Maternal Anxiety and Depression in the Context of Suspected Infant Food Allergy: A Prospective Cohort Study on Trajectories and Predictors

The period of suspected infant food allergy places a significant psychological burden on mothers. However, the key drivers of their long-term emotional trajectories remain unclear. To identify the stronger predictor of long-term maternal anxiety and depression: dietary avoidance or baseline psychological status. A prospective cohort (Oct 2023-Feb 2025) recruited 75 mother-infant dyads from Children's Hospital of Chongqing Medical University, China. Infants were classified as suspected food allergy group ( n=40) or non-food allergy group (n=35). All were exclusively breastfed initially. Maternal anxiety (GAD-7), depression (PHQ-9), allergy-related dietary avoidance, and parental burden (FAQL-PB) were assessed at baseline (infant age 4-6 months) and again at 12 months of age. Multiple linear regression identified predictors of follow-up emotional status. At baseline, mothers in the suspected food allergy group had significantly higher anxiety and depression scores than non-food allergy group ( p <0.001). Avoiding ≥5 food types was associated with greater initial burden. However, after adjustment for baseline scores and demographics, the number of avoided foods was not an independent predictor of follow-up anxiety (β =-0.19, p =0.174) or depression (β =-0.01, p =0.902). Baseline scores were the strongest predictors of their respective outcomes at follow-up (anxiety β=0.51, depression β=0.51, both p <0.001). While quality of life improved significantly for mothers avoiding ≥5 foods ( p =0.041), their anxiety and depression levels did not. For mothers of infants with suspected food allergy, long-term emotional health is more closely tied to initial psychological state than to dietary strictness. Clinical care could consider prioritizing early psychological screening and support, alongside efforts to reduce diagnostic uncertainty. Validation in broader populations is needed.