The impact of pineapple consumption on cervical ripening and labor outcomes: A Nationwide Retrospective Cohort Study among pregnant women in Nigeria

Cervical ripening, a vital precursor to labor, involves complex biochemical and structural changes in the cervix. While medical interventions like prostaglandins and oxytocin are commonly used, dietary factors such as pineapple, containing bromelain - a proteolytic enzyme hypothesized to aid cervical tissue remodeling - have gained attention. This study evaluates the impact of pineapple consumption on cervical ripening and labor outcomes among pregnant women in Nigeria. This nationwide retrospective cohort study included pregnant women aged 18 to 45 years who delivered between January 1, 2018, and December 31, 2023. Participants were categorized into 2 cohorts: those reporting regular 3rd-trimester pineapple consumption (exposed) and those reporting no consumption (unexposed). Data were collected from medical records and structured questionnaires. A total sample size of 2400 participants (1200 exposed and 1200 unexposed) was included based on predefined power calculations. Primary outcomes included cervical ripening (Bishop score), labor duration, and mode of delivery, while secondary outcomes assessed neonatal health. Statistical analysis employed multivariable regression models to adjust for confounding factors such as maternal age, parity, body mass index, gestational age, and socioeconomic status. Linear regression was used for continuous outcomes and logistic regression for binary outcomes. Analyses were performed using Stata Statistical Software: Release 17 (StataCorp LLC, College Station). In multivariable cohort analyses, pineapple consumption was associated with significantly improved cervical ripening (adjusted mean difference 0.8, 95% CI 0.5-1.1, P < .001). Labor duration was shorter among the exposed group (adjusted mean difference -1.7 hours, 95% CI -2.1 to -1.3, P < .001). Women in the exposed cohort had higher odds of spontaneous vaginal delivery (adjusted odds ratio [aOR] 1.8, 95% CI 1.4-2.3, P < .001), with lower cesarean delivery rates. Neonatal outcomes, including birth weight, Apgar scores, and neonatal intensive care unit admissions, showed no significant differences between groups after adjustment. Dose-response analysis demonstrated that higher pineapple consumption was independently associated with shorter labor duration and increased likelihood of vaginal delivery. Third-trimester pineapple consumption was associated with improved cervical ripening, shorter labor duration, and higher rates of spontaneous vaginal delivery without adverse neonatal outcomes. These findings support further investigation of dietary influences on labor outcomes.