Effects of Mediterranean diet or mindfulness-based stress reduction on fetal and neonatal brain development: a secondary analysis of a randomized clinical trial
A. Nakaki, F. Crovetto, Andrea Urru, Gemma Piella, Roger Borràs, Valentin Comte, Kilian Vellvé, Cristina Paulés, Laura Segalés, Marta Dacal, Yvan Gomez, L. Youssef, Rosa Casas, Sara Castro‐Barquero, Andrés Martín-Asuero, Teresa Oller Guzmán, Ivette Morilla, Anabel Martínez‐Arán, Alba Camacho, Mireia Pascual Tutusaus, Ángela Arranz, Mónica Rebollo, Marta Gómez‐Chiari, Núria Bargalló, Óscar J. Pozo, Àlex Gomez‐Gómez, Montserrat Izquierdo Renau, E. Eixarch, Eduard Vieta, Ramón Estruch, F. Crispi, Miguel Ángel González‐Ballester, E. Gratacós
Abstract
Background Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and infant neurodevelopment. Objective To investigate whether structured lifestyle interventions based on a Mediterranean diet or Mindfulness-Based Stress Reduction during pregnancy are associated with differences in fetal and neonatal brain development. Study Design This is a secondary analysis of the randomized clinical trial IMPACT BCN, conducted in Barcelona, Spain, 2017-2020. Singleton pregnancies were randomly allocated into three groups: Mediterranean diet intervention, stress reduction program or usual care. Participants in the Mediterranean diet group received monthly individual sessions and free provision of extra-virgin olive oil and walnuts. Pregnant women in the stress reduction group underwent an 8-week Mindfulness-Based Stress Reduction program adapted for pregnancy. Magnetic resonance (MRI) of 90 fetal brains was performed at 36-39 weeks of gestation and the Neonatal Neurobehavioral Assessment Scale (NBAS) in 692 newborns at 1-3 months. Fetal outcomes were the total brain volume and lobular/regional volumes obtained from a 3D reconstruction and semiautomatic segmentation of MRI images. Neonatal outcomes were the six clusters’ scores of the NBAS. Multiple regression analyses were conducted to assess the association between the interventions and fetal/neonatal outcomes. Results Compared with the usual care group, Mediterranean diet offspring had a larger fetal total brain volume [mean (SD); 284.11 (23.92) cm3 vs. 294.01 (26.29) cm3; p=0.04], corpus callosum [mean (SD) 1.16 (0.19) cm3 vs. 1.26 (0.22) cm3; p= 0.03], right frontal lobe [44.20 (4.09) cm3 vs. 46.60 (4.69) cm3; p=0.02] volumes at MRI, and higher scores in the NBAS clusters of autonomic stability [mean (SD); 7.4 (0.9) vs. 7.6 (0.7); p=0.04], social-interactive [mean (SD); 7.5 (1.5) vs. 7.8 (1.3); p= 0.03], and range of state [mean (SD); 4.3 (1.3) vs. 4.5 (1.0); p=0.04]. Compared to the usual care group, offspring from the stress reduction group had larger fetal left anterior cingulate gyri volume [1.63 (0.32) m3 vs. 1.79 (0.30) cm3; p=0.03] at MRI, and higher scores at NBAS in the neonatal regulation of state [mean (SD); 6.0 (1.8) vs. 6.5 (1.5); p<0.01]. Conclusions Maternal structured lifestyle interventions based on promotion of Mediterranean diet or stress reduction during pregnancy were associated with changes in fetal and neonatal brain development.