Maternal malnutrition and cerebral palsy: what we know
Cerebral palsy is a lifelong condition that affects movement, muscle tone, and posture. It happens because of damage to the developing brain during pregnancy, birth, or shortly after birth, and it is one of the leading causes of physical disability in children worldwide.[1][5]
Researchers now agree that cerebral palsy rarely has a single cause. Instead, it usually results from several factors acting together. These may include premature birth, lack of oxygen to the baby, infections during pregnancy or around birth, genetic factors, and problems with the placenta or the baby’s growth in the womb.[1][5][7] Nutrition is part of this bigger picture, because it influences many of these risk factors.
How maternal malnutrition affects pregnancy and the baby’s brain
When a woman does not get enough energy, protein, vitamins, or minerals before or during pregnancy, her body has to choose between her own needs and those of the growing fetus. Poor nutrition can affect:
1. Growth of the baby
Inadequate nutrition can lead to intrauterine growth restriction and low birth weight. Low birth weight and poor growth are closely linked to preterm birth and other complications that raise cerebral palsy risk.[4][7] Preterm babies have very fragile brains and blood vessels, which makes them more vulnerable to bleeding, oxygen shortage, and white matter injury all key pathways that can lead to cerebral palsy.[7]
2. Timing of birth
Poor nutrition before and during pregnancy increases the risk of preterm birth.[4] Preterm birth, especially before 32 to 34 weeks, is one of the strongest and most consistent risk factors for cerebral palsy because the immature brain is very sensitive to damage.[7] In this way, maternal malnutrition can indirectly raise the risk of cerebral palsy by making preterm birth more likely.
3. Placental function and oxygen supply
Malnutrition can impair placental development and blood flow. This can reduce the supply of oxygen and nutrients to the fetus. Chronic low oxygen and nutrient supply can disturb normal brain development and may contribute to brain injury that underlies cerebral palsy.[1][5] While many studies focus on acute events like sudden lack of oxygen during birth, long term mild shortages during pregnancy may also be harmful.
4. Maternal health and complications
Poor nutrition before and during pregnancy is associated with anemia, infections, and high blood pressure disorders such as preeclampsia.[4] These problems, in turn, can cause placental insufficiency, fetal distress, premature delivery, and the need for emergency interventions. All of these are known contributors to cerebral palsy risk.[1][7]
Specific nutrients that matter for brain development
Several nutrients are especially important for the baby’s brain and overall development. Deficiencies do not guarantee cerebral palsy, but they raise the chances of complications that can lead to brain injury.
Folic acid and related B vitamins
Folic acid is well known for preventing neural tube defects, but research is now exploring its link with broader neurodevelopmental outcomes, including cerebral palsy. A study on continuous maternal folic acid supplementation found that the risk of cerebral palsy in children appears to be influenced by parental metabolic disorders and genital tract inflammation, suggesting that adequate folate status may help offset some of these risks.[3] While this study does not prove that folic acid directly prevents cerebral palsy, it supports the idea that good maternal metabolic and nutritional health is protective.
Iron
Iron deficiency is common among women of reproductive age. In the United States, about 1 in 5 pregnant women are iron deficient.[4] Iron deficiency in pregnancy is linked to premature birth, restricted fetal growth, low birth weight, and developmental delays.[4] These outcomes all overlap with known pathways to cerebral palsy. Iron is also essential for brain myelination and neurotransmitter function. While direct studies connecting maternal iron deficiency to cerebral palsy are limited, the chain of effects from anemia to preterm birth and growth restriction suggests an indirect link.
Vitamin D, essential fatty acids, and other micronutrients
Many women of reproductive age are vitamin D deficient, and a large percentage are folic acid deficient as well.[4] Poor overall micronutrient status is associated with low birth weight, developmental delays, and later cognitive problems.[4] Omega 3 fatty acids, iodine, zinc, and choline are also important for brain development. Deficiencies may not be singled out as direct causes of cerebral palsy in studies, but they form part of the broader nutritional and metabolic environment that shapes fetal brain growth.
Obesity, overnutrition, and metabolic health
Malnutrition does not only mean too little food. It also includes diets that are high in calories but poor in nutrients, which can lead to obesity and metabolic disorders.
Maternal obesity has been tied to a higher risk of neurodevelopmental disorders such as epilepsy in children.[6] Some research suggests that maternal metabolic problems, including obesity and diabetes, may be associated with cerebral palsy through inflammation, abnormal placental function, and higher rates of complications like preeclampsia and preterm birth.[3][6] This means that both undernutrition and unhealthy overnutrition can create a risk environment for the baby’s brain.
Infection, inflammation, and nutrition
Maternal infections during pregnancy such as rubella, cytomegalovirus, toxoplasmosis, and chorioamnionitis are well recognized risk factors for cerebral palsy.[2][5] These infections can trigger inflammation, damage blood vessels, and interfere with normal brain development. Poor nutritional status can weaken the immune system, making infections more likely or more severe.
Genital tract inflammation and metabolic disorders before or during pregnancy have been linked with cerebral palsy risk in children in the folic acid supplementation study.[3] This suggests that controlling inflammation and maintaining good nutritional and metabolic health may reduce some of the pathways that lead from infection to brain injury.
Preterm birth as a key link between malnutrition and cerebral palsy
Preterm birth is one of the most studied and strongest risk factors for cerebral palsy.[7] Babies born preterm are at high risk for:
• Brain hemorrhage
• Periventricular leukomalacia (white matter injury)
• Severe infections
• Breathing problems that reduce oxygen supply
All of these can result in the brain injury patterns seen in children with cerebral palsy.[5][7]
Maternal malnutrition both before and during pregnancy is associated with increased risk of preterm birth.[4] This means malnutrition often acts as an upstream factor, setting off a sequence that includes premature delivery and, for some infants, the brain injuries that lead to cerebral palsy.
What current evidence does and does not say
When we ask whether maternal malnutrition is tied to cerebral palsy risk, it is important to be precise about what is known.
• There is strong evidence that poor maternal nutrition increases the risks of low birth weight, preterm birth, stillbirth, developmental delays, and infant death.[4]
• There is strong evidence that preterm birth, low birth weight, infections, and lack of oxygen are major risk factors for cerebral palsy.[1][5][7]
• There is growing evidence that parental metabolic health and inflammation, which are influence
