(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.
Randomly, 1,221 singleton pregnancies between 19 and 23 weeks gestation were assigned by the researchers to either the Mediterranean diet or a mindfulness-based stress relief program. Or, to be part of the group of control that received only regular 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.
The trial was completed by 1,184 women 392 of whom were assigned to the Mediterranean diet and 391 to reduce stress.
Women in the diet group received two hours each month of group or individual instruction on how to eat the Mediterranean diet, as well as the provision of walnuts and olive oil to supplement meals at home up to the end of the program at 34-36 weeks gestation.
The therapy group consisted of 8 weeks of therapy. This included one day sessions and weekly 2.5-hour sessions in mindfulness based stress reduction.
As compared to 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 88 (21.9%) SGA babies in the control group, compared to 55 (14.0 percent) in the Mediterranean diet group and 61 (15.6%) in the stress reduction group The study team has published their findings 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.
Although the exact mechanism behind this isn’t fully understood, both interventions used in the study have been linked with a decrease in inflammation, oxidative stress, and cell aging – all processes that have been observed in fetal growth restriction as well as placental insufficiency Dr. Gratacos said.
The study also examined a composite secondary endpoint of adverse perinatal outcomes including preeclampsia and preterm birth or perinatal death and severe SGA neonatal acidosis low Apgar score or any other major neonatal morbidity.
Comparing with the control group, women in the Mediterranean diet group (OR0.64) and the stress relief group (OR 0.68) were significantly less likely than those in the group in the control to suffer adverse pregnancy-related outcomes.
One drawback of the study is the possibility for cross-effects, the authors write. The diet may have improved mental health or the stress reduction could have improved eating habits. It’s also possible that women in the control group had fewer interactions with health providers or less personal interaction with health professionals than the intervention groups, impacting the results.
“These results are important new findings, considering that there is no established 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 significant limitations, such as the homogeneous study population, the high-resource setting, and the evaluation of only short-term results, restrict the generalization of the results,” they write. “Consequently these interventions must be implemented into clinical practice following the neurodevelopmental assessment results and other outcomes among children at two years old. Also, replication of the findings across different populations should be in the process of awaiting results.”
SOURCE: https://bit.ly/3HERv6J and https://bit.ly/3pYrERc JAMA, online December 7, 2021.
