Infants born to women who drink artificially sweetened beverages daily during pregnancy may be more likely to have increased BMI as well as an increased risk for being overweight in early childhood, researchers reported in JAMA Pediatrics.
Nonnutritive sweeteners have recently become popular sugar substitutes, but evidence suggests that chronic consumption may paradoxically raise the risk for obesity and metabolic disease in children and adults. However, researchers noted a lack of data on the effect of consumption of nonnutritive sweeteners during pregnancy.
To learn more, the researchers evaluated a cohort of 3033 mother-infant pairs from the Canadian Health Infant Longitudinal Development (CHILD) Study — a population-based birth cohort that recruited healthy pregnant women from 2009 to 2012.
Women completed dietary assessments during pregnancy and infant BMI was measured at 1 year of age (n=2686; 89% follow-up). Mean age of the women was 32.4 years, and mean BMI was 24.8.
At 1 year of age, mean infant BMI z score was 0.19, and 5.1% of infants were overweight. More than one quarter of women (29.5%) drank artificially sweetened beverages during pregnancy, with 5.1% reporting daily consumption.
Results linked daily consumption of artificially sweetened beverages, compared with no consumption, with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk for infant overweight at 1 year of age (adjusted odds ratio=2.19 (95% CI, 1.23-3.88).
Maternal BMI, diet quality, total energy intake, and other obesity risk factors did not explain these effects. There were also no comparable associations for sugar-sweetened beverages, according to the researchers.
Study limitations included the potential for error in self-reported dietary outcomes and the inability to distinguish between different nonnutritive sweeteners or account for nonnutritive sweeteners in solid foods. Additionally, as an observational study, the data do not establish causation, the researchers noted.
“To our knowledge, our results provide the first human evidence that artificial sweetener consumption during pregnancy may increase the risk of early childhood overweight,” they concluded. “Given the current epidemic of childhood obesity and the widespread consumption of artificial sweeteners, further research is warranted to replicate our findings in other cohorts, evaluate specific nonnutritive sweeteners and longer-term outcomes, and study the underlying biological mechanisms.”
In an accompanying editorial, Mark A. Pereira, PhD, of the University of Minnesota in Minneapolis, and Matthew W. Gillman, MD, SM, of Harvard Medical School in Boston, explained that while this study has limitations, the findings warrant further investigation.
“Experimental studies in animals and small intervention trials among pregnant women can explore mechanisms. Observational cohort studies should incorporate substitution as well as addition models and pay close attention confounding,” they wrote. “Randomized clinical trials substituting artificially sweetened beverages for sugar-sweetened beverages or, equally valuable, water for artificially sweetened beverages would be particularly helpful.”
- Azad MB, Sharma AK, de Souza RJ, et al; for the Canadian Healthy Infant Longitudinal Development Study Investigators. Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index. JAMA Pediatr. 2016. doi:10.1001/jamapediatrics.2016.0301.
- Pereira MA, Gillman MW. Maternal Consumption of Artificially Sweetened Beverages and Infant: Weight Gain Causal or Casual? JAMA Pediatr. 2016. doi:10.1001/jamapediatrics.2016.0555.