Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial

Abstract

Background Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. Methods and findings We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks’ gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3–10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0–64.6, p ≤ 0.001) than controls; increased their intake of fish ( p < 0.001), white meat ( p < 0.001), and pulses ( p = 0.05); and reduced their intake of red meat ( p < 0.001), butter, margarine, and cream ( p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56–1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58–1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47–0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference −1.2 Kg, 95% CI −2.2 to −0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offsprin...

Maternal Dietary Patterns during Pregnancy and Their Association with Gestational Weight Gain and Nutrient Adequacy

“…Accordingly, our study's main findings support the previous recommendation as we found an association between the classically traditional healthy Mediterranean dietary pattern richer in vegetables, olive oil, and nuts, and lower GWG. In line with our findings, Bassel et al reported that a Mediterranean-style diet characterized by a high intake of extra virgin olive oil, vegetables, and legumes had a potential role in reducing GWG in British pregnant women [33]. Furthermore, the scientific literature has shown that an increased intake of whole-grain cereal has a positive effect on reducing weight gain not only in a general adult [34] but also in the pregnant women population [35].…”

Liver Diseases in the Perinatal Period: Interactions Between Mother and Infant

“…). The Mediterranean diet in at‐risk pregnant women decreased the odds of gestational diabetes by 35% with a 1.2‐kg reduction in weight gain during pregnancy . Likewise, intensive maternal lifestyle modification counseling reduced the risk of large for gestational age newborns .…”

Proteome Analysis of Walnut Bacterial Blight Disease

“…Walnuts are an excellent source of plant-based protein, fiber, magnesium, polyphenols, and α-linolenic acid, a plant-derived omega-3 fatty acid [ 5 , 6 ]. The regular consumption of walnuts has been linked to positive health outcomes, including improved cognitive function, reduced cancer, diabetes, and weight control, as well as heart, gut, and reproductive health [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], as part of the “Mediterranean diet” [ 15 , 16 ]. The increasing demand for walnuts has supported the robust growth in global nut production [ 4 ], reaffirming the increasing importance of the walnut industry.…”