BackgroundQuantifying long-term offspring cardiometabolic health risks associated with maternal prenatal anxiety and depression can guide cardiometabolic risk prevention. This study examines associations between maternal prenatal anxiety and depression, and offspring cardiometabolic risk from birth to 18 years.MethodsParticipants were 526-8,606 mother-offspring pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were anxiety (Crown-Crisp Inventory score) and depression (Edinburgh Postnatal Depression Scale score) measured at 18 and 32 weeks gestation. Outcomes were trajectories of offspring body mass index; fat mass; lean mass; pulse rate; glucose, diastolic and systolic blood pressure; triglycerides, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol, and insulin from birth/early childhood to 18 years. Exposures were analysed categorically using clinically relevant, cut-offs and continuously to examine associations across the distribution of prenatal anxiety and depression.ResultsWe found no strong evidence of associations between maternal anxiety and depression, and offspring trajectories of any cardiometabolic risk factors, except for small, inconsistent associations with fat mass trajectories that attenuated upon confounder adjustment. For instance, in unadjusted analyses, anxiety at both 18 and 32 weeks was associated with a 1.8% (95% Confidence Interval (CI), 0.29,3.33) higher mean BMI, which spanned the null (difference (95% CI): 0.7% (−0.76,2.13) after adjustment for confounders.ConclusionsThis is the first examination of maternal prenatal anxiety and depression and trajectories of offspring cardiometabolic risk. Our findings suggest that prevention of maternal prenatal anxiety and depression may have limited impact on offspring cardiometabolic health across the first two decades of life.