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Nakaki A, Crovetto F, Urru A, Piella G, Borras R, Comte V, Vellvé K, Paules C, Segalés L, Dacal M, Gomez Y, Youssef L, Casas R, Castro-Barquero S, Martín-Asuero A, Oller Guzmán T, Morilla I, Martínez-Àran A, Camacho A, Pascual Tutusaus M, Arranz A, Rebollo-Polo M, Gomez-Chiari M, Bargallo N, Pozo ÓJ, Gomez-Gomez A, Izquierdo Renau M, Eixarch E, Vieta E, Estruch R, Crispi F, Gonzalez-Ballester MA, Gratacós E. Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:101188. [PMID: 37839546 DOI: 10.1016/j.ajogmf.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and infant neurodevelopment. OBJECTIVE This study aimed to investigate if structured lifestyle interventions involving a Mediterranean diet or mindfulness-based stress reduction during pregnancy are associated with differences in fetal and neonatal brain development. STUDY DESIGN This was a secondary analysis of the randomized clinical trial Improving Mothers for a Better Prenatal Care Trial Barcelona that was conducted in Barcelona, Spain, from 2017 to 2020. Participants with singleton pregnancies were randomly allocated into 3 groups, namely Mediterranean diet intervention, stress reduction program, or usual care. Participants in the Mediterranean diet group received monthly individual sessions and free provision of extra-virgin olive oil and walnuts. Pregnant women in the stress reduction group underwent an 8-week mindfulness-based stress reduction program adapted for pregnancy. Magnetic resonance imaging of 90 fetal brains was performed at 36 to 39 weeks of gestation and the Neonatal Neurobehavioral Assessment Scale was completed for 692 newborns at 1 to 3 months. Fetal outcomes were the total brain volume and lobular or regional volumes obtained from a 3-dimensional reconstruction and semiautomatic segmentation of magnetic resonance images. Neonatal outcomes were the 6 clusters scores of the Neonatal Neurobehavioral Assessment Scale. Multiple regression analyses were conducted to assess the association between the interventions and the fetal and neonatal outcomes. RESULTS When compared with the usual care group, the offspring exposed to a maternal Mediterranean diet had a larger total fetal brain volume (mean, 284.11 cm3; standard deviation, 23.92 cm3 vs 294.01 cm3; standard deviation, 26.29 cm3; P=.04), corpus callosum (mean, 1.16 cm3; standard deviation, 0.19 cm3 vs 1.26 cm3; standard deviation, 0.22 cm3; P=.03), and right frontal lobe (44.20; standard deviation, 4.09 cm3 vs 46.60; standard deviation, 4.69 cm3; P=.02) volumes based on magnetic resonance imaging measures and higher scores in the Neonatal Neurobehavioral Assessment Scale clusters of autonomic stability (mean, 7.4; standard deviation, 0.9 vs 7.6; standard deviation, 0.7; P=.04), social interaction (mean, 7.5; standard deviation, 1.5 vs 7.8; standard deviation, 1.3; P=.03), and range of state (mean, 4.3; standard deviation, 1.3 vs 4.5; standard deviation, 1.0; P=.04). When compared with the usual care group, offspring from the stress reduction group had larger fetal left anterior cingulate gyri volume (1.63; standard deviation, 0.32 m3 vs 1.79; standard deviation, 0.30 cm3; P=.03) based on magnetic resonance imaging and higher scores in the Neonatal Neurobehavioral Assessment Scale for regulation of state (mean, 6.0; standard deviation, 1.8 vs 6.5; standard deviation, 1.5; P<.01). CONCLUSION Maternal structured lifestyle interventions involving the promotion of a Mediterranean diet or stress reduction during pregnancy were associated with changes in fetal and neonatal brain development.
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Affiliation(s)
- Ayako Nakaki
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Department of Surgery and Surgical specializations, Faculty of Medicine and Helath Sciences, University of Barcelona, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Castro-Barquero, Arranz, Eixarch, Crispi and Gratacos)
| | - Francesca Crovetto
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos)
| | - Andrea Urru
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Gemma Piella
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Universitat Autònoma de Barcelona, Barcelona, Spain (Mr Borras); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo)
| | - Valentin Comte
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester)
| | - Kilian Vellvé
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Cristina Paules
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Laura Segalés
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Marta Dacal
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Yvan Gomez
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Lina Youssef
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona Campus, Barcelona, Spain (Dr Youssef)
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Sara Castro-Barquero
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Andrés Martín-Asuero
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Teresa Oller Guzmán
- Instituto esMindfulness, Barcelona, Spain (Dr Martín-Asuero and Ms Oller Guzmán)
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Alba Camacho
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Mireia Pascual Tutusaus
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Angela Arranz
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos)
| | - Monica Rebollo-Polo
- Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Radiology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland (Dr Rebollo-Polo)
| | - Marta Gomez-Chiari
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Dèu, Esplugues de Llobregat, Spain (Drs Rebollo-Polo and Gomez-Chiari); Diagnostic Imaging Department, Hospital Sant Joan de Dèu, Esplugues de Llobregat, Spain (Dr Gomez-Chiari)
| | - Nuria Bargallo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain (Mr Borras and Dr Bargallo); Radiology Department, Center of Image Diagnostic, Hospital Clínic. Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain (Dr Bargallo)
| | - Óscar J Pozo
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (Drs Pozo and Gomez-Gomez)
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Neonatology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain (Dr Izquierdo Renau)
| | - Elisenda Eixarch
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain (Drs Morilla, Martínez-Àran, and Vieta)
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain (Drs Casas, Castro-Barquero, and Estruch); Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Madrid, Spain (Drs Casas, Castro-Barquero, and Estruch)
| | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos).
