护理研究

女性妊娠期坚持地中海饮食对儿童健康影响的研究进展

张芳 , 喻蓉艳 , 占倩倩 , 康飞飞 , 吴瑶君 , 吴波

护理研究 | 科研综述 2026,40(6): 1038-1042

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护理研究 |科研综述 2026 , 40 (6) : 1038 -1042

女性妊娠期坚持地中海饮食对儿童健康影响的研究进展

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张芳, 喻蓉艳, 占倩倩, 康飞飞, 吴瑶君, 吴波

作者信息

¹南昌大学第二附属医院，江西 330036

通讯作者:

ZHANG Fang, E-mail:1191436796@qq.com

张芳，主管护师，硕士研究生在读，E-mail：1191436796@qq.com

Research progress on the impact of women adherence to the Mediterranean diet during pregnancy on children's health

Fang ZHANG, Rongyan YU, Qianqian ZHAN, Feifei KANG, Yaojun WU, Bo WU

Affiliations

¹The Second Affiliated Hospital of Nanchang University, Jiangxi 330036 China

Corresponding Author:

ZHANG Fang, E-mail:1191436796@qq.com

出版时间: 2026-03-25 doi: 10.12102/j.issn.1009-6493.2026.06.023

文章导航

摘要

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对女性妊娠期坚持地中海饮食对儿童健康的影响进行综述，以期为今后制定妊娠期女性风险优化管理与防控策略提供参考。

关键词

妊娠期 / 地中海饮食 / 孕妇 / 婴幼儿 / 健康效应 / 儿童 / 综述

Abstract

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This article reviewed the effects of women's adherence to Mediterranean diet during pregnancy on child health,so as to provide references for future development of risk optimization management,prevention,and control strategies during pregnancy women.

Key words

pregnancy / Mediterranean diet / pregnant women / infants and young children / health effects / children / review

引用本文

张芳, 喻蓉艳, 占倩倩, 康飞飞, 吴瑶君, 吴波. 女性妊娠期坚持地中海饮食对儿童健康影响的研究进展. 护理研究, 2026 , 40 (6) : 1038 -1042 . DOI: 10.12102/j.issn.1009-6493.2026.06.023

Fang ZHANG, Rongyan YU, Qianqian ZHAN, Feifei KANG, Yaojun WU, Bo WU. Research progress on the impact of women adherence to the Mediterranean diet during pregnancy on children's health[J]. Chinese Nursing Research, 2026 , 40 (6) : 1038 -1042 . DOI: 10.12102/j.issn.1009-6493.2026.06.023

正文

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饮食不仅是妊娠期女性健康的重要影响因素，也是胎儿生长发育和长期健康的重要影响因素。高质量的饮食不仅可以降低孕妇不良结局发生风险（如妊娠期体重过度增加、妊娠期糖尿病和妊娠期高血压疾病）^[1]，促进后代健康（如减少低体重出生新生儿^[2]），还可以促进胎儿的良好代谢^[3]。地中海饮食（Mediterranean diet，MD）模式是世界上公认的健康饮食模式之一，具有抗炎、抗氧化等特性^[4]，近年来逐渐成为孕期营养干预领域的研究热点，现对该领域相关研究进行综述，通过对现有证据进行总结和归纳，以期为医疗保健专业人员和个人提供科学建议，为今后制定妊娠期风险优化管理与防控策略提供参考。

1　地中海饮食概述

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地中海饮食是起源于南欧地中海地区的一种传统饮食模式，因其在支持和改善人类健康方面的价值，被公认为是世界上最为健康的饮食模式之一，其特点为：1）大量食用植物性食物，如水果、蔬菜、全谷物、豆类、坚果等；2）食用橄榄油，特别是初级特榨橄榄油，以此作为脂肪的主要来源；3）适量摄入鱼类、家禽肉、鸡蛋和乳制品；4）避免红肉和加工肉类的摄入，或通过鱼肉及白肉代替。地中海饮食有利于保证足够数量和适当比例的热量和营养供应，饱和脂肪酸含量低，富含糖类、纤维和抗氧化剂，单不饱和脂肪酸和n-3多不饱和脂肪酸含量较高，主要来源于橄榄油和鱼类^[5]。当前相关研究中针对孕妇地中海饮食依从性（Mediterranean diet adherence，MDA）的评定通常采用3种方式：1）较短的西班牙版Kidmed指数测量^[6]，其中与地中海饮食相关的成分摄入赋值1分，而负相关化合物摄入赋值-1分。依从性分为3个级别，≥8分为最佳，4~7分为中度，≤3分为较差。2）地中海饮食评分(Mediterranean Diet Scale，MDS)^[7]与地中海饮食相对评分（Relative Mediter-Ranean Diet，rMED）^[8]，其中，地中海饮食评分总分为0~9分，地中海饮食相对评分总分为0~18分，两种评分均为得分越高表示依从性越好。3）食物频率问卷（Food Frequency Questionnaire，FFQ），通过收集妊娠期母体饮食数据计算地中海饮食评分^[9]，根据某百分位数划分依从性组别。

