Table 2.
The outcomes and effect estimates for the included studies.
| Authors | Design and Cohort | Included Participants and Gestational Age | Intervention Type and Comparator | Results |
|---|---|---|---|---|
| Assaf-Balut, C; Garcia de la Torre, N; A Duran et al. [23] Spain |
Prospective randomized interventional study | 874; First Trimester |
MD nutritional therapy | As an early nutritional intervention, MD reduces the incidence of GDM. Comparison of HbA1c levels at 24–28 weeks in women with GDM and normal glucose tolerance: p = 0.001. Values became similar at 36–38 gestational weeks with intervention. |
| Assaf-Balut, Carla; Garcia de la Torre, et al. [24] Spain |
Prospective randomized controlled trial | 874; intervention group (IG), n = 434 control group (CG), n = 440; 8–12 gestational weeks (First Trimester) |
MD nutritional therapy with additional evoo and pistachios | Supplemented MD reduces the incidence of GDM as an early nutritional intervention. IG showed reduced rates of insulin-treated GDM: p =< 0.05 |
| Botto, Lorenzo D.; Krikov, Sergey; et al. [25] USA |
Multicentre population-based case-control study | Mothers of babies with major non-syndromic congenital heart defects (n = 9885); mothers with unaffected babies (n = 9468); maternal diet assessed in the year before pregnancy |
A priori defined MDS with Quartiles 1–4 (worst to best) | Better diet quality is associated with a reduced occurrence of some conotruncal and septal heart defects Overall conotruncal defects: OR 0.63, 95% CI 0.49 to 0.80 Overall tetralogy of Fallot: OR 0.76, 95% CI 0.64 to 0.91 Overall septal defects: OR 0.77, 95% CI 0.63 to 0.94 Overall atrial septal defects: OR 0.86, 95% CI 0.75 to 1.00 |
| Chatzi, L.; Rifas-Shiman, S.; [26] USA, Greece |
Cohort study; Project Viva | Mother-child pairs from USA: 997 Greece: 569 MDA measured during pregnancy with follow-up at median 4.2 and 7.7 years |
MDA with a priori defined MDS through FFQ | Greater adherence to MD during pregnancy may protect against excess offspring cardiometabolic risk. For each 3-point increase in MDS, offspring BMI decreased by 0.14 units (95% confidence interval, −0.15 to −0.13) |
| Chatzi L.; Torrent, M.; et al. [27] Spain |
Cohort study | 507 mothers during the gestational period; 460 children at 6.5 years post-gestational follow-up |
Impact of MDA during pregnancy on asthma and atopy in childhood using a priori defined MDS | Adherence to Med Diet during pregnancy support protective effect against asthma-like symptoms and atopy in childhood Persistent wheeze: OR 0.22; 95% CI 0.08 to 0.90 Atopic wheeze: OR 0.30; 95% CI 0.10 to 0.90 Atopy: (OR 0.55; 95% CI 0.31 to 0.97 |
| Chatzi, L.; Garcia, R.; et al. [28] Spain, Greece |
Cohort study; INMA (Spain) RHEA (Greece) |
During pregnancy with follow-up within 1 year post-gestational; 1771 mother-newborn pairs (Spain); 745 pairs (Greece) |
MDA calculated through completed FFQ | High meat intake during pregnancy may increase the risk of a wheeze in the first year of life; high dairy intake may decrease it RR 0.83, 95% CI 0.72, 0.96 |
| E, Parlapani; et al. [29] Greece |
Cohort study | 82 women delivering preterm singletons ≤34 weeks | FFQ and MDA | High adherence to MD, may favourably affect intrauterine growth (IUGR), premature birth and maternal hypertension (HTN); Low-MDA neonates group had a higher rate of IUGR: OR 3.3 Low-MDA mothers had a higher rate of prematurity: OR 1.6 Low-MDA mothers had a higher gestational HTN: OR 3.8 |
| Fernandez-Barres, S.; et al. [30] Spain |
Cohort study; INMA |
1827 mother-child pairs, assessed during pregnancy | FFQ and MDA | Adherence to MD during pregnancy not associated with a risk of childhood obesity, but is linked to a lower waist circumference; p-value for trend = 0.009 |
| Gesteiro, E.; Rodriguez B., et al. [31] Spain |
Cohort study | 35 women with ‘adequate’ or ‘inadequate’ diets according to HEI (healthy eating index) and MDA score; 1st trimester |
13 point MDA score via FFQ | Maternal diets during the 1st trimester with low HEIs or adherence to MD have a negative effect on insulin markers at birth; Low MDA-score diets had low-fasting glycaemia: p = 0.025 and delivered infants with high insulinaemia: p = 0.049 |
| Gesteiro, E.; Sanchez-Muiz FJ, et al. [32] Spain |
Cross-sectional study | 53 mother-neonate pairs; GDM screening at 24–28 gestational weeks |
