TABLE 2.
Unadjusted cardiometabolic outcomes at follow-up 9–16 y later according to artificially sweetened beverage intake in pregnancy among women with a history of gestational diabetes1
| Artificially sweetened beverage intake in pregnancy (1996–2002)2 | ||||||
|---|---|---|---|---|---|---|
| <1 serving/mo | 1–4 servings/mo | 2–6 servings/wk | ≥1 servings/d | |||
| n | (n = 205) | (n = 72) | (n = 121) | (n = 60) | P 3 | |
| Continuous outcomes (2012–2014) | ||||||
| HbA1C, % | 603 | 5.3 (5.1, 5.6) | 5.5 (5.0, 5.7) | 5.5 (5.2, 5.9) | 5.5 (5.1, 5.9) | 0.02* |
| Fasting glucose, mmol/L | 603 | 5.3 (5.0, 5.9) | 5.5 (5.1, 6.1) | 5.5 (5.0, 6.2) | 5.6 (5.0, 6.4) | 0.11 |
| Fasting insulin, pmol/L | 600 | 44.0 (31.0, 69.0) | 51.5 (38.0, 82.0) | 49.0 (36.0, 80.0) | 60.5 (47.0, 92.0) | <0.001* |
| C-peptide, pmol/L | 601 | 884.4 (686.4, 1221) | 1062.6 (765.6, 1343.1) | 983.4 (739.2, 1247.4) | 1042.8 (811.8, 1234.2) | 0.02* |
| HOMA-IR | 599 | 1.5 (1.0, 2.4) | 1.9 (1.3, 3.3) | 1.8 (1.2, 3.1) | 2.3 (1.5, 3.3) | <0.001* |
| HOMA-B | 599 | 63 (45.5, 101.2) | 78 (51.3, 108.8) | 75.1 (48.7, 101.7) | 85.6 (61.7, 112.9) | 0.04* |
| Triglycerides, mg/dL | 601 | 95.0 (73.0, 135.0) | 107.5 (80.5, 159.0) | 109.0 (85.0, 148.0) | 112.0 (91.0, 172.0) | 0.01* |
| HDL, mg/dL | 601 | 59.0 (49.0, 71.0) | 58.0 (48.5, 69.5) | 55.0 (47.0, 68.0) | 53.0 (46.0, 61.0) | 0.04* |
| LDL, mg/dL | 592 | 113.0 (96.0, 135.0) | 116.0 (90.0, 144.0) | 113.0 (98.0, 133.0) | 110.0 (84.0, 137.0) | 0.78 |
| BMI, kg/m2 | 606 | 26.7 (23.7, 31.3) | 27.7 (24.4, 31.6) | 29.9 (26.1, 33.3) | 30.8 (28.0, 34.3) | <0.001* |
| Waist circumference, cm | 606 | 95.6 (87.0, 105.8) | 98.3 (90.3, 106.8) | 101.2 (91.5, 111.6) | 104.4 (97.9, 115.7) | <0.001* |
| Visceral adipose tissue, cm3 | 192 | 624.0 (328.0, 1077.5) | 824.0 (245.0, 1432.0) | 771.0 (425.5, 1127.0) | 800.0 (353.0, 1609.0) | 0.48 |
| Mean arterial pressure, mm Hg | 607 | 89.8 (84.3, 101.2) | 93.3 (85.8, 100.7) | 91.3 (84.2, 101.2) | 93.1 (85.5, 102.6) | 0.65 |
| CRP, mg/L | 600 | 1.2 (0.6, 3.1) | 1.7 (0.7, 3.6) | 1.9 (0.7, 4.0) | 1.8 (0.6, 5.4) | 0.08 |
| ALT, U/L4 | 284 | 19.0 (16.0, 24.0) | 19.0 (15.0, 29.0) | 20.0 (17.0, 26.0) | 19.0 (14.5, 27.5) | 0.78 |
| AST, U/L4 | 283 | 27.5 (22.5, 33.5) | 28.0 (24.0, 36.0) | 30.0 (24.0, 34.0) | 26.5 (20.0, 35.0) | 0.52 |
| AST:ALT ratio4 | 283 | 1.4 (1.2, 1.8) | 1.5 (1.3, 1.8) | 1.4 (1.1, 1.6) | 1.4 (1.2, 1.6) | 0.27 |
| Liver fat, %4,5 | 280 | 2.5 (1.9, 5.4) | 2.6 (1.7, 7.3) | 3.8 (2.1, 8.0) | 5.0 (2.4, 7.5) | 0.04* |