2　女性妊娠期坚持地中海饮食对婴儿围生期结局的影响

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2.1　早产

早产的临床定义为妊娠期达到28周但不足37周时，因出现规律宫缩并伴有宫颈变化而进行的分娩^[10]。关于孕期坚持地中海饮食与胎儿早产之间的关联多通过前瞻队列研究进行探究，欧洲国家队列研究报告显示，孕期高度坚持地中海饮食能够有效减少胎儿早产风险^[11-14]。早期在丹麦、挪威和英国实施的3项前瞻性队列研究通过食物频率问卷评估妇女的MDA，即每周吃2次以上的鱼、使用橄榄油或菜籽油、每天食用5种水果/蔬菜、其他肉类食用每周不超过2次，结果在丹麦实施的队列显示，地中海饮食妇女与不采用地中海饮食的妇女相比，早产和早期早产比值比分别为0.61和0.28^[11]；在英国实施的病例队列研究显示，地中海饮食依从性不佳的妇女早产的可能性约为高依从性妇女的2倍^[14]；在挪威实施的队列研究显示，符合地中海饮食标准者与不符合地中海饮食任何一项标准者相比，早产风险未降低，但每周摄入2次或2次以上的鱼与早产风险较低相关^[12]。针对法属加勒比海岛屿非裔群体的队列研究显示，MDA与早产风险相关，特别是在超重和肥胖女性中相关性明显^[13]。一项西班牙的回顾性研究采用西班牙版Kidmed指数评估妇女的MDA，结果发现，中等程度的MDA与早产高风险相关^[15]。Assaf-Balut等^[16]在西班牙实施的随机对照试验结果显示，在怀孕期将补充特级初榨橄榄油和开心果作为早期营养干预措施可降低早产率，与一项针对队列研究的Meta分析结果一致，即坚持地中海饮食能够降低早产风险^[17]。

2.2　胎儿生长受限（fetal growth restriction，FGR）与小于胎龄儿（small for gestational age infant，SGA）

胎儿生长受限是指婴儿出生时体重、身长、头围等低于预测体重分布的第10个百分位数。Chatzi等^[18]在西班牙和希腊实施的2项队列研究中使用食物频率问卷对母亲饮食进行评估，MDA通过先验评分进行评估，结果发现，MDA高的妇女分娩的胎儿体重发育受限风险较低。Parlapani等^[19]在希腊实施的前瞻性队列研究中使用食物频率问卷计算MDA评分，以地中海饮食评分的第50个百分位数为基础，分为高MDA组和低MDA组，结果发现，低MDA组新生儿的宫内生长受限（intrauterine growth restriction，IUGR）发生率较高。一项在法属西印度群岛非裔孕妇群体中的研究发现，妊娠期间MDA与胎儿生长受限风险相关性无统计学意义^[13]。

