Maternal consumption of artificially sweetened beverages linked to increased infant BMI

1. Daily intake of artificially sweetened beverages (ASB) during pregnancy was linked to increased infant body mass index (BMI) at 1 year of age and an overall increased risk of infant being overweight.

2. This difference remained after adjusting for potential confounders, such as maternal BMI, caloric intake, smoking, diabetes, and timing of solid food introduction. Sugar sweetened beverage consumption had no observed effect on infant BMI or obesity.

Evidence Rating Level: 2 (Good)

Study Rundown: Childhood obesity is an increasing public health concern, with up to one-third of children in developed countries being overweight or obese. Studies in adult populations have shown that regular consumption of nonnutritive sweeteners (NNS) may increase risk of obesity and metabolic disorders, although the mechanisms of this effect are unknown. This study sought to evaluate the effect of maternal daily artificial sweetener consumption during pregnancy on infant BMI.

While there was no observed effect on birth weight, daily ASB consumption during pregnancy was associated with increased infant BMI at 1 year and increased risk of infant being overweight. This observation remained after adjusting for known confounders such as maternal BMI, maternal caloric intake, smoking, diabetes, and timing of solid food introduction. Sugar sweetened beverage (SSB) consumption had no observed effect on infant BMI or obesity. The effect of ASB on infant weight had a greater effect on male infants and in those with less than 6 months of breastfeeding duration. This study had a good-sized population and adjusted for important confounders. The limitations of this study included the reliance on self-reported dietary data and the complex multifactorial contributions to infant weight gain which may not have been corrected for in this analysis.

Click to read the study, published today in JAMA Pediatrics

Relevant Reading: Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review

In-Depth [retrospective cohort]: This study used data from 2413 mother-infant dyads enrolled from 2009 to 2012 from the Canadian Health Infant Longitudinal Development (CHILD) birth cohort. Maternal diet was evaluated using the food frequency questionnaire (FFQ). The Health Eating Index was used to grade the diet quality. At 1 year of age, infants were measured for mass and length to calculate BMI. Covariates in analysis included sex, birth weight, gestational age, maternal age, diabetes, maternal education, smoking status, time of solid food introduction, and duration of breastfeeding.

A total of 29.5% of mothers consumed ASB during pregnancy with 5.1% reporting daily consumption. After adjustment for covariates, daily consumption of ASBs was associated with higher mean BMI z scores at 1 year of 0.22 (95%CI 0.02-0.41) and a greater incidence of infants being overweight (10.4% vs. 4.5%; aOR 1.94; 95%CI 1.00 -3.76). Maternal SSB consumption did not have any significant effect on infant BMI or overweight incidence. Effect of ASB consumption on infant BMI had a greater effect on male infants (aOR 3.07; 95%CI 1.41-6.69) versus female infants (aOR 0.45; 95%CI 0.09-2.33). This higher incidence was also present amongst infants who were breastfed for fewer than six months (aOR 2.58; 95%CI 1.10-6.07) compared with greater than 6 months (aOR 1.07; 95%CI 0.31-3.67).

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