Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: A randomized clinical trial

doi:10.1016/j.ajog.2005.05.016

American Journal of Obstetrics and Gynecology

Volume 193, Issue 4, October 2005, Pages 1292-1301

https://doi.org/10.1016/j.ajog.2005.05.016 Get rights and content

Objective

We assessed the effect of a cholesterol-lowering diet on maternal, cord, and neonatal plasma lipids and pregnancy outcome.

Study design

Nonsmoking white women with singleton pregnancies (n = 290), aged 21 to 38 years, and with no previous pregnancy-related complications, were randomized to either continue their usual diet or to adopt a diet that promoted fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, and legumes from gestational week 17 to 20 to birth.

Results

Maternal total and low-density lipoprotein cholesterol levels were lowered in the intervention compared with the control group (P < .01). Lipid levels in cord blood and in neonates born to mothers in the intervention versus the control groups did not differ. In the intention-to-treat cohort 1 (0.7%) of 141 women in the intervention group versus 11 (7.4%) of 149 women in the control group delivered before 37 weeks (RR 0.10; 95% CI 0.01-0.77). The incidence of other pregnancy complications and birth weight was similar in both groups.

Conclusion

A cholesterol-lowering diet may modify maternal lipid levels but not cord and neonatal lipids. The marked observed effect of this diet on the reduction of preterm delivery in low-risk pregnancies should encourage future larger studies to clarify the role of such a diet in the prevention of preterm birth.

Section snippets

Study design and population

All pregnant women in Norway are offered an ultrasound investigation at 17 to 18 weeks of gestation. Potential participants received information about the study enclosed with the ultrasound appointment at the National Hospital, Oslo, from June 1999 to November 2001. This information was sent to 2238 women, of whom 985 expressed interest in the study (Figure). Of these, 670 women were screened for inclusion, 294 met the inclusion criteria, 4 withdrew before randomization, leaving 290 women that

Results

The intention-to-treat cohort included all 290 subjects, 149 of whom were randomized to the control diet and 141 were randomized to the intervention diet. The baseline characteristics of the subjects are shown in Table I. All were white. Women that withdrew (n = 21) did not differ from women that completed the study (n = 269) in regard to age, BMI, and baseline lipids (data not shown), but were more likely to be multiparous (57% of withdrawals vs 30% of completers; P = .01).

Compared with the control

Comment

Our main finding was that an antiatherogenic diet modified maternal cholesterol levels, but not cord and neonatal lipids. Second, it reduced the incidence of preterm birth among low-risk women. Preterm delivery is a leading cause of neonatal morbidity and mortality. In addition, premature babies may be at risk of hyperglycemia and hypertension as adults.²³ Thus, these results indicate that dietary intervention in pregnancy can modify cardiovascular risk factors in pregnancy and may result in

Acknowledgments

We thank the obstetric staff at the National Hospital in Oslo for their help and support, Manjula Asaratnam for blood sampling, Ingrid Sparr, Oddveig Dropping, Gabriele Foss, and Tine Sundfør for the dietary advice and assessments, Kjerstin Trygg and staff from the Institute for Nutrition Research for the dietary analyses, Peter Urdal from the Department of Clinical Chemistry at Ullevål University Hospital for lipid analyses of cord blood, and Ingar Holme from the Preventive Medicine Clinic at

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This paper was sponsored by The Norwegian Council on Cardiovascular Disease.

The authors declare that there is no conflict of interest pertaining to the study, and declare that the corresponding author, Janette Khoury, had full access to all the data in the study, and had final responsibility for the decision to submit for publication.

Dr J. Khoury takes responsibility for the integrity of the data and the accuracy of the data analyses.

The Norwegian Council on Cardiovascular Disease had no role in the conduct of the study; in the collection, analysis or interpretation of data; in the preparation of the data; or in the preparation, review, or approval of the manuscript.

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Editors' ChoiceEffect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: A randomized clinical trial

Objective

Study design

Results

Conclusion

Section snippets

Study design and population

Results

Comment

Acknowledgments

Am J Clin Nutr

Am J Clin Nutr

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Am J Obstet Gynecol

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Lancet

Obstet Gynecol

Am J Obstet Gynecol

Metabolism

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J Nutr

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Eur J Obstet Gynecol

Am J Obstet Gynecol

J Nutr

Am J Obstet Gynecol

Editors' Choice
Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: A randomized clinical trial