小于胎龄儿是指出生体重低于同胎龄平均体重的第10个百分位数，或低于同胎龄平均体重2个标准差的新生儿。已有研究结果显示，小于胎龄儿占所有新生儿的7%~10%^[20]，其是死胎、新生儿死亡以及短期和长期心血管、代谢和神经发育后遗症的主要群体^[21]。Martínez-Galiano等^[2]在西班牙的一项配对病例对照研究中使用经验证的食物频率问卷评估女性妊娠期间的饮食摄入量，并评估女性MDA，结果发现，与Predimed's指数≤3分的女性相比，Predimed's指数≥4分的女性生育小于胎龄儿的风险降低41%；橄榄油摄入量超过每天5 g与小于胎龄儿风险降低有关。Peraita-Costa等^[22]对西班牙孕妇的临床病史进行回顾，使用Kidmed指数评估饮食信息，当调整父母体质指数和多胎妊娠时，低依从性孕妇与最佳依从性孕妇相比生育小于胎龄儿的风险较高，但当调整所有重要的可能混杂因素后，这种风险并不高。De Giuseppe等^[23]在意大利通过回顾性研究探讨了小于胎龄儿与母亲孕期MDA、生活习惯及其他风险因素之间的关联，结果发现，71%的妇女采用了地中海饮食,且非小于胎龄儿组的MDA高于小于胎龄儿组。这可能是由于地中海饮食可预防妊娠相关疾病（如妊娠糖尿病和高血压）并对其产生积极影响，进而可间接降低小于胎龄儿风险。Díaz-López等^[24]采用有效的食物频率问卷对孕妇的孕期饮食进行评估，并计算地中海饮食相对评分，结果发现，地中海饮食相对评分得分较高的孕妇分娩小于胎龄儿的风险较低。Crovetto等^[25]在一项平行组随机临床试验中将1 221例小于胎龄儿高危孕妇随机分为地中海饮食组、正念减压组和常规护理组，探讨基于地中海饮食的结构化干预措施是否可以降低出生时小于胎龄儿和其他不良妊娠结局的新生儿百分比，结果发现，提供特级初榨橄榄油和核桃等饮食干预的地中海饮食发生小于胎龄儿的比例较低。Nakaki等^[26]在Crovetto等^[25]研究基础上通过亚组分析发现，地中海饮食组小胎盘体积发生率最低，逻辑回归分析结果显示，胎盘体积小与小于胎龄儿的高风险相关；中介作用分析结果表明，地中海饮食对小于胎龄儿的影响可分解为直接作用和由较小胎盘体积介导的间接作用。Meta分析结果显示，坚持地中海饮食与后代中小于胎龄儿、胎儿生长受限有关，其可使低出生体重风险降低30%，宫内生长受限风险降低54%^[17]。

已有观察性研究及随机对照试验证据表明，妊娠期坚持地中海饮食能够给婴儿在围生期带来一定的健康效应，具体包括早产、胎儿生长受限与小于胎龄儿风险降低。然而当前研究也存在一定问题，需要在今后研究中引起注意，如MDA的准确描述、测试窗口与时间不统一；问卷测试难以定向评估摄入量；地中海饮食具有多样性，很难确定哪些因素更有利于降低婴儿围生期结局风险。

3　女性妊娠期坚持地中海饮食对儿童肥胖及相关代谢健康的影响

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3.1　肥胖

世界卫生组织将儿童肥胖定义为体质指数大于或等于同年龄、性别群体的第95个百分位数（或超标准体重的20%以上），我国与美国疾病控制与预防中心则将体质指数大于或等于同龄、同性别群体的第95个百分位数定义为肥胖。目前儿童超重与肥胖是全球首要公共卫生问题，影响着4 200万名5岁以下儿童^[27]。在我国所有群体中小学生的肥胖检出率最高^[28-29]。识别儿童肥胖最常用的方式是基于人体测量的方法，体质指数是广泛使用的人体测量指标，其临界点广泛用于评估儿童超重与肥胖患病率。关于妊娠期坚持地中海饮食对儿童肥胖影响的研究多来自地中海沿岸国家以及美国，研究设计方面多采用前瞻性队列设计，妊娠期孕妇MDA通常采用地中海饮食评分表示。儿童超重与肥胖多采用年龄和性别特异性体质指数Z得分定义^[30]，部分研究采用腰围、三头肌、肩胛下皮褶厚度进行补充测试。已有研究结果表明，孕期坚持地中海饮食能够有效降低后代超重与肥胖风险。Ashwin等^[31]研究发现，高MDA母亲所生的婴儿体脂百分比低于低MDA母亲所生的婴儿。Fernández-Barrés等^[32]在一项西班牙实施的队列研究中评估妊娠期坚持地中海饮食与儿童超重和4岁时腹部肥胖风险间的关系，结果表明，妊娠期坚持地中海饮食与儿童超重风险相关性无统计学意义，但与较低的腹部肥胖标志物（WC）有关。且研究发现，母亲孕期较高的地中海饮食相对评分与子代出生体型较大的低风险相关^[33]。Díaz-López等^[34]在西班牙对272对母子进行前瞻性关联研究，结果发现，在孕期更严格地采用地中海饮食可能会降低后代在4岁时超重/肥胖发生风险，这种益处似乎在30岁以下、超重/肥胖、不吸烟或来自中下层社会阶层的女性中更为明显。Gonzalez-Nahm等^[35]针对非裔美国人、西班牙裔美国人和白人的对列研究中发现，较高的MDA也与出生时较低的体型相关，这种相关性持续发生于儿童3~8岁，且以3~5岁的白人儿童最为明显。Monthé-Drèze等^[36]对美国1 459对母子的前瞻性队列研究中发现，地中海饮食坚持不佳的妇女，生育的儿童在3~15岁时有较高的体质指数z得分。Chatzi等^[37]研究发现，地中海饮食评分每增加3分，后代体质指数z得分降低0.14个单位，腰围减少0.39 cm，皮褶厚度总和降低0.63 mm，表明母亲在怀孕期间坚持地中海饮食与儿童肥胖风险降低有关。

