| ObjectiveBased on a prospective cohort,this study analyzed the association between the Mediterranean diet(MD)during pregnancy and the neurodevelopment of infants at 12 months of age.We also analyzed cord blood metabolites to explore the role that cord blood metabolites may play in the relationship between MD diet during pregnancy and the neurodevelopment of infants.At the same time,gender stratification was also used in this study to further analyze whether the effects of MD during pregnancy on infant neurodevelopment were different due to gender differences.MethodsThis study was a population-based birth cohort that recruited pregnant women from 3centers in Hefei(Anhui Women and Child Health Care Hospital,the First People’s Hospital of Hefei City,and the First Affiliated Hospital of Anhui Medical University).Baseline data were conducted from March 2018 to January 2021.Baseline information was collected by means of an electronic questionnaire,the general demographic characteristics of pregnant women,perinatal health status,and their lifestyle during pregnancy(e.g.diet during pregnancy)were included.During the follow-up to delivery,cord blood samples were collected and stored in the biobank for subsequent detection of biological indicators of cord blood.The previous collected venous cord blood samples were detected for cord serum metabolic markers including C-peptide,high-density lipoprotein-cholesterol,low-density lipoprotein-cholesterol,total cholesterol,and triacylglycerol.Infant neurodevelopment was assessed at 12 months of age,and 1471 mother-infant pairs were eventually included in the analysis.In this study,diet during pregnancy was evaluated using the MD score,infant neurodevelopment was screened using the Age and stage questionnaire,and the third edition(Ages and Stages Questionnaires,Third Edition,ASQ-3).The distributions of maternal and infant variables were compared using Chi-squared tests for categorical variables and t-tests for continuous variables.The MD score was evaluated based on that modified by Chatzi et al for pregnant women.In this study,pregnant women were divided into high score and low score groups according to high(4-7)and low(0-3)MD scores.Based on Chi-squared tests and logistic regression the associations of MD score(categorical and continuous)with developmental delays in infants was shown.Stratified analyses were used to estimate the association of MD score and log-transformed C-peptide with ASQ-3 failures with the failure of communication domain according to infant gender.Logistic regression was used to assessed relations between MD score with cord blood markers and associations of cord blood markers with ASQ-3 failures.We evaluate the role of log-transformed C-peptide in the association between maternal MD score and the failure of communication domain.Results1471 mother-infant pairs were included in this study.Of these,578(39.3%)were classified as high score group and 893(60.7%)were classified as low score group.Compared with the low score group,the proportion of pregnant women with less than12 years of education(28.4% vs.34.8%),household income less than 6000 yuan (46.7% vs.55.1%),and frequency of physical exercise less than three days a week(31.7% vs.45.1%)were lower in the high score group.In terms of infants’ basic characteristics,compared to the low score group,the children of mothers in the high score group got higher ASQ-3 scores on the communication,fine motor,and personal social performance scales(mean ± SD: 55.5 ± 6.8 vs.53.5 ± 9.2,53.2 ± 8.9 vs.51.8 ± 9.6,49.3 ± 10.7 vs.47.9 ± 12.5).While their scores in gross motion and problem solving abilities(mean ± SD: 45.6 ± 13.7 vs.45.3 ± 13.7,51.4 ±9.7 vs.50.3 ± 10.8)had no significant difference.An analysis between MD and infant neurodevelopment during pregnancy found that infants of high MD score mothers had higher levels of communication domain(2.6 vs.7.4%,P < 0.001),problem-solving domain(1.9 vs.3.8%,P = 0.038),personal social domain(2.1 vs.5.4%,P = 0.002),and any failure(11.8 vs.17.4%,P = 0.003)than infants of low MD score mothers.And there was no statistical difference between gross motor and fine motor domain.After adjusted for confounding factors,there’s only the relationship of MD score and communication domain [RR with 95% CI: 0.34(0.16,0.72)] was proved to be meaningful.In addition,our study showed that the associations of MD score with cord serum markers and associations of cord serum markers with ASQ-3failures were meaningful.Mothers with low MD score had increased risk of higher cord serum markers level in adjusted analyses(included C-peptide,LDL-cholesterol,Total cholesterol and HDL-cholesterol,but except Triacylglycerol).When the relation of cord serum metabolic markers and ASQ-3 failures were analyzed,we found that just cord serum C-peptide level above the 90 th percentile and the failure of communication domains was significative [RR with 95% CI: 2.90(1.28,5.69)].The contribution of maternal MD to failure of communication domain mediated by the loge-transformed cord serum C-peptide [indirect effect in all infants with 95% CI:-0.070(-0.472,-0.017),in boys with 95% CI:-0.163(-0.894,-0.016)and in girls with 95% CI:-0.015(-0.231,0.095)] was showed by Mediation analysis.ConclusionGreater adherence to MD during pregnancy was associated with better infant neurodevelopment,possibly mediated by cord blood C-peptide levels,and the association between MD and infant neurodevelopment was different in boys and girls. |
PDF Full Text Request