The Effects of Lebanese Mediterranean Diet and Lifestyle Factors on Pregnancy Outcomes in Lebanon

Background and aims: Lifestyle factors and appropriate nutrition play an essential role during pregnancy. In specific, following the Mediterranean diet is known to have positive impacts on the mother and the infant, including preventing excessive gestational weight gain and its associated pregnancy complications. However, no study was conducted that tackles the effect of the Lebanese Mediterranean diet on pregnancy outcomes. Thus, our aim is to examine the effect of the Lebanese Mediterranean diet and Lifestyle factors on gestational weight gain. Methods: A prospective cohort study was conducted in South of Lebanon on 71 Lebanese pregnant women (mean age 28.97 (±4.99), mean pre-pregnancy BMI 25.07 (±5.05), 76.1% were multiparous and 14.1% had maternal delivery complications) who were recruited from 6 different clinics. Data collection took place between December 2019 and May 2021. Sociodemographic data and medical history of participants were collected in the first interview. Each trimester, a questionnaire of 6 validated tools was administered and included Perceived Stress Scale (PSS10), Edinburgh Perinatal/Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality Index (PSQI), a Food Frequency Questionnaire to estimate Lebanese Mediterranean Diet Index (LMD), Physical Activity Readiness Medical Examination (PARmed-X for pregnancy) and Arab Family Food Security Scale (AFFSS). Anthropometric data of the mother and the infant, as well as other medical information were collected from the medical charts. The primary outcome, gestational weight gain (GWG), was dichotomized as adequate vs. high weight gain according to the Institute of Medicine (IOM) guidelines. Bivariate analysis followed by Logistic regression were performed to determine the associations between LMD and other factors and GWG. Results: Regression analysis revealed a significant inverse association between stress in the third trimester and the odds of having high GWG (p-value =0.013 and OR=0.926 with 9