3.2　代谢健康

肥胖相关代谢综合征涉及的人体测量学指标与生物学标志物包括三酰甘油、高密度脂蛋白胆固醇、收缩压和舒张压、腰围和空腹血糖等。大量研究表明，地中海饮食在改善儿童或青少年代谢综合征中具有一定益处，具体表现为代谢综合征的组成部分以及相关炎症生物标志物改善^[38-40]。Gesteiro等^[41]通过MDA评分评价妊娠期饮食质量，以确定妊娠早期饮食质量与出生时胰岛素敏感性/抵抗生物标志物之间的关系，结果发现，在分娩前3个月母亲饮食的健康饮食指数或MDA得分较低会对出生时婴儿胰岛素抵抗标志物产生负面影响。Chatzi等^[37]研究发现，地中海饮食评分每增加3分，后代收缩压和舒张压分别降低1.03 mmHg和0.57 mmHg。而Fernández-Barrés等^[33]研究发现，地中海饮食评分与儿童C肽、载脂蛋白B、白细胞介素-6（IL-6）和C 反应蛋白（CRP）之间相关性不明显。

4　女性妊娠期坚持地中海饮食对儿童认知功能与神经发育的影响

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母亲的妊娠期营养水平与胎儿和儿童神经发育有关，饮食模式对后代的行为也存在一定程度的影响。妊娠期坚持地中海饮食对儿童神经发育以及认知具有较大的健康效应。Steenweg-De Graaff等^[42]研究发现，孕期食用地中海饮食与儿童发生行为问题（特别是外化问题）的风险较低之间存在关联（注意力问题和攻击性行为）。House等^[43]对母婴的前瞻性队列研究发现，MDA评分较高的1/3妇女与MDA评分较低的1/3妇女相比，后代出现非典型行为的风险降低，出现适应不良行为的风险降低；且研究发现，儿童抑郁与母亲的MDA成反比，MDA评分较高的1/3妇女与MDA评分较低的1/3妇女相比，后代出现抑郁和焦虑行为的风险较低。Cendra-Duarte等^[44]评估了怀孕期间母亲坚持地中海饮食对4岁儿童行为问题的影响，结果表明，怀孕期间地中海饮食相对评分较高与获得总体问题的临床评分降低有关，包括外化、注意力问题、注意力缺陷/多动问题、对立违抗性问题、抑郁问题。Mahmassani等^[45]在一项涉及1 580对母婴的前瞻性产前队列研究中使用妊娠期改良版地中海饮食评分（MDS-P）评估MDA，结果发现，母亲在怀孕期间的妊娠期改良版地中海饮食评分较高(6~9分)与较低(0~3分)相比，儿童考夫曼简明智力测验非语言和语言得分较高，执行功能元认知指数行为评级量表得分较低，即儿童中期智力更好，元认知问题更少。Nakaki等^[46]通过一项随机对照试验调查怀孕期间地中海饮食干预是否与胎儿和新生儿大脑发育有关，结果发现，与通常的护理组相比，采用地中海饮食的母亲胎儿脑体积、胼胝体、右额叶更大。Crovetto等^[47]将地中海饮食应用于孕妇以探讨其对改善2岁儿童神经发育是否存在影响，通过贝利婴幼儿发育量表(第3版)评估后发现，与常规护理组儿童相比，地中海饮食组的儿童在认知领域和社会情感领域得分更高。

