孕期地中海饮食与减压干预对胎儿脑发育的MRI影响
该研究为IMPACT BCN随机对照试验的二次分析，纳入124例高危小于胎龄儿孕妇，于孕中晚期随机分配至地中海饮食组、减压组或常规护理组，在36.1–39.1周行胎儿脑MRI。结果显示地中海饮食组胎儿右侧岛叶、左侧岛叶更深，胼胝体更长；减压组胎儿左侧岛叶更深，效应量均为亚毫米级。
要点
- 地中海饮食组胎儿右侧岛叶、左侧岛叶更深，胼胝体更长。
- 减压组胎儿左侧岛叶较常规护理组更深。
- 效应量亚毫米级，二维MRI可检测孕期生活方式干预的细微脑改变。
核心结论
- 孕期结构化生活方式干预可能影响胎儿神经发育，效应量虽为亚毫米级但可被二维MRI检测。
研究设计与样本
- IMPACT BCN随机对照临床试验的二次分析，2017年2月至2020年3月纳入1221例高危小于胎龄儿单胎妊娠。
- 孕中期随机分为地中海饮食干预组、减压项目组或常规护理组，随机选取124例子36.1–39.1周行胎儿脑MRI并离线分析。
主要发现
- 地中海饮食组（n=36）较常规护理组（n=44）右侧岛叶更深（28.78±1.16 mm vs 27.88±1.23 mm，P=0.03）。
- 地中海饮食组左侧岛叶更深（28.60±1.21 mm vs 27.49±1.26 mm，P=0.01），胼胝体更长（42.24±2.50 mm vs 40.61±2.13 mm，P<0.01）。
- 减压组（n=44）较常规护理组左侧岛叶更深（28.39±1.13 mm vs 27.49±1.26 mm，P=0.04）。
关键数值与推荐
- 离线分析测量双顶径、枕额径、皮质沟深度、胼胝体长度、蚓部高度及小脑横径。
- 组间比较采用回归模型校正基线 maternal 特征、MRI评估时孕龄、胎儿性别、胎头大小及MRI扫描仪型号。
临床怎么用
- 产前咨询中可提及孕期地中海饮食或减压干预可能对胎儿脑发育有细微影响，但临床意义尚不明确。
- 二维胎儿脑MRI可作为检测孕期干预相关细微脑改变的敏感工具，适用于研究场景。
局限性
- 为二次分析，仅124例子亚组行胎儿脑MRI，样本量有限。
- 效应量均为亚毫米级，临床意义尚未明确，需未来研究进一步揭示。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To assess whether lifestyle interventions based on Mediterranean diet or stress reduction during pregnancy are associated with differences in fetal brain development detectable by two-dimensional magnetic resonance imaging (MRI) in a high-risk population for small-for-gestational-age neonates. METHODS: This was a secondary analysis of the randomized controlled clinical trial, Improving Mothers for a better PrenAtal Care Trial BarCeloNa (IMPACT BCN), which enrolled 1221 singleton pregnancies at high-risk for a small-for-gestational-age neonate between February 2017 and March 2020. At midgestation, participants were randomly allocated into three groups: a Mediterranean diet intervention; a stress-reduction program; or usual care. A randomly selected subgroup (n = 124) underwent fetal brain MRI between 36.1 and 39.1 weeks' gestation and were analyzed offline. Offline analysis included measurements of biparietal diameter, occipitofrontal diameter, cortical sulci depth, corpus callosum length, vermis height and cerebellar transverse diameter. Differences in brain measurement between groups were analyzed by regression models adjusted for baseline maternal characteristics, gestational age at MRI assessment, fetal sex, fetal head size and MRI scanner model. RESULTS: Fetuses in the Mediterranean-diet group (n = 36) showed a significantly deeper right insula (mean ± SD, 28.78 ± 1.16 mm vs 27.88 ± 1.23 mm; P = 0.03), a deeper left insula (mean ± SD, 28.60 ± 1.21 mm vs 27.49 ± 1.26 mm; P = 0.01) and a longer corpus callosum (mean ± SD, 42.24 ± 2.50 mm vs 40.61 ± 2.13 mm; P < 0.01) compared with fetuses in the usual-care group (n = 44). Fetuses in the stress-reduction group (n = 44) also had a deeper left insula (mean ± SD, 28.39 ± 1.13 mm vs 27.49 ± 1.26 mm; P = 0.04) compared with those in the usual-care group. CONCLUSION: Structured maternal lifestyle interventions during pregnancy may influence fetal neurodevelopment. Although the effect sizes were submillimetric, these effects were detectable using two-dimensional MRI, which highlights its potential as a sensitive tool for detecting subtle brain changes during fetal life. Future studies are warranted to truly reveal the clinical meaning of these findings.
引用
- Nakaki A, Gomez Y, Marra MC, et al. Effects of Mediterranean diet and stress-reduction interventions during pregnancy on fetal brain development detected using magnetic resonance imaging. Ultrasound Obstet Gynecol. 2026. PMID: 41999106. doi:10.1002/uog.70214
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。