Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women

Abstract

ImportanceThe 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.ObjectiveTo evaluate whether concordance to a Mediterranean diet pattern around the time of conception is associated with lower risk of developing any APO and individual APOs.Design, Setting, and ParticipantsThis prospective, multicenter, cohort study, the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, enrolled 10 038 women between October 1, 2010, and September 30, 2013, with a final analytic sample of 7798 racially, ethnically, and geographically diverse women with singleton pregnancies who had complete diet data. Data analyses were completed between June 3, 2021, and April 7, 2022.ExposuresAn Alternate Mediterranean Diet (aMed) score (range, 0-9; low, 0-3; moderate, 4-5; and high, 6-9) was computed from data on habitual diet in the 3 months around conception, assessed using a semiquantitative food frequency questionnaire.Main Outcomes and MeasuresAdverse pregnancy outcomes were prospectively ascertained and defined as developing 1 or more of the following: preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, delivery of a small-for-gestational-age infant, or stillbirth.ResultsOf 7798 participants (mean [SD] age, 27.4 [5.5] years), 754 (9.7%) were aged 35 years or older, 816 (10.5%) were non-Hispanic Black, 1294 (16.6%) were Hispanic, and 1522 (19.5%) had obesity at baseline. The mean (SD) aMed score was 4.3 (2.1), and the prevalence of high, moderate, and low concordance to a Mediterranean diet pattern around the time of conception was 30.6% (n=2388), 31.2% (n=2430), and 38.2% (n=2980), respectively. In multivariable models, a high vs low aMed score was associated with 21% lower odds of any APO (adjusted odds ratio [aOR], 0.79 [95% CI, 0.68-0.92]), 28% lower odds of preeclampsia or eclampsia (aOR, 0.72 [95% CI, 0.55-0.93]), and 37% lower odds of gestational diabetes (aOR, 0.63 [95% CI, 0.44-0.90]). There were no differences by race, ethnicity, and prepregnancy body mass index, but associations were stronger among women aged 35 years or older (aOR, 0.54 [95% CI, 0.34-0.84]; P = .02 for interaction). When aMed score quintiles were evaluated, similar associations were observed, with higher scores being inversely associated with the incidence of any APO.Conclusions and RelevanceThis cohort study suggests that greater adherence to a Mediterranean diet pattern is associated with lower risk of APOs, with evidence of a dose-response association. Intervention studies are needed to assess whether dietary modification around the time of conception can reduce risk of APOs and their downstream associations with future development of cardiovascular disease risk factors and overt disease.

Pre-Pregnancy Adherence to Mediterranean Diet and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Greece

“…A recent systematic review and meta-analysis in the non-pregnant population highlighted that adherence to the MD positively affects all parameters of the metabolic syndrome, although further research is needed to specify whether this effect is applicable among healthy and unhealthy individuals [ 50 ]. The protective effect of a MD dietary pattern on pregnancy outcomes has also been demonstrated [ 51 ].…”

A theoretical model of dietary lipid variance as the origin of primary ciliary dysfunction in preeclampsia

“…These studies did not assess efficacy in reducing maternal omega 6:3 ratios. A systematic review of the effects of olive oil consumption on maternal–fetal outcomes shows that higher olive oil consumption is associated with a lower risk of gestational diabetes, preeclampsia, and cardiovascular risk ( Cortez-Ribeiro et al, 2023 ), and patients who adhered most closely to a Mediterranean diet pattern had a significantly lower risk of preeclampsia ( Makarem et al, 2022 ). These studies justify cautious optimism that acquired ciliopathies, including preeclampsia, may also respond to dietary lipid therapy.…”

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

“…While overall dietary patterns that are identified as optimal are similar in nonpregnant and pregnant individuals, increase in caloric intake is needed for fetal development, with higher risk for adverse maternal and fetal outcomes among individuals with inadequate or excessive caloric intake. 35,36 Specific considerations related to dietary intake include avoidance of alcohol 37 and other substances associated with fetal harm (eg, mercury), 38 limiting caffeine intake to less than 200 to 300 mg per day 39 and ensuring adequate folic acid intake (400 µg supplement daily). While maintaining physical activity throughout pregnancy is safe, and pregnant and postpartum individuals are recommended to engage in at least 150 minutes of moderate-intense aerobic activity, systematic reviews demonstrate that pregnancy is associated with decreased physical activity.…”