 0.01). Statistical mediation was only demonstrated for
HR. No associations were observed between LC-PUFA status and externalizing behavioral problems.
Conclusions: The present results are consistent with a role of maternal LC-PUFA status in internalizing
behavioral problems as rated by the mother. These results were not observed when problem behavior
was rated by the teacher. Analyses did not yield strong evidence supporting ANS activity as a possible
mediator in this relationship.