Table 1.
Summary of study characteristics, outcomes and main results of studies included in the analysis.
| Reference | Design, Subjects (n) | Population | Intervention/Method | Primary Outcome | Main Results |
|---|---|---|---|---|---|
| Chen et al. [15] | Prospective study, n = 13,475 | Women from the Nurses’ Health Study II, 24–44 years, who reported having at least one singleton pregnancy lasting 6 months or more. | Semiquantitative FFQ | Gestational diabetes mellitus | Intake of sugar-sweetened cola (≥5 servings/week) was positively associated with the risk of GDM (RR = 1.22; 95% CI 1.01–1.47). No significant association between SSB intake and “diet” beverages was found with the risk of GMD. |
| Gamba et al. [16] | Cross-sectional study from NHANES survey, n = 1154 | Pregnant women that completed dietary data | AHEI-P to measure diet quality 24-h dietary recalls |
Diet quality and total energy intake | Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI 1.6–2.9) and the consumption of 124 more calories. |
| Mijatovic-Vukas et al. [17] | Meta-analysis, 40 studies, n = 30,871 | Women with available diet or PA data during pre-pregnancy/early pregnancy | Different dietary patterns or PA | Gestational diabetes mellitus | Higher SSB intake was associated with higher risk of GDM (RR ≥ 5 week = 1.23; 95% CI 1.05–1.45, p-value = 0.005). The strongest association was observed for sugar sweetened cola (RR high vs. low intake = 1.29; 95% CI 1.07–1.55) but not for non-cola SSB (RR high vs. low = 0.99; 95% CI 0.78–1.25). |
| Wattar et al. [18] | Multicenter, RCT, n = 1252 Meta-analysis, 2 RCT, n = 2397 women |
Women with metabolic risk factors, ≥16 years, <18 weeks’ gestation | Mediterranean-style diet and usual care diet for meta-analysis |
Gestational diabetes or preeclampsia and offspring (stillbirth, small for gestational age, or admission to neonatal care unit) | The risk of gestational diabetes was reduced in Mediterranean-style diet group compared to usual care diet (adjusted OR = 0.65; 95% CI 0.47–0.91, p = 0.01), and gestational weight gain (mean 6.8 versus 8.3 kg). Meta-analysis showed a significant reduction in the risk of gestational diabetes (−33%). |
| Ikem et al. [19] | Prospective longitudinal study, n = 55,139 | Pregnant Danish women, in the ~25-week gestation | Validated semi-quantitative FFQ | Gestational hypertension and preeclampsia. | Western diet (high in fast food, added sugar and saturated fats) increased the risk of GHD (OR 1.18; 95% CI 1.05–1.33) and PE (OR 1.40; 95% CI 1.11–1.76). No significant association between sugary products and GHD was observed (OR = 1.05; 95% CI 0.94–1.16) or PE (OR = 1.10; 95% CI 0.90–1.35) |
| Halldorsson et al. [20] | Prospective cohort study, n = 59,334 | Pregnant Danish women, in the ~ 6–10-week gestation | Validated FFQ | Risk of preterm delivery | Significant association between soft drink intake and the risk of PTD (p for trend <0.001; for both soft drinks). Normal-weight and overweight women who drank one serving of ASB per week showed greater risk of preterm delivery (38%) compared to non-consumers. When the consumption was ≥4 servings of ASB per weeks the risk increased by 78% |
| Brantsaeter et al. [21] | Prospective cohort study, n = 23,423 | Nulliparous pregnant women from the Norwegian Mother and Child Cohort Study (MoBa). Gestational age: 22 weeks | Semiquantitative FFQ | Preeclampsia | Processed meat, salty snacks, and sweet drinks were strongly associated with higher risk of preeclampsia (OR for tertile 3 vs. tertile 1 = 1.21; 95% CI 1.03–1.42). |
| Englund-Ögge et al. [22] | Large prospective cohort study, n = 66,000 | Pregnant Norwegian women with singleton pregnancies, without previously PTD, pregnancy duration between 22 + 0 and 41 + 6 gestational weeks, no diabetes, first enrolment pregnancy. |
Validated FFQ | Risk of preterm delivery | A “prudent pattern” and a “traditional pattern” were associated with significantly reduced risk of PTD (HR = 0.88; 95% CI 0.80–0.97 and HR = 0.91; 95% CI 0.83–0.99) compared to women who adhered to a Western diet. |
