A Mediterranean diet and stress reduction during pregnancy improve child neurodevelopment

Interventions based on a Mediterranean diet or mindfulness-based stress reduction during pregnancy improve child neurodevelopment during the first few years of life. This is shown in an analysis of the IMPACT-BCN clinical trial published in the journal JAMA Network Open.

The clinical trial was coordinated by Eduard Gratacós, research coordinator in Foetal Medicine and Surgery (IRSJD) and director of BCNatal (Hospital Clínic Barcelona and SJD Barcelona Chilndren’s Hospital - FRCB-IDIBAPS and IRSJD), Francesca Crovetto (SJD Barcelona Chilndren's Hospital and IRSJD), Fàtima Crispi (Hospital Clínic and FRCB-IDIBAPS); and the doctoral student Ayako Nakaki (INPhINIT predoctoral fellowship from the "la Caixa" Foundation); with the collaboration of Ramon Estruch, from the Hospital Clínic Internal Medicine Service, head of the FRCB-IDIBAPS Cardiovascular Risk, Nutrition and Ageing group and CIBEROBN researcher; and Eduard Vieta, head of the Hospital Clínic Psychiatry and Psychology Service, head of the FRCB-IDIBAPS Bipolar and Depressive Disorders group and scientific director of CIBERSAM.

The IMPACT-BCN clinical trial was the first to assess the effects of active lifestyle interventions, such as a Mediterranean diet or mindfulness, in pregnant women. A clinical trial published in 2021 in the journal JAMA showed for the first time that a Mediterranean diet or stress reduction during pregnancy reduced the risk of having a baby with low birth weight by 30%.

Now, researchers also wanted to assess the effects of maternal lifestyle interventions during pregnancy on child neurodevelopment. In order to do this, the trial, which was supported by the "la Caixa" Foundation and CEREBRA, analysed the data from 626 children at two years of age using a Bayley test, a standardized test to measure child neurodevelopment.

The results indicate that the children of women who followed a Mediterranean diet programme during pregnancy showed better results in the test, in particular cognitive results (sensorimotor development, object relatedness and concept formation) and socio-emotional results (with regard to relationships and interactions). On the other hand, the children of women who followed a stress-reduction programme during pregnancy showed better results in the socio-emotional domain.

"These results provide a clear positive message that empowers mothers and families. It is possible to have a positive influence on the health of a pregnancy and the future baby with measures that can be applied relatively easily", the authors note.

Study methodology

Over the last 10 years, several studies have shown that unhealthy diets or maternal stress are associated with poorer outcomes in child neurodevelopment. However, this is the first study to assess active interventions on the lifestyles of pregnant women.

In the IMPACT-BCN study, the Mediterranean diet was used. It has shown very clear benefits in the prevention of cardiovascular, neurodegenerative and metabolic diseases and cancer. The Mediterranean diet is based on a high consumption of vegetables, pulses, fish, white meat, dairy, whole grains and healthy fats such as extra virgin olive oil and walnuts. Likewise, stress reduction in the study was carried out with a mindfulness-based stress reduction programme, complemented with relaxation-related activities.

All the Bayley test scores were adjusted for the mothers' socioeconomic status and the children's gender, which are known confounders.

Site participation in the clinical trial

The IMPACT-BCN clinical trial (2017-2020) was conducted at BCNatal (Hospital Clínic and Hospital Sant Joan de Déu) a referral centre for maternal-foetal medicine and a pioneer in clinical practice and research, with one of the largest maternal-foetal and neonatal clinical centres in Europe and a long tradition in conducting high-impact clinical trials. Moreover, the trial was conducted in close collaboration with researchers from IMIM-Hospital del Mar and professionals from the esMindfulness Institute.

Reference paper

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

The results published in JAMA Network Open reinforce the concept that maternal lifestyle during pregnancy is important for the development of the future baby.