Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment

Abstract

ImportanceMaternal suboptimal nutrition and high stress levels are associated with adverse fetal and childhood neurodevelopment.ObjectiveTo test the hypothesis that structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (MBSR) during pregnancy improve child neurodevelopment at age 2 years.Design, Setting, and ParticipantsThis was a prespecified analysis of the parallel-group Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) randomized clinical trial, which was conducted at a university hospital in Barcelona, Spain, from February 2017 to March 2020. A total of 1221 singleton pregnancies (19 to 23 weeks’ gestation) with high risk of delivering newborns who were small for gestational age were randomly allocated into 3 groups: a Mediterranean diet intervention, an MBSR program, or usual care. A postnatal evaluation with the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), was performed. Data were analyzed from July to November 2022.InterventionsParticipants in the Mediterranean diet group received monthly individual and group educational sessions and free provision of extra virgin olive oil and walnuts. Those in the stress reduction group underwent an 8-week MBSR program adapted for pregnancy. Individuals in the usual care group received pregnancy care per institutional protocols.Main Outcomes and MeasuresNeurodevelopment in children was assessed by Bayley-III at 24 months of corrected postnatal age.ResultsA total of 626 children (293 [46.8%] female and 333 [53.2%] male) participated at a mean (SD) age of 24.8 (2.9) months. No differences were observed in the baseline characteristics between intervention groups. Compared with children from the usual care group, children in the Mediterranean diet group had higher scores in the cognitive domain (β, 5.02; 95% CI, 1.52-8.53; P = .005) and social-emotional domain (β, 5.15; 95% CI, 1.18-9.12; P = .01), whereas children from the stress reduction group had higher scores in the social-emotional domain (β, 4.75; 95% CI, 0.54-8.85; P = .02).Conclusions and RelevanceIn this prespecified analysis of a randomized clinical trial, maternal structured lifestyle interventions during pregnancy based on a Mediterranean diet or MBSR significantly improved child neurodevelopmental outcomes at age 2 years.Trial RegistrationClinicalTrials.gov Identifier: NCT03166332

Maternal Diet Quality during Pregnancy Is Associated with Neonatal Brain White Matter Development

“…Of special interest is that maternal dietary quality and nutrient intake during pregnancy have been found to be associated with offspring cognition and behavior development during childhood. A recent study showed higher maternal dietary intake quality during pregnancy was associated with better visual-spatial skills [5] and cognitive scores [6] in offspring at early childhood, in addition to the literature reports of positive associations with higher intelligence and executive functions at mid-childhood [5,7]. Meanwhile, there is also evidence showing associations between specific components of maternal dietary intake and the cognitive, neurophysiological, and behavioral outcomes of offspring.…”

Basic Environmental Supports for Positive Brain and Cognitive Development in the First Year of Life

“…An emerging literature has begun to detail the material and psychosocial factors that drive the development of a robust neural infrastructure supporting cognitive and emotional flourishing. Beginning in utero, fetal neurodevelopment is impacted by maternal psychopathology and stress . Recent data suggest that maternal experiences of psychosocial adversity during pregnancy (poverty, discrimination, low social support, and exposure to neighborhood crime) impact fetal structural and functional brain development .…”

“…Beginning in utero, fetal neurodevelopment is impacted by maternal psychopathology and stress. [8][9][10][11] Recent data suggest that maternal experiences of psychosocial adversity during pregnancy (poverty, discrimination, low social support, and exposure to neighborhood crime) impact fetal structural and functional brain development. [12][13][14] Such early developmental experiences powerfully impact brain development in ways that, while adaptive for expected early adverse contexts, may prove maladaptive later in development.…”

The Mediterranean Diet in Pregnancy: Implications for Maternal Brain Morphometry in a Secondary Analysis of the IMPACT BCN Randomized Clinical Trial

“…Recently, the IMPACT BCN (Improving Mothers for a better PrenAtal Care Trial BarCeloNa) randomized clinical trial showed that structured lifestyle interventions during pregnancy based on a Mediterranean diet or a mindfulness-based stress reduction program reduced the incidence of newborns born small for gestational age (SGA) and other adverse pregnancy outcomes [ 22 ], as well as supporting a different fetal brain structure [ 23 ] and the better neurodevelopment of infants at 2 years of age [ 24 ]. Moreover, the Mediterranean diet intervention was associated with a significant reduction in maternal anxiety and stress for the pregnant women [ 25 ].…”