Could the adoption of a Mediterranean diet improve pregnancy outcomes?

In a recent study published in JAMA network openresearchers investigated the correlation between Mediterranean dietary patterns and adverse pregnancy outcomes (APOs).

Study: Association of Mediterranean Diet Patterns with Adverse Pregnancy Outcomes in U.S. Women. Image Credit: Marian Weyo/Shutterstock


APO is a major risk factor for maternal morbidity and mortality, highlighting the need for APO prevention to maintain and improve women’s healthy life expectancy. A history of APO is considered a risk factor for the need for more intensive lifestyle treatment for primary prevention of cardiovascular disease, the leading cause of death among women in the United States. The Mediterranean diet is explained by high consumption of plant foods such as vegetables, fruits, legumes, monounsaturated fats and nuts, and low consumption of processed meats and saturated fats. Higher adherence correlates with lower risk of several chronic diseases and death.

About research

In the current study, researchers determined whether adherence to a Mediterranean diet before and after delivery is associated with a reduced likelihood of developing APO and specific APOs.

In the current multicenter cohort study, conducted between October 1, 2010, and September 30, 2013, at eight medical centers in the United States, 10,038 nulliparous women who gave birth to singleton infants in the first trimester of pregnancy. were registered and followed to birth. Socio-demographic, medical, and lifestyle data were obtained during the first study visit. At 6–13 weeks of gestation and her 2-day first study visit, the team assessed diet at conception using a modified Block 2005 Food Frequency Questionnaire (FFQ). This FFQ examined dietary intake over the past 3 months by examining intake and frequency of approximately 120 beverages and foods and estimating intake for 35 food groups and 52 nutrients. Her FFQ answered by a pregnant woman was verified.

Adaptability to the Mediterranean diet was established using preconception dietary data provided by Block FFQ, and an Alternative Mediterranean Diet (aMed) score was calculated. All dietary factors were adjusted for optimal energy intake using the nutrient density method. The aMed score included nine components: vegetables, nuts, tree nuts, legumes, whole grains, fish, processed and lean meats, monounsaturated to saturated fat ratio, and alcohol.

Primary study outcomes include the incidence of one or more of the following: eclampsia or pre-eclampsia, prenatal hypertension, gestational diabetes, preterm delivery, delivery of a small-for-gestational-age baby, or stillbirth. It included the occurrence of APO, which is A secondary analysis assessed her specific APO. All results were evaluated by a team of maternal and fetal medical experts.


The predominance of low, moderate and high compliance to the Mediterranean diet before and after conception was 38.2%, 31.2% and 30.6% respectively. A comparison of clinical and sociodemographic characteristics across defined aMed score categories showed that women with higher aMed scores were more likely to be non-Hispanic white, older, married, nonsmokers, and more likely to be educated. indicated to be high and unlikely. Have a body mass index (BMI) in the obese category. Compared with participants with low aMed scores, participants with high aMed scores had a lower prevalence of APO and a significantly lower incidence of neonatal delivery at small gestational age and pre-eclampsia.

In a multivariable model, people with high aMed scores were 21% less likely to develop APO than those with low aMed scores.In addition, high aMed scores were associated with a 28% reduced risk of eclampsia or pre-eclampsia. and reduced the risk of gestational diabetes by 37%. The team also noted no significant associations between aMed scores and the likelihood of premature birth, prenatal hypertension, small-for-gestational age, or stillbirth.

When assessing the relationship between the components of the aMed score and the primary findings, plant-based foods were inversely associated with APO. In particular, consumption of fruits, vegetables, and legumes was associated with a reduced likelihood of developing APO. Following fish guidelines showed a significant association with reduced incidence of APO. Whole grains, nuts, fat, alcohol, and red meat scores were less associated with the risk of developing APO. Higher fruit, vegetable, and fish intake was associated with reduced risk of eclampsia and pre-eclampsia. In contrast, those who consumed more vegetables and less processed and red meat were associated with a lower risk of gestational diabetes.


The results of this study showed that higher compliance with a Mediterranean diet at conception correlated with a lower risk of experiencing APO, especially eclampsia or pre-eclampsia and gestational diabetes. and suggested that women who adhered strongly to this diet prior to conception were the least likely to develop APO.

Additionally, higher consumption of fruits, vegetables, legumes, whole grains, and fish and lower consumption of processed and red meat were associated with a lower risk of APO. may be an important lifestyle intervention to prevent APO.

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