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Original Investigation |

Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index

Meghan B. Azad, PhD1,2; Atul K. Sharma, MSc, MD1,2,3; Russell J. de Souza, RD, ScD4,5,6; Vernon W. Dolinsky, PhD2,7; Allan B. Becker, MD1,2; Piushkumar J. Mandhane, MD8; Stuart E. Turvey, MBBS, DPhil9,10; Padmaja Subbarao, MD11; Diana L. Lefebvre, PhD12; Malcolm R. Sears, MB12 ; for the Canadian Healthy Infant Longitudinal Development Study Investigators
[+] Author Affiliations
1Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
2Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
3George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
5Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
6Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
7Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
8Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
9Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
10Child and Family Research Institute, BC Children’s Hospital, Vancouver, British Columbia, Canada
11Department of Pediatrics & Physiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
12Department of Medicine, McMaster University, Hamilton, Ontario, Canada
JAMA Pediatr. 2016;170(7):662-670. doi:10.1001/jamapediatrics.2016.0301.
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Importance  The consumption of artificial sweeteners has increased substantially in recent decades, including among pregnant women. Animal studies suggest that exposure to artificial sweeteners in utero may predispose offspring to develop obesity; however, to our knowledge, this has never been studied in humans.

Objective  To determine whether maternal consumption of artificially sweetened beverages during pregnancy is associated with infant body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]).

Design, Setting, and Participants  This cohort study included 3033 mother-infant dyads from the Canadian Healthy 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 their infants’ BMI was measured at 1 year of age (n = 2686; 89% follow-up). Statistical analysis for this study used data collected after the first year of follow-up, which was completed in October 2013. The data analysis was conducted in August 2015.

Exposures  Maternal consumption of artificially sweetened beverages and sugar-sweetened beverages during pregnancy, determined by a food frequency questionnaire.

Main Outcomes and Measures  Infant BMI z score and risk of overweight at 1 year of age, determined from objective anthropometric measurements and defined according to World Health Organization reference standards.

Results  The mean (SD) age of the 3033 pregnant women was 32.4 (4.7) years, and their mean (SD) BMI was 24.8 (5.4). The mean (SD) infant BMI z score at 1 year of age was 0.19 (1.05), and 5.1% of infants were overweight. More than a quarter of women (29.5%) consumed artificially sweetened beverages during pregnancy, including 5.1% who reported daily consumption. Compared with no consumption, daily consumption of artificially sweetened beverages was associated with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk of infant overweight at 1 year of age (adjusted odds ratio, 2.19; 95% CI, 1.23-3.88). These effects were not explained by maternal BMI, diet quality, total energy intake, or other obesity risk factors. There were no comparable associations for sugar-sweetened beverages.

Conclusions and Relevance  To our knowledge, we provide the first human evidence that maternal consumption of artificial sweeteners during pregnancy may influence infant BMI. Given the current epidemic of childhood obesity and widespread use of artificial sweeteners, further research is warranted to confirm our findings and investigate the underlying biological mechanisms, with the ultimate goal of informing evidence-based dietary recommendations for pregnant women.

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Figure.
Maternal Consumption of Artificially Sweetened Beverages (ASBs) and Sugar-Sweetened Beverages (SSBs) and Infant Body Composition at 1 Year of Age for 2413 Mother-Infant Dyads

BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared). Error bars indicate 95% CIs.

aMutually adjusted for both types of beverages, maternal total energy intake, Healthy Eating Index score, maternal postsecondary education, maternal smoking and diabetes during pregnancy, breastfeeding duration, infant sex, and introduction of solid foods before 4 months.

bOverweight in infants was defined as a BMI z score exceeding the 97th percentile for age and sex.

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