{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:39:03Z","timestamp":1791290343516,"version":"4.3.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The Mediterranean diet pattern is inversely associated with the leading causes of morbidity and mortality, including metabolic diseases and cardiovascular disease, but there are limited data on its association with adverse pregnancy outcomes (APOs) among US women.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate whether concordance to a Mediterranean diet pattern around the time of conception is associated with lower risk of developing any APO and individual APOs.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective, multicenter, cohort study, the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, enrolled 10\u202f038 women between October 1, 2010, and September 30, 2013, with a final analytic sample of 7798 racially, ethnically, and geographically diverse women with singleton pregnancies who had complete diet data. Data analyses were completed between June 3, 2021, and April 7, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>An Alternate Mediterranean Diet (aMed) score (range, 0-9; low, 0-3; moderate, 4-5; and high, 6-9) was computed from data on habitual diet in the 3 months around conception, assessed using a semiquantitative food frequency questionnaire.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Adverse pregnancy outcomes were prospectively ascertained and defined as developing 1 or more of the following: preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, delivery of a small-for-gestational-age infant, or stillbirth.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 7798 participants (mean [SD] age, 27.4 [5.5] years), 754 (9.7%) were aged 35 years or older, 816 (10.5%) were non-Hispanic Black, 1294 (16.6%) were Hispanic, and 1522 (19.5%) had obesity at baseline. The mean (SD) aMed score was 4.3 (2.1), and the prevalence of high, moderate, and low concordance to a Mediterranean diet pattern around the time of conception was 30.6% (n=2388), 31.2% (n=2430), and 38.2% (n=2980), respectively. In multivariable models, a high vs low aMed score was associated with 21% lower odds of any APO (adjusted odds ratio [aOR], 0.79 [95% CI, 0.68-0.92]), 28% lower odds of preeclampsia or eclampsia (aOR, 0.72 [95% CI, 0.55-0.93]), and 37% lower odds of gestational diabetes (aOR, 0.63 [95% CI, 0.44-0.90]). There were no differences by race, ethnicity, and prepregnancy body mass index, but associations were stronger among women aged 35 years or older (aOR, 0.54 [95% CI, 0.34-0.84]; P<\/jats:italic>\u2009=\u2009.02 for interaction). When aMed score quintiles were evaluated, similar associations were observed, with higher scores being inversely associated with the incidence of any APO.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study suggests that greater adherence to a Mediterranean diet pattern is associated with lower risk of APOs, with evidence of a dose-response association. Intervention studies are needed to assess whether dietary modification around the time of conception can reduce risk of APOs and their downstream associations with future development of cardiovascular disease risk factors and overt disease.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.48165","type":"journal-article","created":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T16:34:12Z","timestamp":1671726852000},"page":"e2248165","source":"Crossref","is-referenced-by-count":60,"title":["Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women"],"prefix":"10.1001","volume":"5","author":[{"given":"Nour","family":"Makarem","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi","family":"Chau","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza C.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gyamfi-Bannerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, School of Medicine, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Tous","sequence":"additional","affiliation":[{"name":"Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Booker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet M.","family":"Catov","sequence":"additional","affiliation":[{"name":"Magee Women\u2019s Research Institute, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa D.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"McNeil","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Noel","family":"Bairey Merz","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Wapner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie A.","family":"Bello","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,12,22]]},"reference":[{"issue":"18","key":"zoi221366r2","doi-asserted-by":"publisher","first-page":"e902","DOI":"10.1161\/CIR.0000000000000961","article-title":"Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association.","volume":"143","author":"Parikh","year":"2021","journal-title":"Circulation"},{"issue":"6","key":"zoi221366r3","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.jand.2017.01.016","article-title":"Racial or ethnic and socioeconomic inequalities in adherence to national dietary guidance in a large cohort of US pregnant women.","volume":"117","author":"Bodnar","year":"2017","journal-title":"J Acad Nutr Diet"},{"issue":"10","key":"zoi221366r4","doi-asserted-by":"publisher","first-page":"1956","DOI":"10.3945\/jn.109.109579","article-title":"Women\u2019s dietary patterns change little from before to during pregnancy.","volume":"139","author":"Crozier","year":"2009","journal-title":"J