In a recent study published in Nutrientsresearchers determined the relationship between maternal adherence to the Mediterranean diet (MedDiet) during pregnancy and the risk of overweight or obese offspring at four years.
Study: Close adherence to a Mediterranean diet during pregnancy reduces childhood overweight/obesity: a prospective study. Image credit: Marian Weyo/Shutterstock.com
Record
The childhood obesity epidemic is a global health concern affecting millions of children under the age of five, causing psychological comorbidities, low self-esteem, behavioral and emotional disorders, and long-term cardiovascular morbidity and cancer.
In addition, the World Health Organization (WHO) report emphasizes the importance of prenatal nutritional balance to prevent childhood obesity.
Close maternal adherence to a Mediterranean-type diet during pregnancy could be a promising strategy to identify potential risks of childhood obesity. Greater adherence to the diet has multiple health benefits for both mother and child.
However, studies examining the impact of prenatal diet on offspring obesity are rare and yield mixed results, warranting further research.
About the study
In the present study, researchers investigated whether maternal adherence to the MedDiet was associated with offspring obesity at four years and assessed the influence of maternal factors on the association.
The team included 272 mother-child dyads from the Ensayo CLInico Para Suplementar con Hierro a EmbarazadaS (ECLIPSES) study for analysis.
The primary study outcome was overweight or obese offspring based on sex-age body mass index (BMI) z-scores above the 85th percentile using WHO child growth standards.
The researchers obtained basic maternal data from questionnaires during face-to-face interviews at recruitment, including medical history, age, education level, socioeconomic status, physical activity, smoking status, and alcohol intake.
In addition to gestational age at birth and type of delivery, they obtained data on child-related variables such as sex, length and weight at birth.
The team assessed prenatal diet using standardized 45-item food frequency questionnaires (FFQs) at 12, 24 and 36 weeks’ gestation and calculated the associated MedDiet (rMedDiet) scores. They measured the offspring’s height and weight at four years.
They calculated the total daily caloric intake using the REGAL food table and determined the socioeconomic status of the household using the Catalan classification of occupations (CCO-2011).
Researchers assessed physical activity using the International Physical Activity Questionnaire (IPAQ) and categorized gestational weight gain (GWG) using the 2009 Institute of Medicine (IOM) recommendations.
They performed multivariate logistic regression modeling to determine odds ratios (OR) for the association between prenatal nutrition and childhood obesity.
The ECLIPSES randomized clinical trial was conducted in Tarragona, Spain from 2013 to 2017 to evaluate the efficacy of maternal iron supplementation at different doses, adjusting baseline hemoglobin levels in early pregnancy, to maternal iron status at the end of pregnancy.
Primary care midwives recruited 791 pregnant women aged ≥18 years to the study at the initial antenatal visit (before week 12 of gestation).
Results
Mean maternal age was 32. 70% were aged ≥30 and 42% were obese or overweight, with body mass index values ≥25 kg m-2.
Most (86%) mothers were from Spain, 44% obtained a university level, 22% had a high socioeconomic status, and 17% smoked during pregnancy. Among mothers, 29% showed low MedDiet adherence, while 23% were highly adherent.
The mean prenatal rMedDiet score was 9.80 and 26% of the offspring were overweight or obese at four years, with a higher prevalence of obesity in males (63%) than females (37%).
The team found significant anthropometric differences (height, weight and body mass index) by gender. The average body mass index and body weight of the offspring at four years was 16 kg m-2 and 18 kg, respectively.
Males had higher weight (19 vs. 17 kg), BMI (16 vs. 15.6), weight-for-age z-scores (0.5 vs. 0.1), and body mass index (0.7 vs. 0.2) than the women.
Overweight/obesity was less prevalent among offspring of mothers with college education, higher socioeconomic status, and higher gestational rMedDiet scores.
After adjusting for potential confounding variables, the team found that higher prenatal MedDiet adherence was associated with a reduced risk of overweight or obese offspring (OR for highest vs. lowest quartile, 0.3).
They obtained similar findings, stratified by maternal age, early pregnancy BMI, educational level, smoking status, socioeconomic status, and GWG.
After confounding adjustment, the team found that each point increase in prenatal MedDiet was associated with a 19% lower risk of children being overweight or obese at four years (OR, 0.8).
Smoking (OR, 2.5), prepregnancy overweight (OR, 2.5) or obesity (OR, 2.6), and excess GWG (OR, 2.9) were significantly associated with being overweight or obese offspring at four years.
The protective effects of the MedDiet on offspring weight were higher in expectant women under 30 years of age who were overweight or obese at initial pregnancy, those who did not smoke, and those with low socioeconomic status.
conclusion
Overall, the study findings showed higher prenatal adherence to the MedDiet associated with lower reduced overweight/obesity at four years, especially among college-educated mothers under 30 years of age from low socioeconomic backgrounds who did not smoke. Future studies could investigate whether the association persists across life stages.
