In Pregnancy Issues and Concerns

A study reports that both healthy diet and mindfulness training can reduce the incidence of babies born small-for-gestational-age (SGA), that is, at birthweights in the bottom 10% for their age. This is important news because SGA babies are more likely to experience adverse outcomes, and there is no preventive treatment.

Let’s look at why investigators thought diet and mindfulness training might help, what their study involved, what they found, and finish up with a take-away.

What Was Their Theory, What Did They Do, and What Did They Find?

The theory: Suboptimal maternal nutrition and high stress are known to increase likelihood of SGA. Investigators decided to test whether improving diet or decreasing stress would reduce the numbers of SGA babies.

The study design: Investigators conducted a randomized controlled trial, meaning participants were allocated to treatment groups by chance, and assigned 1221 pregnant women at high risk for having an SGA baby to either dietary counseling to eat a diet high in whole grains, fresh fruits and vegetables, dairy, legumes, nuts, fish, white meat, and healthy oils; mindfulness training; or to a control group receiving usual care. Both dietary counseling and mindfulness training involved an intensive program, including group classes, one-on-one sessions, written materials, and other resources.

The study results: Among women receiving usual care, 22% had an SGA baby compared with 14% in the diet group and 16% in the mindfulness group. Women in the diet and mindfulness groups were also less likely to have babies with birthweights in the bottom 3% for gestational age. The rates were 5% in both treatment groups versus 10% in women receiving usual care.

These results are all the more remarkable because:

  1. Women in the control group may have been eating an optimal diet on their own, engaging in mindfulness practices, or both, and, in fact, 19% of control-group women were noted as taking yoga or Pilates classes,
  2. Only 62% of those assigned to the diet group and 51% of those assigned to the mindfulness group rated as having high adherence to the program, and
  3. Some causes of SGA might not be affected by improvements in diet or stress reduction.

The Take-Away

The study offers a couple of take-aways, one personal, the other concerning the maternity care system:

First, both strategies worked. Even better, unlike medical treatments, which invariably also have potential harms, lifestyle improvements such as these have no downside. If you are at risk for having an SGA baby—or even if you aren’t—you have nothing to lose and everything to gain by engaging in health promoting practices.

Second, the study exposes a fundamental failure in how conventional prenatal care is designed and delivered. Conventional prenatal care consists of periodically administering assessments and tests intended to detect whether a problem has developed, at which point, in many cases, the best that can be done is damage control. A commentary on the study acknowledges this. After discussing the study, it goes on to say: “Most pregnant people do not receive adequate nutrition education during pregnancy,” and “Mindfulness interventions are time- and resource- intensive.” In other words, care that preserves and promotes prenatal health improves outcomes, but the system isn’t set up to provide it.

The magnitude of this failure becomes all the more apparent when you consider that most participants in this study were White, and all but a few were middle- to upper-income. How much more at a disadvantage are women of color, or who are low-income, or who are both.

We can do better. Consider the results of a study carried out in a system that fosters prenatal health. The study evaluated the results of 6424 Medicaid patients enrolled in 45 Strong Start freestanding birth centers across the country. In the Strong Start program, midwives provide primary care which includes “structured relationship building, time-intensive care, and individualized education.”

The characteristics of the Strong Start participants were similar to U.S. women nationally, but the outcomes were not. Compared with national data, participants in the Strong Start program were less than half as likely to give birth before 37 weeks (4% vs. 10%) and half as likely to have a baby weighing less than 5 1/2 lb. (4% vs. 8%). Zeroing in on Black participants versus Black women nationally, the decreases in rates of preterm birth (5% vs. 14%) and low birthweight (6% vs. 14%) were even more marked. The program also achieved a large decrease in cesarean rates compared with national rates (12% vs. 32%) and in Black women specifically (15% vs. 36%) as well as an increase in breast feeding rates in the total population (92% vs. 83%) and in Black women (89% vs. 64%).

The Strong Start study is proof positive that we have a maternity care system that fails its primary obligation to the women and babies in its care. Unfortunately, changing that would require a restructuring so so radical that it is unlikely ever to happen.

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