Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial.

Alex Gomez-Gomez, Francesca Crovetto, Fàtima Crispi, Eduard Gratacos, Ramon Estruch, Rosa Casas, María Dolores Gómez-Roig, Eduard Vieta, Anabel Martínez-Àran, Ivette Morilla, Oscar J Pozo, Irene Casas, Giulia Casu, Maria Laura Boutet, Marta Larroya, Leticia Benitez, Mariona Genero, Lina Youssef, Sara Castro-Barquero, Rosalia Pascal, Ayako Nakaki

Journal: Nutrients 2023;15(10):2362

PMID: 37242244

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Plain Language Summary

Stress and anxiety are frequent occurrences among pregnant women. Mental disorders can appear before pregnancy, with a changing course during pregnancy and postpartum. During pregnancy, evidence has been provided regarding the potential beneficial effects that structured dietary interventions based on a Mediterranean diet (MedDiet) can have, not only on pregnant women, but also their offspring and the pregnancy itself. The aim of this study was to evaluate the influence of a structured intervention during pregnancy based on a MedDiet on maternal stress and anxiety, mindful state, quality of life and sleep. This study is a parallel, unblinded randomised clinical trial. Participants - pregnant women at high risk for small-for-gestational-age newborns - were randomly assigned (1:1:1) to one of the three study groups: a MedDiet supplemented with extra-virgin olive oil and walnuts; a stress reduction intervention based on the Mindfulness-Based Stress Reduction (MBSR) programme; or usual care without any intervention (control group). Results show that an intervention based on MedDiet during pregnancy: - significantly improved well-being and sleep quality. - is associated with a reduction in maternal anxiety/stress, together with an increase in the cortisol-deactivating enzyme. Authors conclude that a MedDiet intervention significantly reduces maternal anxiety and stress, as well as improving well-being and sleep quality during gestation.

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), = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, = 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, < 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.

Address: 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.; 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.; 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.; Josep Carreras Leukaemia Research Institute, Hospital Clínic, University of Barcelona Campus, 08036 Barcelona, Spain.; Integrative Pharmacology & Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain.; Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, IDIBAPS, University of Barcelona, CIBERSAM, 08035 Barcelona, Spain.; Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain.

DOI: 10.3390/nu15102362