Pregnancy is a critical period where the health and wellbeing of both the mother and the developing baby are of utmost importance. Lifestyle interventions during pregnancy have emerged as a promising approach to promote optimal maternal health and potentially reduce pregnancy complications. These interventions encompass a range of factors such as diet, physical activity, and stress management, all of which have the potential to positively impact long-term outcomes for both the mother and child.
Numerous studies on maternal diet before and during pregnancy have reported long-term implications for both the mother’s and baby’s health, from placental development (1), risk of developing gestational diabetes (2), birth complications (3) and birth weight (4). More recently focus has shifted on the Mediterranean diet in particular, as it is widely recognised for its healthy dietary pattern, which includes a high intake of fruits, vegetables, whole grain cereals, legumes, fish and nuts. Researchers have demonstrated that a Mediterranean diet intervention in pregnant women proved to lower the risk of developing gestational diabetes (5, 6).
Mind–body interventions have also emerged as non-pharmacological therapies. These interventions are based on several practices designed to facilitate the mind’s positive impact on the body. Studies in pregnancy have reported that mindfulness-based interventions played a significant positive role in reducing stress for most types of pregnant women and were associated with lower levels of anxiety, depression and perceived stress (7, 8). However, no studies have evaluated the effect of these interventions on pregnancy outcomes.
The IMPACT BCN Trial: Examining the Effects of Mediterranean Diet and Mindfulness
We recently reported on a study carried out by researchers from BCNatal (Hospital Clínic-IDIBAPS and Hospital Sant Joan de Déu in Barcelona) with the support of Cerebra and published in JAMA. The results demonstrated for the first time, that a Mediterranean diet or mindfulness-based stress reduction intervention during pregnancy reduces the percentage of low birth weight by 29-36% and improves complications in pregnancy for which no previous treatment had demonstrated positive effects, when used in a structured, guided manner (9).
The three-year IMPACT BCN clinical trial involved more than 1,200 pregnant women at high risk of having a small baby at birth. Participants were randomly divided into three groups: one in which they had visits with a nutritionist in order to follow a Mediterranean diet, a second group in which they followed a mindfulness programme to reduce stress, and a control group with standard care.
The Role of Diet in Women’s Wellbeing, Sleep Quality, and Stress during Pregnancy
The group has continued working on the analysis of the data generated by the IMPACT BCN trial with the aim to better understand the mechanisms behind these benefits and further evaluate their impact. A recent subanalysis (10) evaluated the effects of a Mediterranean diet intervention on maternal wellbeing, sleep quality, and stress throughout pregnancy.
Although pregnancy is a transformative and exciting time, it also brings immense physical and emotional changes for women. Hormonal fluctuations, weight gain, and the anticipation of becoming a mother can all contribute to increased stress levels and decreased overall well-being. In addition, sleep disturbances are common during pregnancy, further exacerbating these issues. Although there has been increasing interest on the effects of a Mediterranean diet on mental health, stress, and quality of life in general (11), the role of diet on women’s’ wellbeing during pregnancy remains undefined. The current study, conducted as a part of the IMPACT BCN trial, aimed to address that.
Analysis included participants from the Mediterranean diet and control groups. Participants in the intervention group were given olive oil and walnuts and were encouraged to eat fresh fruit, whole grains, vegetables and dairy products, as well as consuming a diet rich in legumes, fish and white meat. Women in the non-intervention group received pregnancy care as per institutional protocols. Neither group receive advice or intervention on mental health, sleep quality, well-being, stress, or anxiety.
Questionnaires were used to obtain information on dietary patterns, lifestyles, anxiety, stress levels, well-being, and sleep quality at baseline and follow-ups during the study. Levels of cortisone, cortisol, and other metabolites in urine were also measured in a subset of the participants.
The results demonstrated that a Mediterranean diet intervention significantly reduced the stress and anxiety levels of pregnant women, as well as improved their sleep quality and well-being throughout their pregnancy. Considering the increasing importance of the role of mental health during pregnancy, these findings might imply the promotion of a pregnancy-adapted Mediterranean diet among pregnant women as a powerful public health strategy.
Maternal Pro-Inflammatory Diet and its Impact on Perinatal Outcomes
Another recently published subanalysis of the IMPACT trial data (12) identified maternal pro-inflammatory diet as a risk factor to developing maternal overweight and low-weight foetuses. Pregnancy involves several physiological changes to promote foetal growth and prepare the mother for delivery, including a systemic immune-inflammatory response (13). Although gestation is considered to have an anti-inflammatory profile, some pregnancy stages are characterized by increased inflammation. The balance between pro-inflammatory and anti-inflammatory molecules determines a physiological, or complicated pregnancy course (14).
Diet plays a key role in the regulation of chronic inflammation in pregnant and non-pregnant adults (15, 16). The current analysis aimed to further explore the relationship between the Dietary Inflammatory Index (DII) and perinatal outcomes, shedding light on the importance of maternal dietary choices during pregnancy.
The study, conducted as part of the IMPACT BCN trial, involved a large sample of pregnant women. Their dietary information was assessed using a 17-item dietary score to evaluate Mediterranean diet adherence and a 151-item food frequency questionnaire. DII score was established according to 33 food and nutritional pro-inflammatory and anti-inflammatory items.
The results revealed an association between a higher DII with maternal overweight and foetal undergrowth. Pregnant women with an anti-inflammatory diet profile showed a high adherence to the Mediterranean diet. As such, nutritional interventions during pregnancy aiming to improve dietary patterns could be an effective measure to improve the maternal dietary inflammatory profile and reduce the risk of adverse perinatal outcomes.
Promoting Optimal Perinatal Outcomes: The Importance of Lifestyle Interventions
Both studies provide further evidence on the effectiveness of structured lifestyle interventions in pregnant women. They emphasize the importance of maintaining a healthy and balanced diet during pregnancy to reduce the risk of complications and promote optimal foetal development. By implementing strategies to improve maternal nutrition, such as increasing access to fresh and nutritious foods, affordability, educating women about the importance of a healthy diet during pregnancy, and providing support and resources, we can strive towards better perinatal outcomes.
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