Diet, Stress Reduction During Pregnancy Improved Outcomes for Moms and Kids

— Healthy lifestyle interventions improved fertility, postnatal outcomes in two studies

A photo of a woman eating a tomato, mozzarella, and olive salad.

Adhering to certain lifestyle interventions, including diets like the Mediterranean diet and American Heart Association (AHA) diet, were linked to improved outcomes for mothers and their children, according to results of two studies.

In a prespecified analysis of a randomized trial, children whose mothers followed the Mediterranean diet or mindfulness-based stress reduction (MBSR) during pregnancy had higher cognitive and social-emotional domain scores at a mean age of 24.8 months compared with those receiving usual care, reported Francesca Crovetto, MD, PhD, of the Barcelona Center for Maternal and Fetal Medicine, and colleagues in JAMA Network Open.

Using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), kids in the Mediterranean diet group had higher scores compared with the usual-care group in the cognitive domain (β=5.02, 95% CI 1.52-8.53, P=0.005) and social-emotional domain (β=5.15, 95% CI 1.18-9.12, P=0.01), while those in the MBSR group had higher scores in the social-emotional domain (β=4.75, 95% CI 0.54-8.85, P=0.02).

"For the first time, [our research showed that] interventions during pregnancy based on lifestyle improvement have an effect on child neurodevelopment. No previous studies have evaluated this," Crovetto told MedPage Today in an email.

"Children's neurodevelopment is known to depend on several factors; however, until now doctors tended to consider just their life after birth," she said. "But prenatal fetal life is relevant for their future neurodevelopment, too."

The primary analysis of the trial showed that lifestyle interventions, such as a healthy diet or stress reduction practices, lowered the risk of delivering newborns small for gestational age among high-risk women.

Crovetto and her team are still tracking the children, now age 6, to see if the differences have persisted.

In a separate prospective cohort study also published in JAMA Network Open, adherence to the AHA's dietary guidelines prior to conception was found to be associated with a lower likelihood of pregnancy loss during infertility treatment.

However, there was no association between adherence to any of the eight diets studied and the probability of clinical pregnancy or live birth following in vitro fertilization (IVF) or intrauterine insemination, reported Jorge E. Chavarro, MD, ScD, of the Harvard T. H. Chan School of Public Health in Boston, and co-authors.

For women who became pregnant following infertility treatment, the adjusted probabilities of pregnancy loss in the lowest and highest quartile of the AHA dietary pattern were 0.41 (95% CI 0.33-0.50) and 0.28 (95% CI 0.21-0.36), respectively (P=0.02 for trend).

The adjusted probabilities of clinical pregnancy loss were 0.30 (95% CI 0.22-0.39) and 0.15 (95% CI 0.10-0.23), respectively (P=0.007 for trend).

All other diets, excluding the plant-based diet, had similar patterns, the authors noted.

"Our findings provide useful information that can be used in the design of future studies aimed at testing the effects of nutritional interventions on human fertility," Chavarro and team wrote, noting that the "literature on the association between nutrition and infertility treatment outcomes remains sparse, and it is therefore important that this association is evaluated in additional studies."

In an invited commentary, Antonia F. Oladipo, MD, MSCI, of the Hackensack Meridian School of Medicine in Hackensack, New Jersey, and Tia Jackson-Bey, MD, MPH, of the Icahn School of Medicine at Mount Sinai in New York City, noted that "the study population included many individuals who transferred more than 1 embryo during IVF, completed more than 1 infertility treatment cycle, and used a luteal gonadotropin-releasing hormone agonist protocol for IVF."

"This may counter the concept of the population as otherwise favorably positioned for treatment outcomes or may simply be reflective of practice patterns at the research institution," they added.

"Healthcare practitioners should use these findings to frame healthy dietary recommendations for individuals requiring infertility treatment," they concluded.

Study Details

The parallel-group Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) was conducted at a university hospital in Barcelona from February 2017 to March 2020. In total, the study included 1,221 singleton pregnancies at 19 to 23.6 weeks' gestation that were considered high risk for delivering newborns small for gestational age. They were randomized 1:1:1 to three groups: a Mediterranean diet intervention, an MBSR program, or usual care.

For the Mediterranean diet intervention, participants received free extra virgin olive oil and walnuts, as well as monthly individual and group education sessions. They answered dietary assessment questionnaires before and after interventions.

Those in the MBSR group participated in an 8-week program with a focus on pregnancy. At the start and after the program, participants filled out questionnaires about their anxiety, well-being, and mindful state.

To assess the neurodevelopment of kids in all groups, the researchers used the Bayley-III at 24 months' corrected postnatal age.

Chavarro and team collected data from January 2007 to October 2019 at an academic medical center in Boston and included women ages 18 to 45 (median age 35) seeking infertility evaluation and treatment.

Participants provided data on demographics, medical and reproductive history, lifestyle, and diet. In total, 612 women who went through 1,572 infertility treatment cycles were analyzed, including 302 women who underwent 804 intrauterine insemination cycles and 450 women who underwent 768 IVF cycles.

Participants completed a food-frequency questionnaire on more than 131 foods and beverages, and researchers assessed the adherence to eight a priori-defined dietary pattern scores.

Both teams acknowledged limitations to their studies. Crovetto's group noted that only a proportion of children from the original IMPACT BCN trial were included, and some of the observed trends may have become statistically significant with a larger study sample.

Chavarro's group noted that their results may not be generalizable, since their study was conducted at a single center. Furthermore, unmeasured confounding cannot be ruled out, they added.

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    Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow


The randomized study was supported by many sources, including la Caixa Foundation, Cerebra Foundation for the Brain Injured Child, ASISA Foundation, Agència de Gestió d'Ajuts Universitaris, and Instituto de Salud Carlos III.

Crovetto reported personal fees from Centro de Investigaciones Biomédicas en Red sobre Enfermedades Rara.

Co-authors reported multiple relationships with foundations and pharmaceutical companies.

The prospective cohort study was funded by NIH grants.

Chavarro reported receiving grants from the NIH, the FDA, and the CDC.

A co-author reported receiving grants from the Fuji Protein for Research Foundation and scholarships from the Rotary Foundation.

Jackson-Bey reported receiving personal fees from Ferring Pharmaceuticals and Progyny. Oladipo reported no conflicts of interest.

Primary Source

JAMA Network Open

Source Reference: Crovetto F, 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; DOI: 10.1001/jamanetworkopen.2023.30255.

Secondary Source

JAMA Network Open

Source Reference: Salas-Huetos A, et al "Women's adherence to healthy dietary patterns and outcomes of infertility treatment" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.29982.

Additional Source

JAMA Network Open

Source Reference: Oladipo AF, Jackson-Bey T "Baseline dietary patterns and infertility treatment outcomes -- setting the right foundation" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.29988.