British Journal of Nutrition

Dietary Survey and Nutritional Epidemiology

Mediterranean diet adherence during pregnancy and fetal growth: INMA (Spain) and RHEA (Greece) mother–child cohort studies

Leda Chatzia1 c1, Michelle Mendeza2a3, Raquel Garciaa2a3, Theano Roumeliotakia1, Jesús Ibarluzeaa3a4, Adonina Tardóna3a5, Pilar Amianoa3a4, Aitana Lertxundia3a4a6, Carmen Iñigueza3a7, Jesus Vioquea3a8, Manolis Kogevinasa2a3a9a10 and Jordi Sunyera2a3a10a11

on behalf of the INMA and RHEA study groups

a1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece

a2 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

a3 CIBER Epidemiologia y Salud Pública (CIBERESP), Spain

a4 Public Health Division of Gipuzkoa, Instituto Investigation BioDonostia, Basque Government, Spain

a5 Universidad de Oviedo, Spain

a6 University of Basque Country, EHU-UPV, Spain

a7 Centre Superior de Investigation en Salud Publica (CSISP), Valencia, Spain

a8 Departmento Salud Publica, Campus San Juan, Universidad Miguel Hernandez, Elche-Alicante, Spain

a9 National School of Public Health, Athens, Greece

a10 Municipal Institute of Medical Research, Barcelona, Spain

a11 Universitat Pompeu Fabra, Barcelona, Spain


Dietary intake of specific nutrients or food groups during pregnancy could influence fetal growth, but scant evidence is available on effects of dietary patterns. The aim of this study was to evaluate the impact of Mediterranean diet (MD) adherence during pregnancy on fetal growth in two population-based mother–child cohorts in Spain and Greece. We studied 2461 mother–newborn pairs from the Spanish multi-centre ‘INMA’ study (Atlantic area: INMA-Atlantic; Mediterranean area: INMA-Mediterranean), and 889 pairs from the ‘RHEA’ study in Crete, Greece. Maternal diet during pregnancy was assessed by FFQ and MD adherence was evaluated through an a priori score. Fetal growth restriction was based on a customised model, and multivariate log-binomial and linear regression models were used to adjust for several confounders. MD scores differ significantly between the cohorts with women in INMA-Atlantic reporting higher intakes of fish and dairy products, while women in the Mediterranean area reported higher intakes of cereals, vegetables and fruits. Women with high MD adherence had a significantly lower risk of delivering a fetal growth–restricted infant for weight (risk ratios: 0·5; 95 % CI 0·3, 0·9) in the INMA-Mediterranean cohort. Stratified analysis by smoking revealed that higher MD adherence increased birth weight and birth length in smoking mothers, whereas this effect was not apparent in non-smoking mothers. The results of the present study show that several types of MD exist across European Mediterranean regions. High MD adherence may modify the detrimental effect of smoking on birth size, but overall effects of diet were not universal for the studies in this analysis.

(Received October 05 2010)

(Revised April 05 2011)

(Accepted April 08 2011)

(Online publication June 29 2011)


c1 Corresponding author: L. Chatzi, fax +30 2810 394606, email

Abbreviations: BL, birth length; BW, birthweight; FlGR, fetal length growth restriction; FwGR, fetal weight growth restriction; HC, head circumference; INMA, Infancia y medio Ambiente; MD, Mediterranean diet