| | - Miguel Angel Gonzalez-Ballester
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Drs Urru and Piella, Mr Comte, and Dr Gonzalez-Ballester); ICREA, Barcelona, Spain (Dr Gonzalez-Ballester)
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain (Drs Nakaki, Crovetto, Vellvé, Paules, Segalés, Ms Dacal, Drs Gomez, Youssef, Castro-Barquero, Mses Camacho and Pascual Tutsaus, and Drs Arranz, Gomez-Chairi, Eixarch, Crispi and Gratacos); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Drs Nakaki, Bargallo, Eixarch, Crispi and Gratacos); Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain (Drs Crovetto, Izquierdo Renau, and Gratacos); Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain (Drs Eixarch, Crispi, and Gratacos)
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Crovetto F, Nakaki A, Arranz A, Borras R, Vellvé K, Paules C, Boutet ML, Castro-Barquero S, Freitas T, Casas R, Martín-Asuero A, Oller Guzmán T, Morilla I, Martínez-Àran A, Camacho A, Pasqual M, Izquierdo Renau M, Pozo ÓJ, Gomez-Gomez A, Estruch R, Vieta E, Crispi F, Gratacós E. Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2330255. [PMID: 37606923 PMCID: PMC10445211 DOI: 10.1001/jamanetworkopen.2023.30255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/16/2023] [Indexed: 08/23/2023] Open
Abstract
Importance Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and childhood neurodevelopment. Objective To 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 Participants This 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. Interventions Participants 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 Measures Neurodevelopment in children was assessed by Bayley-III at 24 months of corrected postnatal age. Results A 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 Relevance In 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 Registration ClinicalTrials.gov Identifier: NCT03166332.
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Affiliation(s)
- Francesca Crovetto
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Ayako Nakaki
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Angela Arranz
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Roger Borras
- Cardiovascular Institute, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Kilian Vellvé
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Cristina Paules
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Maria Laura Boutet
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Sara Castro-Barquero
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Tania Freitas
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | | | | | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Alba Camacho
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Mireia Pasqual
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Neonatology Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Óscar J. Pozo
- Applied Metabolomics Research Group, Institut Hospital del Mar d′Investigacions Mèdiques, Barcelona, Spain
| | - Alex Gomez-Gomez
- Applied Metabolomics Research Group, Institut Hospital del Mar d′Investigacions Mèdiques, Barcelona, Spain
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Fàtima Crispi
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases, Madrid, Spain
| | - Eduard Gratacós
- BCNatal, Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centre for Biomedical Research on Rare Diseases, Madrid, Spain
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3
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Casas I, Nakaki A, Pascal R, Castro-Barquero S, Youssef L, Genero M, Benitez L, Larroya M, Boutet ML, Casu G, Gomez-Gomez A, Pozo OJ, Morilla I, Martínez-Àran A, Vieta E, Gómez-Roig MD, Casas R, Estruch R, Gratacos E, Crispi F, Crovetto F. Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial. Nutrients 2023; 15:nu15102362. [PMID: 37242244 DOI: 10.3390/nu15102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19-23 weeks' gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34-36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34-36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation.
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Affiliation(s)
- Irene Casas
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
| | - Ayako Nakaki
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Rosalia Pascal
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28040 Barcelona, Spain
- Institut de Recerca Sant Joan de Deu (IRSJD), 08950 Barcelona, Spain
| | - Sara Castro-Barquero
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Lina Youssef
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Hospital Clínic, University of Barcelona Campus, 08036 Barcelona, Spain
| | - Mariona Genero
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
| | - Leticia Benitez
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marta Larroya
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Maria Laura Boutet
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
| | - Giulia Casu
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
| | - Alex Gomez-Gomez
- Integrative Pharmacology & Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Oscar J Pozo
- Integrative Pharmacology & Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, 08035 Barcelona, Spain
| | - Anabel Martínez-Àran
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, 08035 Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, 08035 Barcelona, Spain
| | - María Dolores Gómez-Roig
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28040 Barcelona, Spain
- Institut de Recerca Sant Joan de Deu (IRSJD), 08950 Barcelona, Spain
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Ramon Estruch
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Eduard Gratacos
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Fàtima Crispi
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Institut de Recerca August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Francesca Crovetto
- BCNatal|Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08028 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28040 Barcelona, Spain
- Institut de Recerca Sant Joan de Deu (IRSJD), 08950 Barcelona, Spain
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