Inadequate diet and high stress during pregnancy are risk factors for having low birthweight infants and experiencing poorer cognitive and social development in early childhood. Improving dietary intake and reducing maternal stress during pregnancy may yield long-term benefits for their children’s later development.

Crovetto et al. [JAMA Network Open] conducted a study to test the long-term effects of Mindfulness-Based Stress Reduction (MBSR) or a Mediterranean diet intervention compared to treatment as usual for pregnant women on toddler development.

The study recruited 1,221 Barcelonian mid-gestation pregnant women who were assessed as being at high-risk for delivering low birthweight infants. The prospective mothers were randomly assigned to usual treatment alone, usual treatment plus MBSR, or usual treatment plus a Mediterranean diet. MBSR consisted of eight 2.5 hour weekly group sessions, a full day retreat, and home practice. It used a standard MBSR syllabus that included a specialized focus on maternal yoga and mothers’ relationships with their fetuses.

The Mediterranean diet intervention consisted of monthly 30-minute assessments and 1-hour group sessions conducted by trained nutritionists. Participants were provided with 2 liters of extra virgin olive oil and 450 grams of walnuts each month, along with weekly suggested shopping lists, detailed meal plans, and menus. The usual care group received pregnancy care according to institutional protocols.

Adherence was 72% in the Mediterranean diet group (based on a ≥ 3 point pre-post improvement on a 17 item dietary adherence questionnaire) and 64% in the MBSR group (based on attendance of ≥6 group sessions).

All participants completed dietary questionnaires, and a randomly selected subset (47%) of the sample underwent blood and urine draws to assess biomarkers of walnut and olive oil consumption at both baseline and the final visit. Participants were also assessed on measures of stress, anxiety, wellbeing, and mindfulness. A separate randomly selected subset (27%) of the sample had 24-hour measures of urinary stress hormones at both baseline and the final visit.

In a separately published study, MBSR mothers (16%) and Mediterranean diet mothers (15%) were less likely to deliver low birthweight infants than usual care mothers (22%). In the present study, 626 toddlers (53% male; average age = 25 months) from the women in that original study were assessed on cognitive, language, motor, and social-emotional development and adaptive behavior using the Bayley Scales of Infant and Toddler Development. The number of toddlers is lower than the study sample of mothers, mainly due to difficulties in locating mothers for follow-up or obtaining their consent.

The results showed that Mediterranean diet toddlers had significantly higher Bayley cognitive and social-emotional scores than usual care toddlers. MBSR toddlers had significantly higher Bayley social-emotional scores than usual care toddlers, although the effect size was small.

Mediterranean diet adherence (regardless of group) was significantly positively associated with Bayley cognitive and language scores. Higher levels of consumption of foods containing docosahexaenoic acid was associated with significantly better language scores, while higher consumption of foods containing trans fats was inversely associated with social-emotional scores and language scores.

Maternal levels of stress and anxiety during pregnancy, irrespective of the group, showed significant negative associations with all five Bayley scales. Several FFMQ subscales (especially Describing and Acting with Awareness) showed significant positive associations with multiple Bayley scales.

The study shows improved maternal diet and MBSR during pregnancy have positive long-term effects on early childhood development for mothers at risk of having low birthweight babies. Adding nutritional support and mindfulness meditation to maternity care-as-usual for high-risk mothers could have a significant impact on the lives of children, their families, and on the social competencies gained by society in general. 

Reference:

Crovetto, F., Nakaki, A., Arranz, A.,… Gratacós, E. (2023). 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 Network Open, 6(8), e2330255. 

Link to study