The Mediterranean diet is considered one of the best diets by US News & World Report. We see that in the general population, following this pattern of eating improves lipid levels. However, there is limited evidence on the impact it has during pregnancy. A 2019 study set out to answer whether the Mediterranean diet is good during pregnancy.

What Did the Study Find?

I won’t bury the lead. The study found no difference in lipid levels between the control and the Mediterranean-style diet. There was a moderate reduction in weight gain, but that didn’t fully translate to better outcomes. There was no difference in rates of preeclampsia, or fetal complications. However, the odds of gestational diabetes decreased by 35%. 

Study Participants Were High-Risk

This study was conducted in the UK, with inner-city pregnant women who had metabolic risk factors. These include obesity, high blood pressure, and high cholesterol. One-in-four women enter pregnancy with one of these risk factors. This can lead to complications during pregnancy, but also long-term health risks.

The goal of the study was to understand if a Mediterranean-style of eating could improve maternal and fetal outcomes. Could it prevent gestational diabetes, preeclampsia, and low birth weight?

The Components of the Mediterranean Diet Included

A Mediterranean-style diet would include high intakes of:

• nuts,
• extra-virgin olive oil,
• fruits and vegetables,
• whole grains, and 
• legumes.

A Mediterranean-style diet would include moderate intakes of:

• fish,
• poultry, and
• dairy.

A Mediterranean-style diet would include low  intakes of:

• red and processed meats,
• sugary drinks,
• fast food, and
• food rich in animal fat.

Participants received individualized dietary advice at 18, 20, and 28 weeks in their pregnancy. For the control group, simply the national guidelines were provided. In the Mediterranean-style group, participants received education on the Mediterranean diet as well as nuts and olive oil to help with adherence.

What Were the Findings of the Mediterranean-style diet?

Again, the findings were not what the researchers expected. The original intention of the study was to look at lipid levels, which remained relatively unchanged. Overall, this Mediterranean-style pattern did not reduce the overall risk of poor maternal or fetal outcomes. However, this pattern does have the potential to limit weight gain and reduce the risk of gestational diabetes.

Was This a Good Study?

There were a variety of things that were great about this study. (I specifically appreciate the bespoke recipes to improve cultural relevance.) However, I want to point out a few things that really limit us making generalizations from the data.

First, the only way the researchers measured adherence to the diet was based on participants’ self reports. This is notoriously inaccurate, but it is often the best we have. During pregnancy research is highly scrutinized for ethical concerns, making it especially difficult to get the gold standard.

Second, participants were less than 18 weeks pregnant, which isn’t considered an early intervention. The end point was 36 weeks. The education began at 18 weeks.

While some participants were likely in the first trimester, not all were. It would be better to have education at the first ob/gyn appointment, or even pre-conception. Following women for the entire pregnancy would be better. 

Third, there was no conversation around exercise. A key component of the Mediterranean diet is an active lifestyle and stress management. We also know there are many benefits of exercising during pregnancy, including reducing risk of preeclampsia. 

Does This Mean I Should Not Follow the Mediterranean Diet?

You know it’s never that easy, or that cut and dry!

Many of the tenants of a Mediterranean-style diet are ones that I encourage to my clients and in my course Chill the Fork Out. Lots of plants, more fish, and healthy fats? All winners. Less refined sugar and fast food? Again, that’s a win.

If you’re especially concerned about gestational diabetes, or have some of the key risk factors for metabolic diseases, the Mediterranean diet is a great option.

If those things aren’t on your radar, there is no reason that the Mediterranean diet is not a good option for you. Unlike many “diets”, the Mediterranean diet doesn’t really have any drawbacks. It’s a good, healthy way of eating for most people.

I want to point out that for some people, the Mediterranean diet does not feel culturally relevant to them. I do believe that most of the principles of this eating pattern can be universal. However, I am keenly aware that the standard examples of foods are typical “white people” food. It is worth working with a dietitian who has knowledge of your cultural foods (or is willing to learn)!

In summary, the Mediterranean diet can be a very healthy way to eat during pregnancy!