Daily maternal consumption of artificially sweetened beverages (ASBs) during pregnancy was linked to a 0.20-unit rise in infant body mass index (BMI) z score and a twofold higher risk for overweight, according to a new study of 2413 mother-infant dyads.
"To our knowledge, our results provide the first human evidence that artificial sweetener consumption during pregnancy may increase the risk of early childhood overweight," the researchers write. They note that more than half of Americans report consumption of the drinks in which nonnutritive sweeteners have replaced sugar.
This association was reduced after the researchers adjusted for maternal BMI and was further reduced after adjustment for additional covariates, including total maternal energy intake, diet quality, smoking, diabetes, education, infant sex, birth weight, breast-feeding duration, and solid food introduction. However, even after full adjustment, daily consumption of ASBs remained significantly associated with increased infant BMI z scores..
In contrast, SSB intake was not associated with infant BMI z scores.
The researchers found the highest incidence of overweight among babies born to mothers who reported daily ASB consumption (10.4% vs 4.5% among daily consumers vs nonconsumers; odds ratio [OR], 2.43; 95% CI, 1.30 - 4.55).
These associations were reduced but remained significant after the researchers adjusted for maternal BMI and additional covariates (adjusted OR [aOR], 1.94; 95% CI, 1.00 - 3.76). Again, maternal SSB consumption was not associated with infant overweight (OR, 1.08 [95% CI, 0.65 - 1.08]; aOR, 1.04 [95% CI, 0.60 - 1.80] for daily consumers vs nonconsumers).
"[W]e view the findings of Azad et al as preliminary," Mark A. Pereira, PhD, and Matthew W. Gillman, MD, write in an accompanying editorial.
"They did not address the question of substituting ASBs for SSBs, which themselves - perhaps surprisingly - were not associated with the outcomes."
Dr Pereira and Dr Gillman point to the attenuation of the effect seen by the authors after adjusting for covariates, including prepregnancy BMI and gestational diabetes. "Substantial attenuation by observed covariates raises the possibility of residual confounding from inaccurate measurement as well as unmeasured confounding from prenatal or postnatal factors associated with both maternal ASB intake and infant weight status," the editorialists write.
Still, the findings are important and show the need for further research, Dr Pereira and Dr Gillman write. "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 to confounding. Randomized clinical trials substituting ASBs for SSBs or, equally valuable, water for ASBs would be particularly helpful."
"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," the authors conclude.
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