5　女性妊娠期坚持地中海饮食对儿童过敏性疾病的影响

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过敏性疾病是一个日益严重的公共卫生问题，哮喘、湿疹、过敏性鼻炎和食物过敏是过敏性疾病的4种主要表现^[48]。地中海和南北美洲国家针对妊娠期坚持地中海饮食与儿童过敏性疾病间的关系进行探索，部分研究结果表明，母亲怀孕期间坚持地中海饮食对6~7岁儿童哮喘样症状以及过敏性鼻炎具有保护作用^[49-50]；但也有研究分析发现，在怀孕期间坚持地中海饮食与后代的小气道功能有关，但与哮喘或其他过敏性疾病风险降低相关性不明显^[51]。针对学龄前儿童的分析也存在争议，如有研究发现，孕期坚持地中海饮食和在怀孕期间使用橄榄油烹饪/调味沙拉与儿童出生后第1年的喘息减少相关^[52]；Chatzi等^[53]在一项来自西班牙和希腊的母婴队列分析中也得出类似结果，即怀孕期间摄入大量肉类可能会增加儿童出生后第1年的喘息风险，而大量摄入乳制品可能会降低喘息风险。但Lange等^[54]的分析发现，妊娠期的总体饮食模式与3岁儿童反复喘息、哮喘、湿疹、呼吸道感染或儿童特应性疾病关系不明显，而妊娠期个别营养素的摄入可能决定了后代喘息相关疾病的发生。Nakano等^[55]研究发现，妊娠期坚持地中海饮食，后代4岁时哮喘发病率较低。而一项针对观察性研究的荟萃分析表明，怀孕期间对地中海饮食的高度坚持与12个月内儿童的喘息发生率降低相关，但与哮喘关联不明显^[56]。

6　女性妊娠期坚持地中海饮食对儿童先天性疾病的影响

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Vujkovic等^[57]在一项病例对照研究中选取了50名脊柱裂患儿母亲以及81名健康儿童母亲，通过食物频率问卷获得母亲的食物摄入量信息，采用主成分因子分析和降秩回归分析母亲的饮食模式，结果发现，地中海饮食模式与血清叶酸、红细胞叶酸、维生素B₁₂水平升高及血浆同型半胱氨酸水平降低相关；在地中海饮食习惯较弱的母亲中，后代脊柱裂风险增加。Carmichael等^[58]于1997—2005年在美国进行了一项多中心病例对照研究，结果发现，较高的地中海饮食评分和饮食治疗指数可能与出生缺陷风险降低相关，与非畸形关联更强；在调整了母亲摄入的矿物质/维生素补充剂后，关联仍然存在。Botto等^[59]选取1997—2009年出生的非综合征性先天性心脏病患儿母亲为研究对象，结果发现，良好的饮食质量与圆锥动脉干和房间隔缺损风险降低有关。

7　小结与展望

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现有证据表明，妊娠期坚持地中海饮食能够给儿童带来诸多潜在的健康效应，包括改善围生期结局、控制肥胖与超重、促进认知与神经发育、降低过敏性疾病以及先天性疾病风险等。但多数结果是基于观察性研究得出，高质量的随机对照试验偏少；且该领域的大多数研究于欧洲实施，特别是地中海沿岸国家和地区；研究方向多停留在坚持地中海饮食与儿童健康表面现象的描述，针对地中海饮食中各种主要成分的影响效果及其作用机制研究较少。因此，后续相关研究应当在充分解释其作用机制和因果关系有效性的基础上，通过大规模的临床试验阐明孕期坚持地中海饮食对后代健康的作用，从而为提高妊娠期营养补充及后代健康成长效果提供参考。

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2026年第40卷第6期

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doi: 10.12102/j.issn.1009-6493.2026.06.023

接收时间：2025-04-11
首发时间：2026-10-28
出版时间：2026-03-25

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收稿日期：2025-04-11
修回日期：2026-02-09

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¹南昌大学第二附属医院，江西 330036

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ZHANG Fang, E-mail:1191436796@qq.com

张芳，主管护师，硕士研究生在读，E-mail：1191436796@qq.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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