In the Journals

Intake of artificial sweeteners during pregnancy may increase infant BMI

Recent findings published in JAMA Pediatrics suggested that consuming artificial sweeteners during pregnancy may increase infant BMI.

Meghan Azad

Meghan B. Azad

To determine an association between ASB maternal consumption and infant BMI, the researchers assessed a cohort of 3,033 mothers and infants from the CHILD study, which recruited healthy pregnant women between 2009 and 2012. The researchers administered a dietary assessment to 2,686 women during their pregnancies and measured their infants’ BMI at 1 year.

The mean age of the women was 32.4 years, the researchers reported, and the patients’ mean BMI was 24.8. Infants had an average BMI of 0.19 at 12 months, and 5.1% of them were considered overweight. During pregnancy, 29.5% of women consumed ASBs, including 5.1% on a daily basis. After assessing maternal BMI, diet quality and total energy intake, daily consumption was associated with a greater risk for infants being overweight at age 1 year (adjusted OR = 2.19; 95% CI, 1.23-3.88).

In contrast, sugar-sweetened beverage (SSB) consumption during pregnancy was not associated with infant BMI, the researchers wrote.

“These results support the hypothesis that [nonnutritive sweeteners (NNS)] are responsible for the observed effects rather than other beverage ingredients or additives, such as caffeine or artificial coloring,” Azad and colleagues wrote. “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 NNS and longer-term outcomes, and study the underlying biological mechanisms.”

In a related editorial, Mark A. Pereira, PhD, in the division of epidemiology and community health at the University of Minnesota School of Public Health, and Matthew W. Gillman, MD, in the department of population medicine at Harvard Medical School, wrote that while Azad and colleagues’ findings warrant attention, they are preliminary because the issue of substitution was not addressed.

“People generally drink ASBs as a substitute for SSBs, not in addition to them,” Pereira and Gillman wrote. “Therefore, whether a person drinks one beverage instead of another is an equally, if not more salient, question than whether a person simply drinks more of a particular beverage.”

They also wrote that other confounding factors went unnoticed by Azad and colleagues.

“Intake of ASBs may be associated with obesogenic risk factors including unhealthful lifestyle habits, which may themselves be the culprits in observed associations with weight gain or dysmetabolism,” they wrote. “The findings … remind us that ASBs yield uncertain benefits for the mother and raise the prospect of risk for her child. Until more safety data are available, pregnant women should consider water for proper hydration and as the beverage of choice.” – by Will Offit

Disclosures: Azad and colleagues report no relevant financial disclosures. Gillman reports being a member of the U.S. Preventive Services Task Force.

Recent findings published in JAMA Pediatrics suggested that consuming artificial sweeteners during pregnancy may increase infant BMI.

“To our knowledge, this is the first human study to evaluate the association of maternal sweetened beverage consumption during pregnancy and infant BMI,” Meghan B. Azad, PhD, research scientist at Children’s Hospital Research Institute of Manitoba, and colleagues wrote. “Our study confirms previous research showing that [artificial sweetener beverage (ASB)] consumption is associated with obesity, diabetes, smoking, and poor diet quality, all of which are established maternal risk factors for obesity in offspring.”

Meghan Azad

Meghan B. Azad

To determine an association between ASB maternal consumption and infant BMI, the researchers assessed a cohort of 3,033 mothers and infants from the CHILD study, which recruited healthy pregnant women between 2009 and 2012. The researchers administered a dietary assessment to 2,686 women during their pregnancies and measured their infants’ BMI at 1 year.

The mean age of the women was 32.4 years, the researchers reported, and the patients’ mean BMI was 24.8. Infants had an average BMI of 0.19 at 12 months, and 5.1% of them were considered overweight. During pregnancy, 29.5% of women consumed ASBs, including 5.1% on a daily basis. After assessing maternal BMI, diet quality and total energy intake, daily consumption was associated with a greater risk for infants being overweight at age 1 year (adjusted OR = 2.19; 95% CI, 1.23-3.88).

In contrast, sugar-sweetened beverage (SSB) consumption during pregnancy was not associated with infant BMI, the researchers wrote.

“These results support the hypothesis that [nonnutritive sweeteners (NNS)] are responsible for the observed effects rather than other beverage ingredients or additives, such as caffeine or artificial coloring,” Azad and colleagues wrote. “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 NNS and longer-term outcomes, and study the underlying biological mechanisms.”

In a related editorial, Mark A. Pereira, PhD, in the division of epidemiology and community health at the University of Minnesota School of Public Health, and Matthew W. Gillman, MD, in the department of population medicine at Harvard Medical School, wrote that while Azad and colleagues’ findings warrant attention, they are preliminary because the issue of substitution was not addressed.

“People generally drink ASBs as a substitute for SSBs, not in addition to them,” Pereira and Gillman wrote. “Therefore, whether a person drinks one beverage instead of another is an equally, if not more salient, question than whether a person simply drinks more of a particular beverage.”

They also wrote that other confounding factors went unnoticed by Azad and colleagues.

“Intake of ASBs may be associated with obesogenic risk factors including unhealthful lifestyle habits, which may themselves be the culprits in observed associations with weight gain or dysmetabolism,” they wrote. “The findings … remind us that ASBs yield uncertain benefits for the mother and raise the prospect of risk for her child. Until more safety data are available, pregnant women should consider water for proper hydration and as the beverage of choice.” – by Will Offit

Disclosures: Azad and colleagues report no relevant financial disclosures. Gillman reports being a member of the U.S. Preventive Services Task Force.