Association between the Maternal Mediterranean Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis

孕產(chǎn)婦地中海飲食與圍產(chǎn)期結(jié)局之間的聯(lián)系：系統(tǒng)綜述和Meta分析

Authors: Jirong Xu, Haixia Wang, Jingfeng Bian, Ming Xu, Nan Jiang, Wei Luo, Ping Zu, Wanjun Yin, and Peng Zhu

Source: Adv Nutr. 2024 Feb; 15(2): 100159.

DOI: 10.1016/j.advnut.2023.100159

Abstract

Background:Mediterranean diet is a global, well-known healthy dietary pattern.

Objective:This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies.

Method:PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest.

Results:Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity.

Conclusions:The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings.

PROSPERO registration no.: CRD42023406317.

Keywords: Mediterranean diet, dietary pattern, pregnancy, perinatal outcomes, fetal outcomes, maternal outcomes, neonatal outcomes, meta-analysis

摘要

背景 地中海飲食是一種眾所周知的健康飲食模式。

目的 系統(tǒng)性審查關(guān)于孕期地中海飲食與圍產(chǎn)期結(jié)局之間關(guān)系的所有現(xiàn)有證據(jù)，包括隨機(jī)對(duì)照實(shí)驗(yàn)（RCT）和隊(duì)列研究。

方法 截止至2023年3月10日，在PubMed、Web of Science和Cochran Library上進(jìn)行了搜索相關(guān)研究，并以人工篩選補(bǔ)充。使用隨機(jī)效應(yīng)模型來估計(jì)合并效應(yīng)量及95%置信區(qū)間（95% CI）的大小，以得到特定圍產(chǎn)期結(jié)局的風(fēng)險(xiǎn)。

結(jié)果 共納入5個(gè)RCTs和18個(gè)隊(duì)列研究，包括了107,355名懷孕參與者。在RCT的累積分析中，觀察到孕期堅(jiān)持地中海飲食顯著降低了妊娠期糖尿病（OR，0.56；95%CI：0.34，0.93），以及LGA的發(fā)病率（0.55；95%CI：0.35，0.88）。隊(duì)列研究匯總分析表明，與最低依從性的孕產(chǎn)婦地中海飲食相比，其最高依從性與降低多種不良妊娠結(jié)局的風(fēng)險(xiǎn)顯著相關(guān)，包括妊娠期糖尿?。∣R，0.82；95%CI：0.67，1.00），妊娠期高血壓（0.73；95%CI：0.60，0.89），子癇前期（0.77；95%CI：0.64，0.93），早產(chǎn)（0.67；95%CI：0.49，0.91），低出生體重（0.70；95%CI：0.64，0.78），宮內(nèi)生長(zhǎng)受限（0.46；95%CI：0.23，0.91），以及增加分娩時(shí)的妊娠年齡（WMD，0.11 wk；95%CI：0.03，0.20）。此外亞組分析和Meta回歸分析并沒有確定混雜因素和地理位置的調(diào)整是本研究異質(zhì)性的主要來源。

結(jié)論 懷孕期間堅(jiān)持地中海飲食與圍產(chǎn)期結(jié)局的顯著改善有關(guān)，且未來有必要進(jìn)行更大和更高質(zhì)量的RCTs和隊(duì)列研究進(jìn)一步驗(yàn)證。

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