Mediterranean diet or mindfulness-based stress reduction during pregnancy may improve child neurodevelopment outcomes

1. The offspring of individuals consuming a Mediterranean diet or engaging in a mindfulness-based stress reduction program during pregnancy had better neurodevelopmental outcomes in certain domains at age 24 months compared to the control group. 

Evidence Rating Level: 3 (Average)

Study Rundown:Prior studies have demonstrated that maternal high-fat diets, obesity, and psychological stress are associated with adverse fetal neurodevelopment. Researchers aimed to determine whether lifestyle interventions, specifically a consuming Mediterranean diet or engaging in mindfulness-based stress reduction (MBSR), can improve offspring neurodevelopment. The Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) randomized clinical trial included 1221 pregnant individuals with risk factors for small for gestational age (SGA) infants. These participants were randomized into a Mediterranean diet group, an MBSR group, or a control group. Compared to controls, the offspring of these intervention groups scored higher on certain developmental assessments at the corrected age of 24 months, with the Mediterranean diet group scoring higher for cognition and social-emotional development, and the MBSR group scoring higher for social-emotional development. Overall, this study demonstrates that these lifestyle interventions may be beneficial for offspring neurodevelopment, particularly for those with risk factors for having an SGA infant. 

Click to read the study in JAMA Network Open

In-Depth [randomized clinical trial]: The IMPACT BCN was an unblinded, randomized clinical trial. The trial enrolled 1221 individuals with singleton pregnancies at 19 to 23 weeks gestation with pregnancies at high risk for delivering SGA infants per the Royal College of Obstetrics and Gynaecologists criteria. Participants were randomized into three groups: the Mediterranean diet group, the MBSR group, and the control group. Those in the Mediterranean diet group participated in monthly educational sessions with nutritionists, which included meal plans and recipes. The MBSR group participated in monthly classes and daily at-home sessions. The control group received only standard prenatal care. Nutrition and mindfulness-based questionnaires were administered to all participants at the time of enrollment and again when they reached 34 to 36 weeks gestation. When the participants’ offspring reached a corrected age of 24 months, the Bayley-III was administered, which is a developmental evaluation for young children. 626 children completed this assessment. Two blinded psychologists assessed the offspring’s cognitive, language, and motor development. Parents filled out questionnaires regarding the children’s social-emotional and adaptive behaviors. Compared to children in the control group, those in the Mediterranean diet group had higher scores for cognition (β, 5.02; 95% CI, 1.52-8.53; P = .005) and social-emotional development (β, 5.15; 95% CI, 1.18-9.12; P = .01). The MBSR group had higher scores for social-emotional development only (β, 4.75; 95% CI, 0.54-8.85; P = .02). This study has several limitations. Adherence was poor, with only 626 children from the initial 1221 pregnancies evaluated at the follow-up period. Adherence was notably poorer among those with lower education and socioeconomic status (SES). The study population also had a low proportion of gestational diabetes and obesity, as well as greater education and socioeconomic status compared to the general public. Furthermore, the social-emotional and adaptive behavioral domains were assessed via parent assessments, which is a clear source of bias. The findings of this study should be further investigated before any recommendations are made in clinical practice. 

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