Mediterranean Diet, Mindfulness Each Reduce Small-for-Gestational Age Births

By Lisa Rapaport

January 06, 2022

(Reuters Health) - Pregnant women at high risk for having small-for-gestational age newborns may be able to avoid that outcome by following a Mediterranean diet or practicing mindfulness-based stress reduction, a clinical trial suggests.

Researchers randomly assigned 1,221 women with singleton pregnancies at 19 to 23 weeks' gestation to participate in a Mediterranean diet program, a mindfulness-based stress reduction program, or join a control group receiving only usual pregnancy care. Avoidance of small-for-gestational age (SGA) infants, which researchers defined as a birth weight below the 10th percentile, was the primary endpoint of the trial.

A total of 1,184 women completed the trial, including 392 assigned to the Mediterranean diet group and 391 randomized to stress reduction.

Women in the diet group received two hours per month of individual or group education on how to follow a Mediterranean diet as well as provisions of walnuts and olive oil to supplement food consumed at home through the end of the intervention at 34-36 weeks gestation.

Women in the therapy group received 8 weeks of therapy including one day-long session as well as weekly 2.5-hour sessions in mindfulness-based stress reduction.

Compared with the control group, women were significantly less likely to have SGA births in both the Mediterranean diet group (odds ratio 0.58) and the stress reduction group (OR 0.66). Overall, there were a total of 88 (21.9%) SGA babies in the control group, compared with 55 (14.0%) in the Mediterranean diet group and 61 (15.6%) in the stress reduction group, the study team reports in JAMA.

"The relationship between poor or sub-optimal lifestyle and small-for-gestational-age and other pregnancy complications is well established," said senior study author Dr. Eduard Gratacos of the University of Barcelona, in Spain.

"However, so far, no clinical trials had addressed whether structured lifestyle interventions focused on nutrition or stress could reduce the rate of small-for-gestational age births," Dr. Gratacos said by email.

While the exact mechanism for this isn't clear, both interventions used in the study have been associated with reductions in inflammation, oxidative stress, and cell aging - all processes that have been documented in fetal growth restriction and placental insufficiency, Dr. Gratacos said.

The study also focused on a composite secondary endpoint of adverse perinatal outcomes including preterm birth, preeclampsia, perinatal mortality, severe SGA, neonatal acidosis, low Apgar score, or any major neonatal morbidity.

Compared with the control group, women were significantly less likely to experience adverse perinatal outcomes in both the Mediterranean diet group (OR 0.64) and the stress reduction group (OR 0.68).

One limitation of the study is the potential for cross effects, the authors note. The diet might have improved mental health or the stress reduction might have improved eating habits. It's also possible that the women in the control group had fewer interactions with health providers or less personal interaction with providers than the intervention groups, impacting the outcomes.

"These results represent important novel findings, given that there is no proven intervention for prevention of SGA," write Margaret Bublitz and Dr. Methodius Tuuli of the Warren Alpert Medical School of Brown University in Providence, Rhode Island, in an accompanying editorial.

"The important limitations, including the homogeneous study population, high-resource setting, and evaluation of only short-term outcomes, limit the generalizability of the findings," they write. "Accordingly, implementation of these interventions into clinical practice should await results of the neurodevelopmental assessment and other outcomes among the offspring at 2 years of age and replication of the study results in other populations."

SOURCE: https://bit.ly/3HERv6J and https://bit.ly/3pYrERc JAMA, online December 7, 2021.

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