Mediterranean Diet Associated with Lower Risk of Adverse Pregnancy Outcomes, Suggests New Study

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Greater concordance to the Mediterranean diet was associated with a 28% lower risk of preeclampsia or eclampsia in a new study of more than 7000 women published in JAMA Network Open.

“The Mediterranean diet pattern is inversely associated with the leading causes of morbidity and mortality, including metabolic diseases and cardiovascular disease, but there are limited data on its association with adverse pregnancy outcomes (APOs) among US women,” wrote authors led by Natalie Bello, MD, MPH, director, hypertension research, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Bello and colleagues evaluated whether adherence to a Mediterranean diet pattern around the time of conception is associated with lower risk of developing any APO as well as individual APOs, including preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, delivery of a small-for-gestational-age infant, or stillbirth.

The study was part of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), which enrolled 10 038 women between 2010-2013. Of the women enrolled in nuMoM2b, 7798 (mean age, 27.4 years) were included in the current study.

Participants who were pregnant with their first child answered a semiquantitative food frequency questionnaire during their first study visit, which occurred in the first trimester. The questionnaire focused on participants’ eating habits during the 3 months prior to their visit and asked the women to report their intake of common foods and beverages. Investigators scored each participant response on a scale from 0 to 9 points based on their adherence to the Mediterranean diet, with 6 to 9 points constituting a “high Mediterranean diet score.”

Of the 7798 participants, 9.7% were aged ≥35 years, 10.5% were non-Hispanic Black, 16.6% were Hispanic, and 19.5% had obesity at baseline.

Overall, results showed that greater adherence to the Mediterranean diet was associated with a lower risk of APOs “with evidence of a dose-response association,” suggesting that “women with the highest concordance to this diet pattern prior to conception had the lowest risk of developing APOs.”

The mean score was 4.3 points and researchers observed that around the time of conception:

• 30.6%, or 2388 participants, had high concordance to the diet;
• 31.2%, or 2430 participants had moderate concordance; and
• 38.2%, or 2980 participants, had low concordance.

In multivariable models, a high vs low score was associated with 37% lower odds of gestational diabetes (adjusted odds ratio [aOR]=0.63; 95% CI, 0.44-0.90), 28% lower odds of preeclampsia or eclampsia (aOR=0.72; 95% CI, 0.55-0.93), and 21% lower odds of any APO (aOR=0.79; 95% CI, 0.68-0.92). The team did not observe any differences by race, by race, ethnicity, and prepregnancy body mass index, but associations were stronger among women aged ≥35 years (aOR=0.54; 95% CI, 0.34-0.84; P=.02 for interaction).

“Our findings add to the growing body of evidence demonstrating that the Mediterranean diet pattern may play an important role in preserving the health of women across the lifespan, including during pregnancy,” concluded Bello et al. "Long-term intervention studies are needed to assess whether promoting a Mediterranean-style diet pattern around the time of conception and throughout pregnancy can prevent APOs or reduce their downstream associations with future CVD risk. This may be particularly useful to study in pregnant persons at high risk for APOs."

Reference: Bello NA, Makarem N, Chau K, et al. Association of a Mediterranean diet pattern with adverse pregnancy outcomes among US women. JAMA Netw Open. 2022;5(12):e2248165.