Nutr"},{"issue":"10132","key":"zoi221366r5","doi-asserted-by":"publisher","first-page":"1830","DOI":"10.1016\/S0140-6736(18)30311-8","article-title":"Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.","volume":"391","author":"Stephenson","year":"2018","journal-title":"Lancet"},{"issue":"26","key":"zoi221366r6","doi-asserted-by":"publisher","first-page":"2599","DOI":"10.1056\/NEJMoa025039","article-title":"Adherence to a Mediterranean diet and survival in a Greek population.","volume":"348","author":"Trichopoulou","year":"2003","journal-title":"N Engl J Med"},{"issue":"8","key":"zoi221366r7","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1161\/CIRCULATIONAHA.108.816736","article-title":"Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women.","volume":"119","author":"Fung","year":"2009","journal-title":"Circulation"},{"issue":"4","key":"zoi221366r8","first-page":"237","article-title":"Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort.","volume":"21","author":"Mart\u00ednez-Gonz\u00e1lez","year":"2011","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"7498","key":"zoi221366r9","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1136\/bmj.38415.644155.8F","article-title":"Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study.","volume":"330","author":"Trichopoulou","year":"2005","journal-title":"BMJ"},{"issue":"22","key":"zoi221366r10","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1001\/archinte.167.22.2461","article-title":"Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study.","volume":"167","author":"Mitrou","year":"2007","journal-title":"Arch Intern Med"},{"issue":"8","key":"zoi221366r11","doi-asserted-by":"publisher","DOI":"10.3390\/nu12082236","article-title":"Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms: a review.","volume":"12","author":"Mart\u00edn-Pel\u00e1ez","year":"2020","journal-title":"Nutrients"},{"issue":"23","key":"zoi221366r12","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1161\/CIRCULATIONAHA.115.017158","article-title":"Changes in diet quality scores and risk of cardiovascular disease among US men and women.","volume":"132","author":"Sotos-Prieto","year":"2015","journal-title":"Circulation"},{"issue":"1","key":"zoi221366r13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/ejcn.2013.177","article-title":"Relation of the Mediterranean diet with the incidence of gestational diabetes.","volume":"68","author":"Karamanos","year":"2014","journal-title":"Eur J Clin Nutr"},{"issue":"3","key":"zoi221366r14","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1093\/ajcn\/nqab145","article-title":"Healthy dietary patterns and common pregnancy complications: a prospective and longitudinal study.","volume":"114","author":"Li","year":"2021","journal-title":"Am J Clin Nutr"},{"issue":"9","key":"zoi221366r15","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.022589","article-title":"Mediterranean-style diet and risk of preeclampsia by race in the Boston Birth Cohort.","volume":"11","author":"Minhas","year":"2022","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"zoi221366r16","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/AOG.0000000000003659","article-title":"Association of acculturation with adverse pregnancy outcomes.","volume":"135","author":"Premkumar","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"1","key":"zoi221366r17","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/AOG.0000000000003868","article-title":"Association of living in a food desert with pregnancy morbidity.","volume":"136","author":"Tipton","year":"2020","journal-title":"Obstet Gynecol"},{"key":"zoi221366r18","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.puhe.2016.09.019","article-title":"Social determinants and lifestyles: integrating environmental and public health perspectives.","volume":"141","author":"Graham","year":"2016","journal-title":"Public Health"},{"issue":"14","key":"zoi221366r19","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1055\/s-0036-1586510","article-title":"Racial\/ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy.","volume":"33","author":"Grobman","year":"2016","journal-title":"Am J Perinatol"},{"key":"zoi221366r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.01.019","author":"Haas","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"zoi221366r21","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.ypmed.2007.08.012","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"45","author":"von Elm","year":"2007","journal-title":"Prev Med"},{"issue":"3","key":"zoi221366r22","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1093\/oxfordjournals.aje.a114416","article-title":"A data-based approach to diet questionnaire design and testing.","volume":"124","author":"Block","year":"1986","journal-title":"Am J Epidemiol"},{"issue":"12","key":"zoi221366r23","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1016\/0895-4356(90)90099-B","article-title":"Validation of a self-administered diet history questionnaire using multiple diet records.","volume":"43","author":"Block","year":"1990","journal-title":"J Clin Epidemiol"},{"issue":"479","key":"zoi221366r24","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1198\/016214506000000771","article-title":"Structured measurement error in nutritional epidemiology: applications in the Pregnancy, Infection, and Nutrition (PIN) Study.","volume":"102","author":"Johnson","year":"2007","journal-title":"J Am Stat Assoc"},{"issue":"1","key":"zoi221366r25","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1079\/PHN2005763","article-title":"Validity