Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this study, a Mediterranean diet reduced odds of low-weight births in high-risk pregnancies.

2. Furthermore, mindfulness-based stress reduction reduced odds of low-weight births.

Evidence Rating Level: 1 (Excellent)

High stress and poor maternal nutrition have been associated with higher risk of infants being born small for gestational age (SGA), defined as birth weight below the 10th percentile. Infants born SGA often have increased morbidity and mortality in the perinatal period as well as increased risk for long-term adverse health outcomes. However, there are currently no effective preventative or therapeutic strategies against SGA. Therefore, developing interventions that potentially target maternal nutrition and stress to reduce SGA could be highly beneficial.

This randomized control trial aimed to determine the effectiveness of a Mediterranean diet or mindfulness-based stress reduction techniques in reducing risk of newborns born SGA. This study followed 1184 adult, pregnant patients at high risk for SGA at a single institution in Spain. Patients with pregnancies with fetal abnormalities or neonatal malformations were excluded from the study. Patients were randomized between 19-23 weeks of gestation, 1:1:1 to 3 study groups: 1) Mediterranean diet group (n=392), which received monthly individual and group education sessions and free extra-virgin olive oil and walnuts; 2) stress reduction group (n=391) where they underwent an 8-week stress reduction program that met weekly and provided guided meditation and prenatal yoga practices; 3) control group (n=401) who received standard pregnancy care. The primary outcome was percentage of newborns born SGA and secondary outcomes included rate of adverse perinatal events such as preterm birth, preeclampsia, low Apgar score, or perinatal mortality and morbidity.

Compared to the control group, odds of newborns born SGA were significantly decreased in the Mediterranean diet group (odds ratio 0.58) and stress reduction group (odds ratio 0.66). Furthermore, odds of secondary outcomes were also decreased in both Mediterranean diet and stress reduction group. However, this study was limited in that the study population was highly homogenous, with patients being predominantly White, with normal body mass index and of medium-to-high socioeconomic status. Nonetheless, these results suggest the exciting potential impact of nutritional and psychological interventions that can effect SGA, but further studies in more diverse pregnant patients are needed.

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