🥗 Why is the Mediterranean Diet Recommended during Pregnancy?

"What should I eat?" during pregnancy. The question is perhaps one of the most curious topics. While there are countless contradictory suggestions floating around on the internet, one of the nutritional models that scientists agree on the most is the Mediterranean diet. In this article, we will explain, without exaggeration and honesty, what the Mediterranean diet is, why it is recommended during pregnancy, and what scientific evidence we rely on when saying this.

🫒 What Exactly is the Mediterranean Diet?

The Mediterranean diet, as its name suggests, is a diet style traditionally adopted in countries around the Mediterranean (especially Southern Italy, Greece and Spain). In fact, it is a dietary pattern (a general way of eating that defines the weight of food groups relative to each other) rather than a strict "diet". Many elements of Turkish cuisine naturally overlap with this pattern; Dishes with olive oil, seasonal vegetables, legumes and fish are not strangers to our tables.

The basic components of the Mediterranean diet are:

• Plenty of olive oil: Extra virgin olive oil is used as the main fat source instead of butter, margarine and lard.
• Vegetables and fruits: Abundant, colorful and in season at every meal.
• Whole grains: Unrefined (unprocessed, with the bran intact) grains such as whole wheat, bulgur, and oats instead of white bread and white rice.
• Legumes: Vegetable sources of protein and fiber such as lentils, chickpeas, and beans.
• Nuts and seeds: Unsweetened and unsalted varieties such as walnuts, almonds and hazelnuts.
• Fish: Several servings per week, especially low-mercury types.
• Small amounts: White meat (chicken) and dairy products are consumed in moderate amounts.
• Very little/avoided: Red meat, processed meat (sucuk, salami), sugary drinks, fast food and animal fats are limited.

🔬 Why is it recommended during pregnancy? What Does the Evidence Say?

The strongest evidence for the Mediterranean diet in pregnancy comes directly from a randomized controlled trial (the most scientifically reliable type of research in which participants are randomly divided into two groups) on the subject. The name of this study is ESTEEM.

ESTEEM study (2019)

In the ESTEEM study conducted in England (Al Wattar et al., PLoS Medicine , 2019), more than 1,200 pregnant women with metabolic risk factors (obesity, chronic high blood pressure or high triglyceride level) were divided into two groups. One group received individual Mediterranean-style nutritional counseling at 18, 20, and 28 weeks of gestation; the other group received usual care. The results were quite instructive:

• The risk of gestational diabetes (pregnancy-related high blood glucose that usually resolves after birth) was reduced by approximately 35% in the Mediterranean diet group (adjusted odds ratio 0.65; 95% confidence interval 0.47–0.91).
• Mothers gained less weight during pregnancy (mean 6.8 kg vs 8.3 kg).

Broader and more recent evidence

ESTEEM's findings were strengthened by more comprehensive reviews in subsequent years. In a large systematic review and meta-analysis published in 2026 (Scarpato et al., Nutrition , 2026), which formed the basis for the Italian National Dietary Guidelines (“La Dieta Mediterranea”)—19 randomized controlled trials and 14 observational studies, totaling more than 180,000 pregnant women—higher adherence to the Mediterranean diet was associated with a significantly lower risk of gestational diabetes (risk ratio 0.74 in randomized studies), preterm birth, and low birth weight; The certainty of evidence for these three outcomes was reported to be "moderate-high". Another meta-analysis pooling only randomized studies (Waugh et al., European Journal of Obstetrics & Gynecology, 2024) also found a similar reduction in gestational diabetes (risk ratio 0.71).

The same direction is supported by much larger observational studies. In the nuMoM2b study (Makarem et al., JAMA Network Open , 2022), which followed more than 7,700 pregnant women in the United States, the risk of any adverse pregnancy outcome was found to be approximately 21% lower in women with high adherence to the Mediterranean diet at the beginning of pregnancy; A 37% risk reduction was found in gestational diabetes and a risk reduction of up to 28% in preeclampsia (a serious condition caused by pregnancy-related high blood pressure and organ damage). Similarly, the Boston Birth Cohort study (Minhas et al., Journal of the American Heart Association, 2022) showed that the risk of preeclampsia was reduced by approximately 20% or more in women with a Mediterranean diet, and this protection was especially evident in black women. A large meta-analysis (Xu et al., Advances in Nutrition, 2024) pooling 23 studies and more than 107,000 pregnant women also confirmed these observational findings, reporting an approximately 23% risk reduction in preeclampsia.

