Mediterranean Diet and Stress Reduction helps prevent adverse pregnancy outcomes: JAMA

Small for gestational age (SGA) birth is a leading cause of perinatal morbidity and mortality, with no effective prevention or treatment. Suboptimal maternal nutrition and high stress levels have been linked to poor fetal growth and adverse pregnancy outcomes.

A new study found that compared to usual care, treating pregnant women at high risk for SGA with a structured Mediterranean diet or mindfulness-based stress reduction significantly reduced the percentage of newborns with birth weights below the 10th percentile.

This study was conducted by Francesca Crovetto and team with the objective To see if structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) can reduce the percentage of newborns born with SGA and other adverse pregnancy outcomes in high-risk pregnancies. The findings of this study were published in the Journal of American Medical Association on 7th December, 2021.

This was a parallel-group randomized clinical trial at a university hospital in Barcelona, Spain, involving 1221 women with singleton pregnancies (19-23 weeks' gestation) who were at high risk for SGA. Enrollment occurred between February 1, 2017 and October 10, 2019, with follow-up until delivery (final follow-up on March 1, 2020). Participants in the Mediterranean diet group (n = 407) received two hours of individual and group education each month, as well as free extra-virgin olive oil and walnuts. Individuals in the stress reduction group (n = 407) participated in an 8-week stress reduction program adapted for pregnancy, which included weekly 2.5-hour sessions and one full-day session. Individuals in the usual care group (n = 407) received prenatal care in accordance with institutional protocols. The primary end point was the proportion of newborns who were SGA at birth, defined as having a birth weight less than the 10th percentile. A composite adverse perinatal outcome was the secondary end point (at least 1 of the following: preterm birth, preeclampsia, perinatal mortality, severe SGA, neonatal acidosis, low Apgar score, or presence of any major neonatal morbidity).

The findings of this study are:

1. The trial was completed by 1184 (97%) of the 1221 randomized individuals (392 individuals assigned to the Mediterranean diet group, 391 to the stress reduction group, and 401 to the usual care group).

2. SGA was observed in 88 newborns (21.9%) in the control group, 55 (14.0%) in the Mediterranean diet group, and 61 (15.6%) in the stress reduction group.

3. A composite adverse perinatal outcome occurred in 105 newborns (26.2%) in the control group, 73 (18.6%) in the Mediterranean diet group, and 76 (19.5%) in the stress reduction group.

4. Structured interventions based on a Mediterranean diet or mindfulness-based stress reduction significantly reduced the risk of SGA newborns in individuals at high risk for this condition; however, the findings need to be replicated as well as assessed in additional patient populations before recommending these treatments to patients.

In conclusion, these findings should be considered preliminary and should be replicated, as well as evaluated in additional patient populations, before recommending these treatments to patients.

Reference:

Crovetto F, Crispi F, Casas R, et al. 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: The IMPACT BCN Randomized Clinical Trial. JAMA. 2021;326(21):2150–2160. doi:10.1001/jama.2021.20178