Maternal Adherence to the Mediterranean Diet and Adverse Pregnancy Outcomes: Findings from the Multi-Center PLATONE Project

<b>Background/Objectives:</b> Pregnancy is a critical period during which lifestyle factors, including diet, can affect maternal and fetal outcomes. The Mediterranean Diet (MD) may offer advantages, but evidence on its impact on adverse pregnancy outcomes is limited. We evaluated the association between an MD and adverse pregnancy outcomes, cesarean delivery, and stillbirth outcomes in a large sample of hospitalized women in Italy. <b>Methods:</b> A cross-sectional analysis of retrospectively assessed dietary exposure was conducted using data from 1511 pregnant women recruited within the multi-center PLATONE project. Adherence to the MD was assessed through the nine-item MEDI-LITE. Multivariable logistic regression was used to evaluate the relationship between MD and adverse pregnancy outcomes. <b>Results:</b> High, average, and poor adherence to the MD were reported by 30.8%, 45.3%, and 23.9% of participants, respectively. In a multivariable adjusted analysis, each one-unit increase in the MEDI-LITE adherence was associated with a lower likelihood of adverse pregnancy outcomes (OR = 0.94; 95%CI: 0.88-0.99), while downward trends were also observed for cesarean delivery (OR = 0.96; 0.90-1.01) and stillbirth (OR = 0.94; 0.83-1.06). Among specific MEDI-LITE components, moderate intake of dairy products was associated with reduced adverse pregnancy outcomes, while moderate-to-high fruit consumption was linked to lowered cesarean odds. <b>Conclusions:</b> Maternal adherence to an MD was associated with lower odds of adverse pregnancy outcomes. Given the observational design and because MEDI-LITE is a validated adherence score rather than a tool to test causal effects on pregnancy outcomes, these findings should be interpreted as associations and do not allow causal inference.