Maternal MDA and offspring lipoprotein profile | Neonates of mothers who consumed low adherence of MD during pregnancy presented impaired lipoprotein and higher homocysteine levels; Mothers’ diet in the nAA + AT x mTT group (neonates carrying FTO rs9939609 T allele x Mothers homozygous for FTO rs9939609 T allele) had a significantly lower MDA score: p = 0.05 |
| Gonzalez-Nahm, S. et al. [33] USA |
Cohort study | 390 women whose infants had DNA methylation cord blood data available; FFQ at preconception or 1st trimester |
MDA via FFQ | Suggests that maternal diet can have a sex-specific impact on infant DNA methylation at specific imprinted DMRs; OR = 7.40, 95% CI = 1.88–20.09 |
| Haugen, M.; et al. [34] Norway |
Cohort study; MoBa |
MD criteria met: 569 women; 1–4 criteria met: 25,397 women; 0 MD criteria met: 159 women; 18–24 gestational weeks |
MDA via FFQ | Women who adhered to the MD criteria did not have a reduced risk of preterm birth compared to women who met none of the criteria; OR: 0.73, 95% CI: 0.32, 1.68 Intake of fish twice a week or more associated with lower preterm birth; OR: 0.84; 95% CI: 0.74, 0.95 |
| House, J.; et al. [35] USA |
Cohort study; NEST |
325 mother-infant pairs; 1st trimester; follow-up at 2 years post-gestation |
MDA via FFQ | Offspring of women with high MDA less likely to exhibit neurobehavioural effects: Depression; OR = 0.28 Anxiety; OR = 0.42 Social relatedness; OR = 2.38 |
| Castro-Rodriguez, J.; et al. [36] Spain, Chile |
Cohort study | Gestational period; follow-up in 1000 preschoolers (at 1.5 yrs and 4 yrs) | MDA via FFQ | Low fruit and high meat consumption by the child had a negative effect on allergic responses (wheezing, rhinitis, or dermatitis); as did the high consumption of pasta and potatoes by the mother |
| Lange, N. [37] USA |
Longitudinal prebirth cohort study; Project Viva |
1376 mother-infant pairs; 1st and 2nd trimesters with follow-up at 3 years post-gestation |
MDA via FFQ | Dietary pattern during pregnancy not associated with recurrent wheeze; OR per 1-point increase in MD: 0.98, 95% CI, 0.98–1.08 |
| Mantzoros, C.; et al. [38] USA |
Prospective cohort study; Project Viva |
780 women; 1st and 2nd trimesters; post-gestational cord blood |
MDA | Adherence to MD during pregnancy not associated with cord blood leptin or adiponectin; p-value = 0.38 |
| Monteagudo, C.; et al. [39] Spain |
Cohort study | 320 umbilical cord serum samples | MDS-p (med diet score adapted to pregnancy) | Adherence to the MD and folic acid supplementation during pregnancy may indicate being overweight in newborns; OR = 3.33 (p = 0.019) |
| Peraita-Costa, I. et al. [40] Spain |
Retrospective cross-sectional population-based study | 492 mother-child pairs; immediately post-delivery and for 6 months thereafter |
MDA with two groups identified: low and high adherence | Low adherence to an MD was not associated with a higher risk of a low birthweight newborn; aOR = 1.68; 95% CI 1.02–5.46 |
| Saunders, L.; et al. [41] French West Indies |
Cohort study; TIMOUN |
728 pregnant women who delivered liveborn singletons with no malformations | Semi-quantitative FFQ analysed for MDA | Results suggest that adherence to a Caribbean diet may include benefits of MD, contributing to a reduction in preterm delivery in overweight women; A OR: 0.7, 95% CI 0.6, 0.9 |
| Steenweg-de Graaff, J.; et al. [42] The Netherlands |
Population-based cohort; Generation R Study |
During pregnancy at median 13.5 weeks; Post-gestation in 3104 children at 1.5, 3, and 6 years of age | MDA via FFQ | High adherence to traditional Dutch diet and low adherence to MD are linked to an increased risk of child externalizing problems; OR per SD in MDS: 0.90, 95% CI: 0.83–0.97 OR per SD in Traditionally Dutch Score: 1.11, 95% CI: 1.03–1.21 |
| Vujkovic, M.; et al. [43] The Netherlands |
Case-control study | 50 mothers of children with Spinal Bifida; 81 control mothers post-gestation |
Dietary assessment via FFQ | MD seems to show an association with reducing the risk of offspring being affected by SB; Weak MDA; OR: 2.7 (95% CI 1.2–6.1) High MDA; OR: 3.5 (95% CI 1.5–7.9) |
| Smith, L.; et al. [44] United Kingdom |
Population-based cohort study | 922 LMPT; 965 term births; 32–36 weeks gestation (3rd Trimester) |
Maternal interview for dietary factors: MDA, low fruit and vegetable intake, use of folic acid supplements | Women with 0 adherence to MD were nearly twice as likely to deliver LMPT; RR 1.81 (1.04 to 3.14) Smokers and low consumption of fruit and vegetables had a particularly high risk; RR 1.81 (1.29 to 2.55) |
MD = Mediterranean Diet, MDS = Mediterranean Diet Score, MDA = Mediterranean Diet Adherance, FFQ = Food Frequency Questionnaire, HEI = Healthy Eating Index.