🏥 What Do Health Authorities Say?

The place of the Mediterranean diet in pregnancy is not based on a single official recommendation from a single institution for a certain year, saying "follow this diet", but on a broad scientific consensus that supports each other. One of the most recent reflections of this consensus is the pregnancy section in the American Diabetes Association's (ADA) 2026 Diabetes Standards of Care ( Diabetes Care, 2026 ). This guide recommends that a diet in pregnancy and gestational diabetes be based on “fruits, vegetables, legumes, whole grains, nuts, seeds, fish, and other lean protein sources,” limiting processed foods, fatty red meat, and sugary drinks—so, although not named, the pattern described is squarely the Mediterranean diet.

Similarly, the American College of Obstetricians and Gynecologists (ACOG) states that a diet rich in Mediterranean-style foods, including fish, during pregnancy is associated with reduced complications such as gestational diabetes. The current prenatal care guide of the World Health Organization (WHO) also recommends that every pregnant woman receive healthy nutrition and physical activity counseling. As can be seen, although the name "Mediterranean diet" is not mentioned in every text, the healthy eating pattern described by these institutions largely overlaps with the Mediterranean diet.

🐟 Fish: The Most Important Component and Mercury Warning

Fish is the most valuable but also the most demanding part of the Mediterranean diet. The omega-3 fatty acids (especially DHA) it contains are critical for the baby's brain and eye development. However, some larger fish accumulate mercury (a heavy metal that can damage the nervous system) in the food chain; Therefore, fish selection is important.

According to a joint recommendation from the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) (October 2021), pregnant and breastfeeding women can safely consume 2-3 servings per week (about 110 grams per serving) of low-mercury, “best choices” fish. ACOG recommends a total of about 230-340 grams (8-12 ounces) of fish per week.

✅ Safe (low mercury) options

• Salmon
• Sardines and anchovies
• Trout
• Mackerel (Atlantic mackerel — NOT king mackerel)
• Small-medium sized fish such as sea bream, sea bass, whiting

❌ Fish to avoid (high mercury)

• Swordfish
• Shark
• King mackerel (king mackerel)
• Tilefish
• Marlin and orange roughy
• Bigeye tuna; White/albacore tuna should be limited to ~170 grams per week at most.

🛒 Following the Mediterranean Diet During Pregnancy: Practical Steps

Implementing this diet into daily life is easier than you think. Here are the small but effective changes:

• Change your oil: Make extra virgin olive oil the main oil in meals and salads.
• Devote half of your plate to vegetables: Include colorful vegetables at every main meal.
• Fish 2-3 days a week: Grill or bake salmon or sardines.
• Make legumes your friend: Eat lentil soup, chickpeas or beans a few times a week.
• Transform the snack: Instead of biscuits, a handful of raw walnuts or almonds, a piece of fruit.
• Choose whole grains: whole wheat bread instead of white bread, bulgur instead of rice.
• Stop sugary drinks: Instead of carbonated/sugary drinks, use water, buttermilk or unsweetened herbal teas (safe during pregnancy).
• Reduce red and processed meat: make processed meats such as sucuk, salami and sausages an occasional exception.

🩺 When to Consult a Doctor / Dietitian?

The Mediterranean diet is safe and beneficial for most healthy pregnant women. However, be sure to individualize your nutrition with an expert in the following cases:

• If you have diabetes diagnosed before or during pregnancy or gestational diabetes.
• If you have a food allergy (e.g. nut allergy) or celiac disease.
• If you started underweight or cannot eat enough due to excessive nausea and vomiting.
• If you have a condition that requires protein/potassium restriction, such as kidney disease.
• If there are special situations where energy needs increase, such as multiple pregnancy (twins/triplets).

📝 Closing

The Mediterranean diet offers one of the most scientifically sound grounds for those looking for the "truth" of nutrition during pregnancy. It stands out because it reduces the risk of gestational diabetes, supports healthy weight gain, and is increasingly associated with problems such as preeclampsia. Remember, though: no diet alone guarantees everything. The best results are achieved by combining a balanced diet + regular physical activity + timely prenatal care + supplements recommended by your doctor. Color your plate, love olive oil, and follow along with your healthcare team every step of the way.

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