4. Discussion
anxiety, Jacka, depressive, depression, weight loss
MAJOR DEPRESSIVE DISORDER 2
In this randomized clinical trial that involved pregnant women at high risk for an SGA newborn, an intervention based on MedDiet significantly reduced maternal anxiety and stress and improved well-being and sleep quality. These effects were revealed by self-reported stress questionnaires and biomarkers, as reflected by the increased estimated activity of a cortisol-deactivating enzyme.Interest in mental health and care has grown exponentially in recent years and associations between healthy dietary patterns and mental health parameters have been reported. Jacka et al. conducted a randomized controlled trial to investigate the efficacy of a dietary intervention based on the MedDiet for the treatment of symptoms related to major depressive episodes in subjects with Major Depressive Disorder, independently of other factors such as physical activity, smoking habit, or weight loss [However, the evidence about the effects of dietary interventions on mental health during pregnancy is limited. Our study reveals that following the MedDiet during pregnancy is associated with a reduction in maternal anxiety/stress, together with an increase in the cortisol-deactivating enzyme. These findings are in line with previous data. In a recent study, Papandreou et al. conducted a randomized clinical trial with 40 pregnant women incorporating MedDiet recommendations into the Clinical Decision Support Systems, showing an improvement in nutritional status and reduction in health-related anxiety and depression [In addition to its beneficial effects on anxiety and stress, our study first demonstrates an improvement in maternal well-being and sleep quality with MedDiet. The association between higher MedDiet adherence and subjective well-being has been found in observational studies [Several biological mechanisms have been postulated regarding the relationship between diet and mental health. First, it should be noted that the MedDiet is an easy-to-follow dietary pattern and is not only a healthy diet but also promotes a healthy lifestyle, including cultural and lifestyle elements such as conviviality, seasonality, traditional recipes, physical activity, and culinary activities [Important implications regarding the mental health of the mother may be expected, including a potential benefit during the postpartum period. Maternal mental health alterations, principally anxiety, are associated with several adverse outcomes for both the mother and the offspring, including postnatal depression, pre-term birth and the poor cognitive and behavioral development of the infants [The major strengths of the present study include a very well-characterized population of pregnant women who followed a structured intervention in a randomized clinical trial. Moreover, the use of different validated questionnaires with clinical applicability to assess mental stress, well-being and sleep quality provided rigor and validity to the results of the study, as well as the ability to analyze various stress-related biomarkers in a subgroup of patients with the aim of measuring stress in an empirical way. The use of validated questionnaires and biomarkers may mitigate the potential misclassification of self-reported data, along with the inherent risk of inaccuracies in the measurements.The study has some limitations. Firstly, the trial was not designed for this purpose, although maternal stress, well-being and sleep quality were prespecified in the study protocol and assessed from the beginning of the study. Secondly, we were not able to assess long-term dietary intake, including measuring diet before pregnancy or the dietary changes from the beginning of the pregnancy. Most women were of white ethnicity and middle to high socio-economical level; hence, the results should not be extrapolated to other populations with different characteristics. These findings should be considered preliminary and require replication, including reseatch involving other study populations and an evaluation of the underlying mechanisms of action.