Maternal Nutritional Status and Intrauterine Programming: Epigenetic Mechanisms and Their Impact on Offspring Health

Maternal nutritional status before and during pregnancy is an important modifiable factor that may influence foetal development and long-term offspring health. Both undernutrition and excessive maternal body weight have been associated with adverse metabolic, cardiovascular, neurodevelopmental and immune-related outcomes in offspring. This narrative review summarises selected experimental, clinical and epidemiological evidence on maternal nutritional status, intrauterine programming and offspring health. Relevant literature was identified by searching the PubMed, Scopus and Web of Science databases covering publications from 2000 to 2026, with the majority of included papers published after 2015. The search terms included maternal nutrition, undernutrition, obesity, intrauterine programming, DOHaD, epigenetics, DNA methylation, microRNA and offspring health. The available evidence suggests that maternal undernutrition is associated with intrauterine growth restriction (IUGR) and an increased risk of cognitive and metabolic disorders. In contrast, maternal overweight or obesity is associated with macrosomia, as well as an increased risk of obesity, cardiovascular disease and metabolic dysfunction in later life. Both extremes of maternal nutritional status may also negatively affect the psychological health of the offspring. These associations suggest a potential role for epigenetic mechanisms; however, causal conclusions from observational studies in humans remain limited. Overall, the findings highlight the importance of optimising maternal nutritional and metabolic status before and during pregnancy as a key strategy for promoting favourable intrauterine programming and improving long-term offspring health. A better understanding of the underlying epigenetic mechanisms could facilitate the development of targeted nutritional and preventive interventions. As a narrative review, this analysis is limited by the associative nature of human observational studies and the inherent challenges in separating intrauterine effects from postnatal environmental confounders.