| GGT, U/L4 | 286 | 17.0 (12.0, 28.0) | 16.0 (13.0, 30.0) | 18.0 (13.0, 30.0) | 22.0 (15.0, 35.0) | 0.27 |
| Bilirubin, mg/dL4 | 285 | 0.4 (0.3, 0.5) | 0.3 (0.3, 0.5) | 0.3 (0.2, 0.4) | 0.3 (0.3, 0.5) | 0.15 |
| Binary outcomes at follow-up (2012–2014)6 | ||||||
| Hyperglycemia | 603 | 18 (8.8) | 10 (13.9) | 16 (13.2) | 8 (13.3) | 0.48 |
| Type 2 diabetes | 607 | 45 (22.0) | 22 (30.6) | 33 (27.3) | 20 (33.3) | 0.23 |
| Hypertriglyceridemia | 601 | 13 (6.3) | 13 (18.1) | 11 (9.1) | 6 (10.0) | 0.04* |
| Obesity | 606 | 59 (28.8) | 26 (36.1) | 60 (49.6) | 33 (55.0) | <0.001* |
| Elevated ALT 4 | 284 | 52 (56.5) | 18 (52.9) | 38 (57.6) | 18 (52.9) | 0.96 |
| Elevated AST:ALT ratio4 | 284 | 12 (13.0) | 6 (17.7) | 4 (6.1) | 4 (11.8) | 0.35 |
| Elevated liver fat score4,7 | 280 | 34 (37.0) | 15 (44.1) | 34 (51.5) | 19 (55.9) | 0.11 |
Data presented as mean (SD), median (IQR), or n (%), as applicable. All values are unadjusted. *Statistical significance, P < 0.05. ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; fs, fasting serum; GGT, γ-glutamyltransferase; HOMA-B, homeostatic model assessment for β-cell function; T2DM, type 2 diabetes mellitus.
Outcomes not shown for the 149 women missing artificially sweetened beverage intake in pregnancy.
P values for parametric continuous variables calculated using ANOVA; P values for nonparametric continuous variables calculated using Wilcoxon 2-sample test statistic; and P values for categorical variables calculated using chi-square test statistic or Fisher's exact test, as applicable.
Outcomes related to liver function exclude women with habitual alcohol intake at follow-up of >24 g/d, approximately equivalent to 2 standard drinks/d.
Calculated liver fat % = 10(−0.805 + 0.282 × metabolic syndrome (yes = 1; no = 0) + 0.078 × T2DM (yes = 2; no = 0) + 0.525 × log(fs-insulin [mU/L]) + 0.521 × log(fs-AST [U/L]) – 0.454 × log(AST/ALT)).
The following definitions were used for the binary outcomes: elevated ALT, ≥19.0 U/L; elevated AST:ALT ratio, ratio ≥2; elevated liver fat score, >−0.640; hypertriglyceridemia, triglycerides ≥200 mg/dL; hyperglycemia, fasting glucose ≥7.0 mmol/L; type 2 diabetes, HbA1c ≥6.5%, fasting glucose ≥7.0 mmol/L, or 2-h oral glucose tolerance test glucose ≥11.1 mmol/L or self-report of physician diagnosis; obesity, BMI ≥30.0.
Liver fat score = −2.89 + 1.18 × metabolic syndrome (yes = 1/no = 0) + 0.45 × T2DM (yes = 2/no = 0) + insulin (mU/L) + 0.04 × AST (U/L) – 0.94 × AST/ALT.