top of page

ESTEEM Study Findings

ESTEEM: Effect of simple, targeted diet in pregnant women with metabolic risk factors on pre-eclampsia.


New research findings: how a Mediterranean diet can help pregnant women

The ESTEEM trial at Barts Research Centre for Women’s Health (BARC) has found that by adopting a Mediterranean style diet, pregnant women can reduce their risk of developing diabetes during pregnancy (gestational diabetes) by 35% and can expect to gain less weight during their pregnancy.

What is gestational diabetes?

East London has one of the highest rates of gestational diabetes in the country, with as many as 10-15% of mothers developing the condition. It can cause problems including premature birth and pre-eclampsia, which is a leading cause of death in mothers and babies

How did the study work?

The ESTEEM trial was designed to discover whether a Mediterranean diet could reduce the risk of gestational diabetes and is the largest of its kind globally.

1,252 women with metabolic risk factors were involved in the trial, with one group receiving routine antenatal care, and others adopting a Mediterranean diet in addition to their antenatal care.

This diet included a high intake of nuts and extra virgin olive oil (both were provided by researchers to ensure that the cost wasn’t a barrier to adopting the diet) and fruit and vegetables, and advised participants to avoid sugary drinks, fast food, and food rich in animal fat.

Working with a local community team, we made the diet culturally sensitive to a multi-ethnic inner-city population by providing a bespoke recipe book which includes substitutions like extra virgin olive oil instead of ghee. Participants also received individualised dietary advice at three points throughout their pregnancy.

What did the researchers find?

The results, published in the journal PLOS Medicine show that adopting a Mediterranean-style diet led to a 35% lower risk of developing diabetes in pregnancy, and on average 1.25kg less pregnancy weight, compared to those who received routine antenatal care.

The participants in the Mediterranean-style diet group reported better overall quality of life than those in the control group and reduced bloatedness in pregnancy, but there was no effect on other symptoms such as nausea, vomiting or indigestion.

There was also no improvement in other pregnancy complications such as high blood pressure, pre-eclampsia, stillbirth, or admission to a neonatal care unit.

What the researchers are saying

Click the image to hear Prof Thangaratinam talk about the ESTEEM trial







Professor Shakila Thangaratinam from Queen Mary University of London adds: “This is the first large study to evaluate the value of a Mediterranean-style diet in pregnancy, and it shows that high-risk mothers can benefit from a Mediterranean-style diet to reduce their weight gain and risk of gestational diabetes.

“Implementing this diet seems to be effective, cheap and acceptable to women. The fact that we managed to alter eating habits in a highly diverse East London population suggests that our approach could be successful in other settings.”


Dr Bassel Wattar from Queen Mary University of London and the University of Warwick says: “Although diet and physical activity has been shown to reduce the risk of type 2 diabetes and cardiovascular complications in the general population, we have not always observed these benefits in pregnant women. Now we know that pregnant women from an inner city, high risk, multi-ethnic population are able to adapt their diet to a Mediterranean-style, and that this can bring them important benefits including a reduction in weight gain and a lower risk of developing gestational diabetes.”


See the ESTEEM recipe book 

bottom of page