and reliability of the Block98 food-frequency questionnaire in a sample of Canadian women.","volume":"9","author":"Boucher","year":"2006","journal-title":"Public Health Nutr"},{"issue":"5","key":"zoi221366r27","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1097\/01.AOG.0000437382.03963.88","article-title":"Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists\u2019 task force on hypertension in pregnancy.","volume":"122","year":"2013","journal-title":"Obstet Gynecol"},{"key":"zoi221366r28","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00386-X","author":"Alexander","year":"1996","journal-title":"Obstet Gynecol"},{"issue":"13","key":"zoi221366r30","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019158","article-title":"Mediterranean diet score, dietary patterns, and risk of sudden cardiac death in the REGARDS study.","volume":"10","author":"Shikany","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"zoi221366r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.01.042","author":"Yee","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"zoi221366r32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002857","article-title":"Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): a pragmatic multicentre randomised trial.","volume":"16","author":"Al Wattar","year":"2019","journal-title":"PLoS Med"},{"issue":"10","key":"zoi221366r33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0185873","article-title":"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.","volume":"12","author":"Assaf-Balut","year":"2017","journal-title":"PLoS One"},{"issue":"21","key":"zoi221366r34","doi-asserted-by":"publisher","first-page":"2150","DOI":"10.1001\/jama.2021.20178","article-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.","volume":"326","author":"Crovetto","year":"2021","journal-title":"JAMA"},{"issue":"9","key":"zoi221366r35","doi-asserted-by":"publisher","DOI":"10.3390\/nu11092209","article-title":"Dietary patterns and cardiometabolic outcomes in diabetes: a summary of systematic reviews and meta-analyses.","volume":"11","author":"Kahleova","year":"2019","journal-title":"Nutrients"},{"issue":"9","key":"zoi221366r36","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.numecd.2014.03.003","article-title":"Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials.","volume":"24","author":"Schwingshackl","year":"2014","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"5","key":"zoi221366r37","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1093\/jn\/nxaa002","article-title":"Mediterranean diet increases endothelial function in adults: a systematic review and meta-analysis of randomized controlled trials.","volume":"150","author":"Shannon","year":"2020","journal-title":"J Nutr"},{"issue":"2","key":"zoi221366r38","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1161\/01.HYP.37.2.232","article-title":"Brief review: hypertension in pregnancy: a manifestation of the insulin resistance syndrome?","volume":"37","author":"Solomon","year":"2001","journal-title":"Hypertension"},{"issue":"1","key":"zoi221366r39","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/HJH.0b013e32835b0556","article-title":"C-reactive protein and later preeclampsia: systematic review and meta-analysis taking into account the weight status.","volume":"31","author":"Rebelo","year":"2013","journal-title":"J Hypertens"},{"issue":"12","key":"zoi221366r40","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1001\/jama.285.12.1607","article-title":"Association of maternal endothelial dysfunction with preeclampsia.","volume":"285","author":"Chambers","year":"2001","journal-title":"JAMA"},{"issue":"5","key":"zoi221366r41","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1038\/s41581-019-0119-6","article-title":"Pre-eclampsia: pathogenesis, novel diagnostics and therapies.","volume":"15","author":"Phipps","year":"2019","journal-title":"Nat Rev Nephrol"},{"key":"zoi221366r42","doi-asserted-by":"publisher","first-page":"705S","DOI":"10.1093\/ajcn\/nqy216","article-title":"Dietary patterns before and during pregnancy and maternal outcomes: a systematic review.","volume":"109","author":"Raghavan","year":"2019","journal-title":"Am J Clin Nutr"},{"key":"zoi221366r43","doi-asserted-by":"publisher","first-page":"729S","DOI":"10.1093\/ajcn\/nqy353","article-title":"Dietary patterns before and during pregnancy and birth outcomes: a systematic review.","volume":"109","author":"Raghavan","year":"2019","journal-title":"Am J Clin Nutr"},{"key":"zoi221366r26","volume-title":"Nutritional Epidemiology","year":"2012","edition":"3rd ed"},{"key":"zoi221366r1","doi-asserted-by":"crossref","unstructured":"Hoyert? DL. Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention. February 23, 2022. Accessed June 1, 2022. https:\/\/stacks.cdc.gov\/view\/cdc\/113967","DOI":"10.15620\/cdc:113967"},{"key":"zoi221366r29","unstructured":"The R Project for Statistical Computing. A language and environment for statistical computing. Accessed May 21, 2022. https:\/\/www.r-project.org\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2799855\/makarem_2022_oi_221366_1671050375.61876.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T16:34:18Z","timestamp":1671726858000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2799855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,22]]},"references-count":43,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.48165","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,22]]}}}