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The Effect of Adherence to a Mediterranean Diet in Early Pregnancy on Maternal and Fetus Health

Written by
Dr Fathalla Ali, PHD Paediatrics


The health outcome of pregnant women and their newborn child is influenced by many environmental factors. Maternal nutrition is one of the important factors that create a suitable environment for the developing fetus. In a systematic review, published in Nutrients Journal, the author concluded that the adherence to a Mediterranean Diet during pregnancy is associated with favourable health outcomes for both the mother and the developing fetus. Mediterranean Diet is “characterized by a high intake of fruits, vegetables, whole grain cereals, legumes, fish and nuts; low to moderate intake of dairy products and limited intake of red meats and red wine”. It is also characterized by a low percentage of saturated fats that are derived from animal foods and high percentage of unsaturated and polyunsaturated fatty acids that are derived from extra virgin olive oil and oily fish. 

The main results in this systematic review are (1):

  • Adherence to Mediterranean Diet at a high level during pregnancy may protect against asthma-like symptoms and atopy in childhood (2).
  • Adherence to Mediterranean Diet during pregnancy may protect neonate from intrauterine growth restriction and low birth weight (3). Additionally, women who did not have any aspect of Mediterranean Diet during pregnancy are more likely to have risk for late and moderate preterm births than those who adhere to Mediterranean Diet (4).
  • Adherence to the Mediterranean Diet in early pregnancy may protect fetus against cardiometabolic risk. For example, less adipose offspring and low blood pressure in childhood were associated with pregnant women who adhered to Mediterranean Diet in early pregnancy (5).
  • The high level of serum and red blood cell folate, Vitamin B12 and lower plasma homocysteine was correlated with reduced the risk of spina bifida in fetus who their mothers adhered to Mediterranean Diet during pregnancy (6).
  • Adherence to Mediterranean Diet supplemented with extra virgin olive oil and pistachios decreased the incidence of gestational diabetes and improve maternal and neonatal outcomes (7).
  • Adherence to Mediterranean Diet decrease the risk of female sex-linked DNA hypo-methylation. DNA methylation played a significant role in fetus development (8).
  • Adherence to Mediterranean Diet in early pregnancy is associated with favourable neurobehavioral outcomes in early childhood. Children of mothers with high Mediterranean Diet adherence are less likely to show depressive and anxiety behaviours and less likely to show social relatedness behaviours (9).
  • Adherence to the Mediterranean Diet during pregnancy decreased the risk of child externalizing behaviours such as inattention, aggression (10).
  • Low adherence to Mediterranean Diet during the first trimester of pregnancy negatively affect insulin resistance/ sensitivity markers at birth (11)

Keywords: Mediterranean Diet, pregnancy, maternal health, fetus


  1. Amati, F., Hassounah, S., & Swaka, A. (2019). The Impact of Mediterranean Dietary Patterns During Pregnancy on Maternal and Offspring Health. Nutrients, 11(5), 1098. Click here.
  2. Chatzi, L., Torrent, M., Romieu, I., Garcia-Esteban, R., Ferrer, C., Vioque, J., Kogevinas, M., & Sunyer, J. (2008). Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax, 63(6), 507–513. Click here.
  3. Parlapani, E., Agakidis, C., Karagiozoglou-Lampoudi, T., Sarafidis, K., Agakidou, E., Athanasiadis, A., & Diamanti, E. (2019). The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 32(7), 1084–1091. Click here.
  4. Smith, L. K., Draper, E. S., Evans, T. A., Field, D. J., Johnson, S. J., Manktelow, B. N., Seaton, S. E., Marlow, N., Petrou, S., & Boyle, E. M. (2015). Associations between late and moderately preterm birth and smoking, alcohol, drug use and diet: a population-based case-cohort study. Archives of disease in childhood. Fetal and neonatal edition, 100(6). Click here.
  5. Chatzi, L., Rifas-Shiman, S. L., Georgiou, V., Joung, K. E., Koinaki, S., Chalkiadaki, G., Margioris, A., Sarri, K., Vassilaki, M., Vafeiadi, M., Kogevinas, M., Mantzoros, C., Gillman, M. W., & Oken, E. (2017). Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood. Pediatric obesity, 12 Suppl 1(Suppl 1), 47–56. Click here.
  6. Vujkovic, M., Steegers, E.A., Looman, C.W., Ocké, M.C., Spek, P., van der Steegers-Theunissen, R.P. (2009). The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG International Journal of Obstetrics and Gynaecology, 116(3), 408–415. Click here.
  7. Assaf-Balut, C., García de la Torre, N., Durán, A., Fuentes, M., Bordiú, E., Del Valle, L., Familiar, C., Ortolá, A., Jiménez, I., Herraiz, M. A., Izquierdo, N., Perez, N., Torrejon, M. J., Ortega, M. I., Illana, F. J., Runkle, I., de Miguel, M. P., Montañez, C., Barabash, A., Cuesta, M., … Calle-Pascual, A. L. (2017). A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study. PloS one, 12(10). Click here.
  8. Gonzalez-Nahm, S., Mendez, M., Robinson, W., Murphy, S. K., Hoyo, C., Hogan, V., & Rowley, D. (2017). Low maternal adherence to a Mediterranean diet is associated with increase in methylation at the MEG3-IG differentially methylated region in female infants. Environmental epigenetics, 3(2). Click here.
  9. House, J. S., Mendez, M., Maguire, R. L., Gonzalez-Nahm, S., Huang, Z., Daniels, J., Murphy, S. K., Fuemmeler, B. F., Wright, F. A., & Hoyo, C. (2018). Periconceptional Maternal Mediterranean Diet Is Associated With Favorable Offspring Behaviors and Altered CpG Methylation of Imprinted Genes. Frontiers in cell and developmental biology, 6, 107. Click here.
  10. Steenweg-de Graaff, J., Tiemeier, H., Steegers-Theunissen, R. P., Hofman, A., Jaddoe, V. W., Verhulst, F. C., & Roza, S. J. (2014). Maternal dietary patterns during pregnancy and child internalising and externalising problems. The Generation R Study. Clinical nutrition (Edinburgh, Scotland), 33(1), 115–121. Click here.
  11. Gesteiro, E., Rodríguez Bernal, B., Bastida, S., & Sánchez-Muniz, F. J. (2012). Maternal diets with low healthy eating index or Mediterranean diet adherence scores are associated with high cord-blood insulin levels and insulin resistance markers at birth. European journal of clinical nutrition, 66(9), 1008–1015. Click here.

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