Programming offspring bone health: mechanistic perspectives on maternal macro- and micronutrient intake

Maternal nutrition is a critical determinant of offspring bone health through the process of fetal programming. Adequate intake of both macro- and micronutrients during pregnancy supports skeletal development, bone mineralization, and long-term bone health. In contrast, maternal undernutrition, overnutrition, or nutrient imbalance can impair bone quality, alter microarchitecture, and increase the risk of osteoporosis in later life. Emerging evidence indicates that these effects are mediated by hormonal regulation, oxidative stress, and epigenetic modifications that influence osteoblast function and gene expression. In this narrative review, we critically evaluate the effect of maternal nutrition on offspring bone health and underlying mechanisms, with emphasis on macro- and micronutrients. Studies in animal and human models reveal that both excessive and deficient maternal diets disrupt the offspring's bone microarchitecture, highlighting how nutrient-sensing pathways, endocrine signalling, and epigenetic mechanisms perpetuate these effects across generations. Despite substantial advances in understanding maternal nutrition's role in offspring bone health, critical gaps remain, particularly in human intervention trials evaluating the impact of maternal macro and micronutrient status on progeny skeletal development. Accordingly, this review highlights current research gaps and outlines future directions necessary to advance understanding in this field. A deeper knowledge of these mechanisms will help develop targeted nutritional strategies during pregnancy to optimize offspring skeletal outcomes and reduce long-term risk of bone disease.