The Mediterranean diet is a global, well-known healthy dietary pattern. This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies. PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest. Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity. The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings.

摘要

地中海饮食是一种全球知名的健康饮食模式。本综述旨在综合关于孕期母亲地中海饮食与围产期结局之间关系的现有证据，包括随机对照试验（randomized controlled trials， RCTs）和队列研究。检索了建库至2023年3月10日的PubMed、Web of Science和Cochrane图书馆，并辅以人工筛选。使用随机效应模型来估计特定感兴趣结局的合并大小和 95% 置信区间 （CI）。综合了 5 项随机对照试验和 18 项队列研究的数据，涉及 107,355 名怀孕受试者。在随机对照试验中，观察到母亲地中海饮食显著降低了妊娠期糖尿病的发生率[比值比（OR），0.56;95%CI：0.34,0.93]，以及小于胎龄期的糖尿病（0.55;95%CI：0.35,0.88）。在队列研究中，母亲地中海饮食的最高依从性得分与各种不良妊娠结局的风险较低呈负相关，包括妊娠期糖尿病（OR，0.82;95% CI：0.67,1.00）、妊娠高血压（0.73;95% CI：0.60,0.89）、先兆子痫（0.77;95% CI：0.64,0.93）、早产（0.67;95% CI：0.49,0.91）、低出生体重（0.70;95% CI： 0.64,0.78）、宫内生长受限（0.46;95% CI：0.23,0.91）和分娩时胎龄增加（加权均数差，0.11 周;95% CI：0.03,0.20）。Meta回归分析没有将混杂因素和地理位置的调整确定为异质性的预测因素。结果表明，在怀孕期间坚持地中海饮食似乎对围产期结果有益。未来有必要进行更大规模和更高质量的随机对照试验和队列研究，以证实目前的研究结果。