Announced on June 6, 2017, “Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study” by Zhu, et al., describes a relationship between Danish mothers consuming diet beverages during pregnancy and higher body mass index z-score as a marker of overweight/obesity in 7 year old children. With insufficient consideration of the extensive data regarding non-calorie sweeteners and diet beverage intake, the authors state “Our findings further raise the questionability of promoting (artificially sweetened beverages) ASBs as ‘healthier’ alternatives for (sugar sweetened beverages) SSBs, particularly among high risk pregnant women.” While epidemiological studies can be used to identify trends and associations, it is inappropriate to consider these types of studies to identify causal relationships without consideration of the extensive research on low-calorie sweeteners and diet beverages.
The researchers evaluated data from 1,379 women with gestational diabetes that were participating in the Danish National Birth Cohort study between 1996 and 2002. This study evaluated what women reported consuming for the previous month by completing a single questionnaire at 25 weeks of gestation and what a parent reported their child’s weight and height to be at 7 years of age.
For example, the authors suggest that their findings are biologically plausible because of possible changes to metabolic changes in the mother. This statement does not consider the well-established evidence that non-caloric sweeteners do not have an adverse effect on glycemic response in people consuming them at typical levels such as those described by the participants in these studies. It is important to note that the women in this study had a well-established risk factor for their children to be overweight/obesity throughout life because they were diagnosed with gestational diabetes.
In this study, women that consumed diet beverages in this study had a greater pre-pregnancy body mass index (BMI) but lower total daily energy intake during pregnancy. The authors report that this may suggest the intention for women with higher BMI to seek healthier alternatives during pregnancy. It is critical that women with gestational diabetes be supported in achieving their goals to support a healthy pregnancy. The 2016 Academy of Nutrition and Dietetics (AND) Gestational Diabetes Evidence-Based Nutrition Practice Guideline recommends that “Individualized [medical nutrition therapy] MNT is important in helping pregnant women with GDM achieve and maintain normal glycemic levels and appropriate weight gain, while meeting essential nutrients for pregnancy to promote positive maternal and fetal outcomes.” While MNT for each mother with gestational diabetes is customized, her recommended diet may include non-caloric sweeteners and products such as diet beverages. The AND guidelines recognize that “The FDA has concluded the safety of six high-intensity sweeteners [saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame and advantame] when consumed within the ADI by the general population, including pregnant women. Steviol glycosides and Luo Han Guo (monk fruit) extracts are also GRAS when consumed within the ADI.” The American Medical Association Council on Scientific Affairs and the American Academy of Pediatrics Committee on Nutrition task force have also recognized the safety of these sweeteners for both the infant and the mother.
The authors also suggest that changes to the gut microbiome may also alter metabolism in the mother. While research regarding the microbiome continues to explore the interaction of people and the microbes that inhabit our bodies, there are no data to support the claim that aspartame or sucralose, sweeteners commonly found in diet beverages, directly alter the gut microbiome.
Importantly, no associations between maternal diet beverage intake and body weight was identified during infancy or early childhood. It is critical to note the numerous modifiable factors during infancy and childhood can affect body weight including diet, eating behaviors, and physical activity. These are all important factors that parents can address early in life to reduce their child’s risk for overweight/obesity.
Rather than focusing on possible associations to be drawn from this study, pregnant women and parents of young children should be supported in reducing the well-established risk factors for obesity.