西班牙巴塞罗那大学Eduard Gratacós团队研究了地中海饮食或基于正念的压力缓解措施预防高危孕妇分娩的新生儿小于胎龄出生体重的效果。该研究于2021年12月7日发表于《美国医学会杂志》上。

出生时小于胎龄（SGA）是围产期婴儿发病和死亡的主要原因，尚无有效的预防或治疗措施。母亲营养不良和精神压力过大与胎儿生长不良和不良妊娠结局有关。

为了探讨基于地中海饮食或基于正念的压力缓解（减压）的高危妊娠结构化干预措施是否可降低出生时SGA的新生儿比例和其他不良妊娠结局，2017年2月1日至2019年10月10日，研究组在西班牙巴塞罗那的一所大学医院进行了一项平行组、随机、临床试验，共招募了1221名单胎妊娠（妊娠19-23周）的SGA高危孕妇，均随访至分娩（最终随访时间为2020年3月1日）。

将参与者随机分组，其中地中海饮食组407例，每月接受2小时的个人和团体教育课程，并免费提供特级初榨橄榄油和核桃；减压组407例，接受为期8周的适合孕妇的压力缓解计划，包括每周2.5小时的疗程以及1个全天疗程；常规护理组407例，根据机构协议接受孕期护理。主要终点为分娩时SGA的新生儿百分比，定义为出生体重低于第10百分位。次要终点为综合不良围产期结局（至少以下1项：早产、先兆子痫、围产期死亡率、严重SGA、新生儿酸中毒、低Apgar评分或存在任何重大新生儿疾病）。

1221名参与者的平均年龄为37岁，1184名（97%）完成了试验，其中392名分配到地中海饮食组，391名分配到减压组，401名分配到常规护理组。对照组中有88例（21.9%）新生儿出现SGA，显著高于地中海饮食组的55例（14.0%）和减压组的61例（15.6%）。对照组中有105名新生儿（26.2%）出现综合不良围产儿结局，显著高于地中海饮食组的73名（18.6%）和减压组的76名（19.5%）。

研究结果表明，与常规护理相比，采用结构化的地中海饮食或以正念为基础的压力缓解措施治疗SGA高危孕妇，可显著降低出生体重低于10%的新生儿的比例。

附：英文原文

Title: Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals: The IMPACT BCN Randomized Clinical Trial

Author: Francesca Crovetto, Fàtima Crispi, Rosa Casas, Andrés Martín-Asuero, Roger Borràs, Eduard Vieta, Ramon Estruch, Eduard Gratacós, IMPACT BCN Trial Investigators, Cristina Paules, Ayako Nakaki, Killian Vellvé, Giulia Casu, Sara Castro-Barquero, Tania Freitas, Ana M. Ruiz-León, Rosa Lamuela-Raventós, Teresa M Oller-Guzmán, Anabel Martínez-Aàn, Ivette Morilla, Alex Gomez-Gomez, óscar J. Pozo, Carmen M. Collado, Marta Selma-Royo, Mònica Domenech, Angela Arranz, Francesc Figueras

Issue&Volume: 2021/12/07

Abstract:

Importance  Being born small for gestational age (SGA) is a leading cause of perinatal morbidity and mortality with no effective prevention or therapy. Maternal suboptimal nutrition and high stress levels have been associated with poor fetal growth and adverse pregnancy outcomes.

Objective  To investigate whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) in high-risk pregnancies can reduce the percentage of newborns who were born SGA and other adverse pregnancy outcomes.

Design, Setting, and Participants  Parallel-group randomized clinical trial conducted at a university hospital in Barcelona, Spain, including 1221 individuals with singleton pregnancies (19-23 weeks’ gestation) at high risk for SGA. Enrollment took place from February 1, 2017, to October 10, 2019, with follow-up until delivery (final follow-up on March 1, 2020).

Interventions  Participants in the Mediterranean diet group (n=407) received 2 hours monthly of individual and group educational sessions and free provision of extra-virgin olive oil and walnuts. Individuals in the stress reduction group (n=407) underwent an 8-week stress reduction program adapted for pregnancy, consisting of weekly 2.5-hour sessions and 1 full-day session. Individuals in the usual care group (n=407) received pregnancy care per institutional protocols.

Main Outcomes and Measures  The primary end point was the percentage of newborns who were SGA at delivery, defined as birth weight below the 10th percentile. The secondary end point was a composite adverse perinatal outcome (at least 1 of the following: preterm birth, preeclampsia, perinatal mortality, severe SGA, neonatal acidosis, low Apgar score, or presence of any major neonatal morbidity).

Results  Among the 1221 randomized individuals (median [IQR] age, 37 [34-40] years), 1184 (97%) completed the trial (392 individuals assigned to the Mediterranean diet group, 391 to the stress reduction group, and 401 to the usual care group). SGA occurred in 88 newborns (21.9%) in the control group, 55 (14.0%) in the Mediterranean diet group (odds ratio [OR], 0.58 [95% CI, 0.40-0.84]; risk difference [RD], 7.9 [95% CI, 13.6 to 2.6]; P=.004), and 61 (15.6%) in the stress reduction group (OR, 0.66 [95% CI, 0.46-0.94]; RD, 6.3 [95% CI, 11.8 to 0.9]; P=.02). The composite adverse perinatal outcome occurred in 105 newborns (26.2%) in the control group, 73 (18.6%) in the Mediterranean diet group (OR, 0.64 [95% CI, 0.46-0.90]; RD, 7.6 [95% CI, 13.4 to 1.8]; P=.01), and 76 (19.5%) in the stress reduction group (OR, 0.68 [95% CI, 0.49-0.95]; RD, 6.8 [95% CI, 12.6 to 0.3]; P=.02).

Conclusions and Relevance  In this randomized trial conducted at a single institution in Spain, treating pregnant individuals at high risk for SGA with a structured Mediterranean diet or with mindfulness-based stress reduction, compared with usual care, significantly reduced the percentage of newborns with birth weight below the 10th percentile. Due to important study limitations, these findings should be considered preliminary and require replication, as well as assessment in additional patient populations, before concluding that these treatments should be recommended to patients.

DOI: 10.1001/jama.2021.20178

Source: https://jamanetwork.com/journals/jama/article-abstract/2786831