Pregnant women who eat a Mediterranean diet can significantly cut their risk of having a baby born small or underweight, says new study.

Being born too small for gestational age (SGA) is a major cause of perinatal disease and death, but there is no way to stop or treat it. Maternal poor nutrition and high stress levels have been linked to poor fetal growth and bad pregnancy outcomes.

This new study looked into whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) in high-risk pregnancies can cut the number of babies born small and other bad things that happen during pregnancy.

Small for gestational age (SGA) infants, defined as birth weights below the 10th percentile, account for a significant fraction of perinatal mortality and morbidity, as well as impaired neurodevelopment in children.

SGA currently has no effective preventive or treatment. SGA and other obstetric problems may be linked to maternal lifestyle variables such as poor nutrition and excessive levels of stress.

This link is thought to be mediated by impacts on systemic and placental inflammation, oxidative stress, and cellular senescence, all of which are involved in the pathophysiology of SGA.

However, no randomized controlled trials have been conducted to assess the effect of therapies aiming at improving diet, lowering stress, or both on the prevention of SGA.

Interventions based on the Mediterranean diet may minimize negative health outcomes such as cardiovascular events, diabetes, cognitive decline, and other inflammatory-related disorders. Two randomized trials employing the Mediterranean diet in pregnant women with obesity or “normal weight” found that the incidence of gestational diabetes was reduced significantly. Although it was not the primary goal, one of these trials revealed a decrease in the incidence of SGA.

Mindfulness meditation and other mind-body therapies have emerged as useful adjuncts for stress-related disorders, although evidence of their effects on objective health outcomes is limited. Mindfulness-based stress reduction (also known as stress reduction) is a systematic approach that has been widely employed in medical studies. Small studies in pregnancy have found that stress reduction is possible and is associated with lower subjective stress and anxiety. However, no studies have been conducted to examine the impact of stress reduction on pregnancy outcomes.

The purpose of this study was to see if structured lifestyle interventions based on the Mediterranean diet or stress reduction minimize the incidence of birth weight below the 10th percentile and adverse pregnancy outcomes in people at risk for SGA.

The trial was completed by 1184 (97 percent) of the 1221 randomized individuals (median [IQR] age, 37 [34-40] years) (392 persons assigned to the Mediterranean diet group, 391 to the stress reduction group, and 401 to the usual care group).

SGA occurred in 88 newborns (21.9 percent) in the control group, 55 (14.0 percent) in the Mediterranean diet group (odds ratio [OR], 0.58 [95 percent CI, 0.40-0.84]; risk difference [RD], 7.9 [95 percent CI, 13.6 to 2.6]; P =.004), and 61 (15.6 percent) in the stress reduction group (OR, 0.66 [95 percent CI, 0.46-0.94]; RD, 6.3 [95 percent CI, −11.8 to −0.9]; P = .02).

The composite adverse perinatal outcome occurred in 105 newborns (26.2 percent) in the control group, 73 (18.6 percent) in the Mediterranean diet group (OR, 0.64 [95 percent CI, 0.46-0.90]; RD, 7.6 [95 percent CI, 13.4 to 1.8]; P =.01), and 76 (19.5 percent) in the stress reduction group (OR, 0.68 [95 percent CI, 0.49-0.95]; RD, −6.8 [95% CI, −12.6 to −0.3]; P = .02).

This randomized trial carried out at a single hospital in Spain found that treatment of pregnant women at high risk for SGA with a structured Mediterranean diet or mindfulness-based stress reduction, compared to usual care, significantly reduced the percentage of newborns with birth weights below the 10th percentile in this randomized trial conducted at a single institution in Spain. 

This randomized trial carried out at a single institution in
Spain found that the percentage of babies born with a birth weight below the 10th percentile dropped significantly when pregnant women at high risk for SGA were treated with a structured Mediterranean diet or mindfulness-based stress reduction instead of usual care.

Due to significant study limitations, these findings should be regarded as preliminary and require replication, as well as review in additional patient populations, before recommending these treatments to patients.

Source: doi:10.1001/jama.2021.20178

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