A recent study published in the British Journal of Nutrition has revealed that drinking artificially sweetened beverages (ASBs) during pregnancy may increase the likelihood of children becoming overweight as they grow older. The study, conducted by researchers in Denmark, aimed to assess whether maternal consumption of ASBs or sugar-sweetened beverages (SSBs) during pregnancy is linked to overweight in offspring from birth through adolescence.
The Growing Concern of Childhood Obesity
Childhood obesity has more than doubled over the past three decades, contributing to a rise in associated health conditions, such as diabetes and heart disease. As a result, many pregnant women opt for ASBs, believing they are a healthier alternative to sugary drinks and a way to avoid weight gain. However, emerging research suggests that artificial sweeteners in these drinks could disrupt metabolism, alter gut bacteria, or increase cravings for sweets — even before birth. Despite mixed findings from previous studies, some have raised concerns about the potential link between artificial sweeteners and obesity in children.
Overview of the Study
This nationwide longitudinal cohort study utilized data from the Danish National Birth Cohort (DNBC), which enrolled 101,042 pregnant women between 1996 and 2002. The women were followed through their pregnancies and for up to 18 years after childbirth. The study collected data from interviews conducted during pregnancy (at gestational weeks 12 and 30) and at 6 and 18 months postpartum. A food frequency questionnaire was used to capture maternal intake of ASBs and SSBs during pregnancy, categorizing consumption as none, less than 1 serving per week, 1-6 servings per week, or 1 or more servings per day.
Key outcomes measured included large for gestational age (LGA) birth weight and the incidence of overweight at 5 and 12 months, as well as at 7, 11, 14, and 18 years of age. Overweight was defined using body mass index (BMI) cut-offs specific to age and sex.
Key Findings of the Study
Of the original cohort, 66,668 women provided data on ASB consumption, and 66,568 provided data on SSB consumption. It was found that women who consumed 1 or more ASBs per day tended to be younger, had higher pre-pregnancy BMIs, smoked more frequently, and had lower socioeconomic status. On the other hand, women who consumed fewer than 1 serving per week of ASBs were more likely to have higher physical activity levels and longer breastfeeding durations.
Interestingly, no association between ASB consumption and overweight or LGA babies was observed at birth or during infancy (5 and 12 months). However, from the age of 7 onward, a consistent pattern emerged. Children of mothers who consumed ASBs — whether 1-6 servings per week or 1 or more per day — had significantly higher odds of being overweight at ages 7, 11, 14, and 18 compared to those whose mothers did not consume ASBs. The risk remained significant after adjusting for confounding factors, with a modest increase in the odds of overweight at 18 years for those who consumed 1 or more ASBs per day.
In contrast, SSB consumption was associated with a lower risk of overweight in children at ages 11 and 18. However, the study noted that mothers who consumed SSBs tended to have healthier baseline characteristics, such as lower pre-pregnancy BMI and higher socioeconomic status. These factors may partially explain the lower risk of overweight in their children. For instance, children of mothers who consumed 1 or more SSBs per day had a lower risk of being overweight at 18 years compared to non-consumers.
Further Insights
The study also explored the potential role of total energy intake, rather than just the type of beverage consumed. When total energy intake was considered, the relationship between ASBs and increased overweight risk remained largely unchanged, suggesting that the artificial sweeteners themselves could be influencing the outcomes. Additionally, substituting ASBs with SSBs appeared to lower the risk of overweight, further supporting the notion that artificial sweeteners might have a direct impact on weight outcomes.
Importantly, the impact of ASB consumption was most noticeable from age 7 onward. No significant weight differences were observed in early infancy, suggesting that prenatal exposure to ASBs might influence long-term taste preferences or metabolic responses, which could become evident as children begin making their own food choices. However, the study could not account for other potential confounding factors, such as postnatal dietary habits.
Conclusion and Implications
This large-scale cohort study has highlighted a modest but consistent increase in the risk of overweight in children exposed to ASBs during pregnancy, particularly after age 7. On the other hand, SSB consumption during pregnancy was unexpectedly linked to a lower risk of overweight, although this association may be due to other factors, such as socioeconomic status and lifestyle.
These findings challenge current dietary recommendations for pregnant women, particularly those with obesity or diabetes, who are often encouraged to replace sugar with artificial sweeteners. While the risk increase associated with ASB consumption is small, even modest effects could have significant public health implications.
Given the study’s limitations, including gaps in data for early childhood and unanswered questions about postnatal exposure, the results underscore the need for a reevaluation of dietary advice for pregnant women. The study also calls for further research into safer alternatives for managing gestational weight gain and their long-term impact on child health.
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