Mediterranean diet, stress reduction improves child neurodevelopment

Mediterranean diet, stress reduction improves child neurodevelopment | Image Credit: © JenkoAtaman - © JenkoAtaman - stock.adobe.com.

According to a recent study published in JAMA Network Open, child neurodevelopmental outcomes by age 2 years are significantly improved by a Mediterranean diet or mindfulness-based stress reduction (MBSR) intervention during pregnancy.

Offspring neurodevelopment is associated with prenatal well-being and health, with unhealthy high-fat dietary patterns and periconceptional obesity linked to worse neurodevelopment. Maternal stress is also associated with poorer postnatal neurodevelopmental outcomes.

Inflammation and hypothalamic-pituitary-adrenal axis activation have been reported as potential mechanisms for the association between prenatal health and postnatal neurodevelopment. Interventions have been indicated to impact these inflammations, but data on how interventions impact neurodevelopmental outcomes is lacking.

A Mediterranean diet has been associated with reduced adverse outcomes in high-risk adults and MBSR has been assessed for stress-related conditions. The impacts of a Mediterranean diet and MBSR on newborn outcomes was assessed during the Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN).

To determine how child neurodevelopmental outcomes are impacted by a Mediterranean diet or stress reduction interventions during pregnancy, investigators conducted a secondary end point trial of the IMPACT BCN. Enrollment in the trial occurred from February 2017 to October 2019.

Participants included pregnant women at 19 to 23.6 weeks of gestation at enrollment with a high risk of delivering newborns small for gestational age (SGA). These patients were randomized 1:1:1 into a Mediterranean diet intervention group, an MBSR intervention group, and a control group without intervention.

A baseline visit occurred at enrollment and a follow-up visit at the end of intervention. During these visits, participants completed questionnaires. Biological samples and perinatal data were also obtained. The percentage of SGA newborns was measured as the primary outcome of the initial trial, and adverse perinatal outcomes as the secondary outcome. 

Offspring neurodevelopmental evaluation was included as a secondary outcome, measured using the Bayley-III scale when children were aged 2 years. At the time of the study publication, measurement of this outcome was ongoing. Domains evaluated included cognitive, motor, social-emotional, and adaptive.

The dietary intervention included a standard Mediterranean diet adapted for pregnancy. Participants completed a 30-minute assessment and 1-hour group session each month. The intervention period was a median 12.1 weeks.

The stress reduction intervention included an MBSR program adapted for pregnancy. Participants attended 2.5 hours of group classes per week, alongside a full day session and daily home practice. 

Avalidated 151-item food frequency questionnaire and a 17-item dietary assessment questionnaire were used to assess the dietary intervention.The MBSR intervention was evaluated through the Perceived Stress Scale, the State-Trait Anxiety Inventory personality and anxiety questionnaires, the World Health Organization Five Well-being Index, and the Five Facet Mindfulness Questionnaire.

There were 1221 pregnant women in the IMPACT BCN trial, 51% of which had children assessed with Bayley-III. High adherence was reported in 71.8% of the Mediterranean diet group and 63.7% of the MBSR group.

When evaluated through Bayley-III, children in the Mediterranean diet group had a mean score of 123.6 in the cognitive domain and 108.8 in the social-emotional domain. The MBSR group had a mean score of 108.2 in the social-emotional domain. These scores were significantly higher than those in the usual care group, which were 118.6 and 103.4 respectively.

Significant positive associations were also reported between the Mediterranean diet intervention and cognitive and language Bayley-III domains. All 5 Bayley-III domains showed significant negative associations with maternal stress and anxiety levels, with higher maternal well-being linked to higher Bayley-III language, adaptive, and social-emotional scores.

These results indicated improved neurodevelopment at age 2 years in offspring of pregnant women receiving either a Mediterranean diet or MBSR intervention. Investigators recommended further randomized clinical trials be performed to confirm if these results are replicated.

Reference

Crovetto F, Nakaki A, Arranz A, et al. 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(8):e2330255. doi:10.1001/jamanetworkopen.2023.30255