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Randomized Controlled Trial
. 2023 May 18;15(10):2362.
doi: 10.3390/nu15102362.

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

Irene Casas  1 , Ayako Nakaki  1   2 , Rosalia Pascal  1   3   4 , Sara Castro-Barquero  1   5   6 , Lina Youssef  1   2   7 , Mariona Genero  1 , Leticia Benitez  1   2 , Marta Larroya  1   2 , Maria Laura Boutet  1 , Giulia Casu  1 , Alex Gomez-Gomez  8 , Oscar J Pozo  8 , Ivette Morilla  9 , Anabel Martínez-Àran  9 , Eduard Vieta  9 , María Dolores Gómez-Roig  1   3   4 , Rosa Casas  5   6 , Ramon Estruch  5   6 , Eduard Gratacos  1   2   10 , Fàtima Crispi  1   2   10 , Francesca Crovetto  1   3   4
Affiliations
Randomized Controlled Trial

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

Irene Casas et al. Nutrients. .

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

Keywords: Mediterranean diet; anxiety; pregnancy; sleep quality; well-being.

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Conflict of interest statement

Ayako Nakaki reports personal fees from La Caixa Foundation (Doctoral INPhINIT—RETAINING, fellowship n LCF/BQ/DR19/11740018), during the conduct of the study. Eduard Vieta reports, outside the submitted work, personal fees from Abbott, Allergan, Angelini, Lundbeck, Sage, and Sanofi; grants from Dainippon Sumitomo, Ferrer, and Janssen. Ramon Estruch reports grants from Fundación Dieta Mediterránea, Spain and Cerveza y Salud, Spain; he reports personal fees for given lectures from Brewers of Europe, Belgium, Fundación Cerveza y Salud, Spain, Pernaud-Ricard, Mexico, Instituto Cervantes, Alburquerque, USA, Instituto Cervantes, Milan, Italy, Instituto Cervantes, Tokyo, Japan, Lilly Laboratories, Spain, and Wine and Culinary International Forum, Spain, and non-financial support to organize a National Congress on Nutrition. Eduard Gratacós reports, during the conduct of the study, grants from La Caixa Foundation, grants from Cerebra Foundation for the Brain Injured Child, and grants from AGAUR. Francesca Crovetto reports a personal fee from Centro de Investigaciones Biomédicas en Red sobre Enfermedades Raras, during the conduct of the study. The remaining authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of participants from the IMPACT BCN trial involved in the current study.
Figure 2
Figure 2
Changes in maternal stress (A), anxiety (B) and sleep quality (C) at baseline (20 weeks of gestation) and final (33 weeks) evaluation according to intervention groups.
Figure 2
Figure 2
Changes in maternal stress (A), anxiety (B) and sleep quality (C) at baseline (20 weeks of gestation) and final (33 weeks) evaluation according to intervention groups.
Figure 3
Figure 3
Percentage of high- vs. low-stress participants, and poor vs. good well-being (WHO-5) according to intervention groups. High stress is shown in dark grey color and defined as a State-trait Anxiety Inventory (STAI) personality score above 75th percentile in Usual care (A) and Mediterranean diet group (B). Poor well-being is shown in in dark grey color and defined as a Five Well-Being Index WHO score below 52.
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