(P14-093-23) Mediterranean Diet and Female Reproductive Health Over Lifespan: A Systematic Review and Meta-Analysis

Objectives: To conduct a systematic review and meta-analysis of the effects of Mediterranean diet (MD) on female reproductive health outcomes over the life-course.

Methods: We performed a systematic review of randomized controlled trials (RCTs) and prospective studies examining effects of MD on multiple female reproductive health outcomes over the life-course, including clinical outcomes from childhood to adulthood (menarche, polycystic ovary syndrome [PCOS], endometriosis, and outcomes related to fertility, pregnancy, and menopause). We searched PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov to identify eligible studies published up to February 2022. We performed random-effects meta-analysis to pool risk estimates from individual studies to obtain summary relative risks (RRs) and 95% confidence intervals (CIs).

Results: Thirty-two studies (9 RCTs, 22 prospective cohort studies, and 1 nested case-control study) involving 103,204 predominantly Caucasian women ( >95%) were included. The pooled RR (95% CI) comparing randomization to MD versus a control diet based on seven RCTs was 0.74 (0.55-0.99) for gestational diabetes mellitus, 0.45 (0.26-0.76) for preterm birth, 0.71 (0.51-1.00) for gestational hypertension, and 0.82 (0.54-1.22) for preeclampsia; the effect sizes for preterm birth were greater in RCTs that initiated the interventions in first trimester vs. after first trimester (p-heterogeneity=0.02). Similarly, we observed significant inverse associations for all the above-mentioned pregnancy outcomes based on nine cohort studies. There was suggestive evidence of favorable associations between MD adherence with fertility and weight management during pregnancy. Limited studies suggested associations between higher MD adherence and later time to menarche and fewer vasomotor menopausal symptoms, null associations for PCOS-like phenotype and pregnancy loss, and positive associations for luteal phase deficiency.

Conclusions: Adherence to MD may lower risks of adverse pregnancy outcomes among predominantly Caucasian populations. For fertility-related outcomes, available evidence supporting potential beneficial effects is suggestive yet limited. For other reproductive outcomes across the lifespan, data remains sparse.

Funding Sources: National University of Singapore