Effect of Mediterranean Diet in Pregnant Women with Metabolic Risk Factors

by | Nov 19, 2019 | 2019, Diabetes, Mediterranean Diet, Pregnancy and Lactation, Women's Health

Written by Chrystal Moulton, Staff Writer. Mediterranean diet attributed to significantly reduced risk of gestational diabetes in high- risk mothers.

Mediterranean DietThe Mediterranean diet is characterized by high intake of nuts, extra virgin olive oil, fruits, vegetables, non-refined grains, fish, and legumes. Unlike the western diet, the Mediterranean diet has been attributed to various health benefits including: lowering the risk of cardiovascular disease (lowering LDL cholesterol, improved blood pressure) and reducing the risk of developing diabetes 1,2.  To date, much of the research on metabolic syndrome and Mediterranean diet is based on the general population. Furthermore, there is no clear dietary recommendations for pregnant women with pre-existing metabolic risk factors 3.  However, the Mediterranean diet has been suggested as a potential benefit to both mother and child in preventing pre-eclampsia, gestational diabetes, and restricted fetal growth 4-6.  In a randomized study, researchers assessed the effect of a Mediterranean diet on maternal outcomes (specifically gestational diabetes and pre-eclampsia) and offspring outcomes (including stillbirth, NICU admission, and low birth weight & size) 7.

This study was a randomized control trial conducted in 5 centers in Britain. A total of 1,252 pregnant women were randomized to the intervention group (n=593) or control group (n=612). Women in the intervention group received personalized dietary intervention at 18 weeks gestation, and group sessions at 20- and 28-weeks’ gestation. Dieticians also followed up with them by phone at 24 weeks and 32 weeks gestation to emphasize dietary goals and assess their general health. Women allocated to the control group were advised to follow the UK national recommendations for postnatal care and weight management in pregnancy. Both groups were also supplemented with vitamin D and folic acid. Women who were at high risk for pre-eclampsia were also provided a low dose aspirin (75mg). Both groups completed the Food Frequency Questionnaire and Esteem Q questionnaire at 36 weeks or at delivery to assess quality of life, physical activity, and gastrointestinal symptoms. Main outcome measures were composite maternal outcome (including pre-eclampsia and gestational diabetes) and composite offspring outcome (including stillbirth, NICU admission, and small for gestational age).

The study was comprised of 553 participants in the intervention group and 585 participants in the control group. Among participants, 69% were obese, and 27% were first time mothers. Forty-seven % had raised triglycerides and 5% had chronic hypertension when they became pregnant. Researchers found no significant differences between the intervention group and the control group in regards to the primary outcomes measured (composite maternal and offspring outcomes) [22.8% v. 28.6% aOR= 0.76, p=0.08]. However, a significant reduction in the risk of gestational diabetes was observed in the intervention group (aOR= 0.65, p=0.01). Also, women in the intervention group gained less weight than women in the control (mean difference= -1.2kg, p=0.03). No significant effect was observed to offspring outcomes (p>0.05) nor was there any significant effect on pre-eclampsia (p=0.19).

Researchers concluded that the Mediterranean diet was a viable option to prevent gestational diabetes. Future studies should examine a more balanced demographic.

Source: Al Wattar, Bassel H., Julie Dodds, Anna Placzek, Lee Beresford, Eleni Spyreli, Amanda Moore, Francisco J. Gonzalez Carreras et al. “Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial.” PLoS medicine 16, no. 7 (2019).

© 2019 H. Al Wattar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Posted November 19, 2019.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

References:

  1. Salas-Salvadó J, Bulló M, Estruch R, et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Annals of internal medicine. 2014;160(1):1-10.
  2. Kesse-Guyot E, Ahluwalia N, Lassale C, Hercberg S, Fezeu L, Lairon D. Adherence to Mediterranean diet reduces the risk of metabolic syndrome: a 6-year prospective study. Nutrition, Metabolism and Cardiovascular Diseases. 2013;23(7):677-683.
  3. Rogozińska E, Marlin N, Jackson L, et al. Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation. Health technology assessment. 2017;21(41):1-158.
  4. Chatzi L, Mendez M, Garcia R, et al. Mediterranean diet adherence during pregnancy and fetal growth: INMA (Spain) and RHEA (Greece) mother–child cohort studies. British Journal of Nutrition. 2012;107(1):135-145.
  5. Timmermans S, Steegers-Theunissen RP, Vujkovic M, et al. The Mediterranean diet and fetal size parameters: the Generation R Study. British Journal of Nutrition. 2012;108(8):1399-1409.
  6. Rodríguez-Bernal CL, Rebagliato M, Iñiguez C, et al. Diet quality in early pregnancy and its effects on fetal growth outcomes: the Infancia y Medio Ambiente (Childhood and Environment) Mother and Child Cohort Study in Spain. The American journal of clinical nutrition. 2010;91(6):1659-1666.
  7. Al Wattar BH, Dodds J, Placzek A, et al. Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial. PLoS medicine. 2019;16(7).