New Research Asks If Mediterranean Diet Meets Nutritional Requirements During Pregnancy
Researchers have evaluated whether adopting the Mediterranean Diet during pregnancy can meet the unique requirements of the body during this time.
A recent article published in the Frontiers in Public Health Journal found that The Mediterranean Diet could help avoid multiple pregnancy-related challenges, such as maternal weight gain, nutrient deficiencies, and other complications.
Background: Why Consider Mediterranean Diet During Pregnancy?
Studies have described that up to 30% of pregnant females remain deficient in micronutrients, such as folic acid and vitamins A, B6, C, D, and E. Dietary patterns during gestation. However, a modifiable factor might have permanent health consequences on the neonate.
The guidelines for nutritional supplementation during pregnancy vary widely across different geographical regions.
For instance, in Spain, they only recommend additionally supplementing folic acid and iodine during pregnancy and rely mainly on adhering to MedDiet to meet the requirements of most other micronutrients.
The Mediterranean Diet includes fruits and vegetables, whole grains, legumes, seeds, nuts in high amounts, and fish, seafood, eggs, and fermented dairy products, e.g., yogurt, in moderate amounts. It uses extra virgin olive oil (EVOO) as the main source of fat for dressings and cooking.
In the recent Improving Mothers for a Better Prenatal Care Trial BarCeloNa (IMPACT BCN), a nutritional intervention based on The Mediterranean Diet, demonstrated a decreased prevalence of perinatal complications by 26%.
Assaf-Balut et al. showed that adherence to the Mediterranean Diet lowered the risk of gestational diabetes, premature birth, and urinary tract infections.
Multiple recent studies have described the health benefits of the Mediterranean Diet for mother and fetus. However, studies have not explored the extent to which pregnant women in Mediterranean areas could benefit from local food.
How The Study Exploring The Mediterranean Diet During Pregnancy Was Carried Out
Further, the team enquired about each participant’s usual and frequent consumption of enlisted foods in the Food Frequency Questionnaire (FFQ). They computed energy and nutrient intake, i.e., total dietary fiber, vitamins, and minerals intake, using the FFQ-derived food consumption data.
They included participants with energy intake in a predefined limit between <500 kcal/day and >3,500 kcal/day.
They compared dietary intake of magnesium, iron, calcium, zinc, sodium, phosphorous, potassium, and vitamins B1, B9, B12, A, C, D, and E with pregnancy requirements per the dietary reference intakes (DRIs) for the European and American DRI for pregnant women and Spanish general population, where intake levels above DRI implied a lower probability of inadequate micro and macronutrient intake.
Finally, the team used multivariate linear regression models to assess the variations in nutritional intake below the DRIs between study groups while controlling for confounding factors.
Results Of The Study Exploring Mediterranean Diet In Pregnancy
The final study sample had 1,356 pregnant women whose Mediterranean Diet adherence scores, FFQ scores, and total energy intake data were available.
In the group with low Mediterranean Diet adherence scores, the maternal age was lower, the number of Latin pregnant women was higher, and there were more smokers; in addition, these women had a higher waist circumference at enrolment and higher weight and BMI throughout gestation.
Conversely, in the group with high Mediterranean Diet adherence scores, white females were more, and women had attained a higher education. They consumed more protein, fat, and fiber and fewer carbohydrates.
Among the low and high adherence groups, vitamin A and B12 intake were comparable, but vitamins B1, B9, C, D, and E varied.
Thus, among participants with an intake of macro and micronutrients below 2/3 DRIs, the authors noted an insufficient vitamin D, B9, iron, and calcium intake in 82.3%, 12.3%, 52.6%, and 13% of participants, respectively.
Likewise, the authors profiled these two groups for fatty acid intake and observed significant differences for all FA items.
The participants with higher adherence to the Mediterranean Diet had adequate EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), two FAs essential for fetal growth, especially of the brain and eyes.
Notably, EVOO in Mediterranean Diet supplemented mono- and polyunsaturated fatty acids (MUFAs and PUFAs) as oleic, α-linolenic, and linoleic acids.
Conclusions: Does The Mediterranean Diet Provide Nutritional Needs In Pregnancy?
According to the authors, this is the first study directly assessing whether adherence to the healthy Mediterranean Diet was associated with sufficient micronutrient (and overall nutrient) intake per DRIs specified for pregnancy.
They noted a direct association between nutritional status and adherence to a pregnancy-adapted Mediterranean Diet.
Even though it is an easy-to-follow diet, some nutrient requirements are challenging to meet only with the Mediterranean Diet, including in high-income countries. Thus, many pregnant females in the study cohort were deficient in multiple micronutrients, especially vitamin D and B9, iron, and calcium.
However, high adherence to the Mediterranean Diet lowered the proportion of participants with micronutrient intake below DRIs (without supplementation) for iron, calcium, folic acid, magnesium, and vitamin C.
These associations remained significant even after adjusting for potential confounders, such as age, educational level, and pre-conceptional BMI, to name a few.
To conclude, pregnancy-adapted Mediterranean Diet should be promoted as a cost-effective public health strategy in one-to-one nutritional counselling given to expecting women.
With minimal or no financial cost, it could help avoid multiple pregnancy-related challenges, such as maternal weight gain, nutrient deficiencies, and other complications.
The Mediterranean Diet & Extra Virgin Olive Oil (EVOO) During Pregnancy : New Studies
The three specific diets included in the research include the alternative Mediterranean Diet, alternative healthy eating index and the diet of dietary approaches to stop hypertension (DASH).
The Mediterranean Diet is known for its emphasis on fresh vegetables, whole grains, nuts and healthy fats such as Extra Virgin Olive Oil.
The study was conducted by the National Institute of Child Health and Human Development (NICHD) Eunice Kennedy Shriver and was published in the American Journal of Clinical Nutrition.
It studied nearly 1,900 women who responded to questionnaires about their diets between weeks 8 and 13 of pregnancy. The participants were also asked to estimate what they ate in the previous three months. This allowed their responses to be analysed according to three measures of healthy eating: the alternative healthy eating index (AHEI), the alternative Mediterranean diet (AMED) and the diet of dietary approaches to stop hypertension (DASH).
The findings showed that women with a high score of the alternative Mediterranean diet (AMED) or dietary approaches to stop hypertension (DASH) diets between weeks 24 and 29 of pregnancy had a 50% lower risk of having a preterm birth. While women with a high alternative healthy eating index AHEI score between weeks 16 and 22 of gestation had a 32% lower risk of gestational diabetes than women with a low score.
These findings led researchers to report that healthier dietary patterns during periconception and pregnancy characterized by higher AHEI, AMED or DASH scores were associated with lower risks of common pregnancy complications, including gestational diabetes and hypertension, pre-eclampsia, and premature babies.
For more information on the benefits of Extra Virgin Olive Oil and The Mediterranean Diet During pregnancy see here.
- Castro-Barquero, S. et al. (2023) “Diet quality and nutrient density in pregnant women according to adherence to Mediterranean diet”, Frontiers in Public Health, 11. doi: 10.3389/fpubh.2023.1144942. https://www.frontiersin.org/articles/10.3389/fpubh.2023.1144942/full