Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals

Abstract

IMPORTANCE Being born small for gestational age (SGA) is a leading cause of perinatal morbidity and mortality with no effective prevention or therapy. Maternal suboptimal nutrition and high stress levels have been associated with poor fetal growth and adverse pregnancy outcomes. OBJECTIVE To investigate whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) in high-risk pregnancies can reduce the percentage of newborns who were born SGA and other adverse pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS Parallel-group randomized clinical trial conducted at a university hospital in Barcelona, Spain, including 1221 individuals with singleton pregnancies (19-23 weeks' gestation) at high risk for SGA.

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

“…There are still very few studies correlating MD in pregnancy and the development of malformations in the unborn fetus, as few are the evidence correlating maternal MD adherence to fetal growth restriction, risk of SGA newborn and preterm delivery. [ 17 ]. Currently, there is only one randomized controlled study that implemented an early nutritional intervention with MD supplementation with extra virgin olive oil and pistachios, resulting in a significant reduction in preterm birth rate [ 18 ].…”

“…This research gap was partially filled by a Spanish randomized control trial conducted on three groups of women with high-risk pregnancies who underwent either MD or mindfulness-based stress reduction interventions versus usual care. The study showed that the percentage of newborns with birth weight below the 10th percentile dropped significantly in the groups that received either one or the other intervention [ 17 ].…”

Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial

“…The main results of this trial have been previously described [ 26 ] and the study protocol has been described elsewhere [ 27 ]. For the present analysis, from the total sample of 1221 randomized participants, 215 participants were excluded because of missing data on dietary information, and 36 participants showed extreme energy intake outside predefined limits [ 28 ], including 970 participants at high risk of developing SGA during pregnancy in the final dataset ( Figure 1 ).…”

“…Newborns’ birthweight: Birthweight percentile was calculated with birthweight adjusted by gestational age at delivery and gender, according to standards for the Spanish population [ 26 ]. SGA was defined as birthweight below the 10th percentile, severe SGA as birthweight below the 3rd percentile [ 33 , 34 ].…”

“…Another study by de Andrade Miranda et al has reported an association between a proinflammatory diet and inadequate birthweight including SGA and large for gestational age infants [ 25 ]. In addition, our group has demonstrated—for the first time—in a recent clinical trial (the Improving Mothers for a better PrenAtal Care Trial Barcelona (IMPACT BCN)) with more than 1200 pregnant women involved that a structured lifestyle intervention during pregnancy can reduce SGA for which no previous treatment gave positive effects [ 26 ]. Specifically, a nutritional intervention—based on MD—was applied in one of the trial arms and demonstrated a reduction in the incidence of SGA by 36% (14% in the MD group vs. 21.9% in the non-intervention group) and perinatal complications by 26% (18.6% in the MD group vs. 26% in the non-intervention group) [ 26 ].…”