| Rasmussen et al. [24] | Prospective, longitudinal cohort study, n = 59,949 | Pregnant Danish women at 12 and 30 weeks of gestation | FFQ | Spontaneous and induced preterm birth (gestational age < 259 days (<37 weeks)). | Association between Western diet and induced PTD (OR = 1.66; 95% CI 1.30–2.11) and Western diet and spontaneous PTD (OR = 1.18; 95% CI 0.99–1.39) were observed comparing the highest vs. the lowest quintile. |
| Muktabhant et al. [35] | Systematic review of 27 RCTs or quasi-RCTs, n = 3964 | Pregnant women with or without overweight and obesity. Gestational age: ≤20 weeks or >20 weeks. | Nutrition intervention, exercise intervention, health education or counselling | Gestational weight gain | Results were not statistically significant and consistent. Significant reduction for women that received behavioral counselling compared standard care (RR = 0.72; 95% CI 0.54–0.95). |
| i-WIP Collaborative Group [36] | Systematic review and meta-analysis of 36 RCTs, n = 12,526 | Pregnant women (≥20 years.) with or without overweight and obesity. | Nutrition intervention, physical activity and mixed interventions | Gestational weight gain | Obese women that followed-up behavioral interventions based on diet and physical activity advice during pregnancy reduced gestational weight gain and decreased the risk of cesarean. No strong evidence was found for the effect of life-style interventions on individual offspring outcomes. |
| Poston et al. [37] | Multicenter, RCT, n = 1555 | Obese pregnant women, 15–18 weeks plus 6 days of gestation and age >16 years. | Behavioural intervention or standard antenatal care | Gestational diabetes and large-for-gestational-age infants (≥90th customized birthweight centile) | No differences between groups were observed for the primary outcomes. |
| Petrella et al. [38] | Prospective, RCT, n = 61 | Pregnant women with BMI >25 at first trimester and age >18 years. | No intervention or a TLC Program including diet (overweight: 1700 kcal/day, obese: 1800 kcal/day) and mild physical activity (30 min/day, 3 times/week). | Gestational weight gain, GDM, gestational hypertension, PTD | Gestational weight gain in obese women randomized to TLC was lower than control group (6.7 Kg vs. 10.1 Kg, p = 0.047). Lower incidence of GDM was observed in women randomized in TLC Program compared to the control group (23.3% vs. 57.1%, p = 0.009) |
| Renault et al. [39] | 3-arm RCT, n = 342 | Pre-pregnancy BMI ≥30 kg/m2, gestational age <16 weeks’ gestation, age >18 years | D + PA, PA and control | Gestational weight gain | Added sugar from foods appeared to be related to gestational weight gain (p for trend = 0.02). Sweets, snacks, cakes, and soft drinks were strongly associated with weight gain |
| Diemert et al. [40] | Prospective cohort study, n = 200 | Healthy low-risk women (>18 years.), gestational age 12 + 0 to 14 + 6 weeks | Self-reported dietary intake | Gestational weight gain | Especially, overweight and obese women gained more weight than recommended. Saturated fat and sugar were the nutrients that most contributed to total energy consumption. |
| Olafsdottir et al. [41] | Observational study, n = 495 | Pregnant women between 11 and 15 weeks | Semi-quantitative FFQ | Gestational weight gain | Higher intake of sweets during early pregnancy increased the risk of gaining excessive weight (OR = 2.52, CI 1.10–5.77, p = 0.029). |
| Maslova et al. [42] | Prospective cohort study, n = 46,262 | Pregnant women with 6–10 weeks of gestation. | Complete data on dietary intake and GWG | Gestational weight gain | Added sugar consumption was strongly associated with GWG (Q5 vs. Q1: 34, 95% CI 28 to 40 g/week, p for trend <0.0001). |
| Uusatilo et al. [43] | Observational study, n = 3360 | Fin women whose baby presented human leucocyte antigen-conferred susceptibility to type 1 diabetes. Recruited in 10th gestational week on average. | Validated FFQ | Gestational weight gain | “Fast food” dietary pattern (high in sweets, soft drinks, hamburgers, pizza and other fast foods) was positively associated with weight gain rate (kg/week) |
| Shin et al. [44] | Cross-sectional study, n = 253 | Pregnant US women, from 16 to 41 years, included in the NHANES survey 2003–2012. | 24 h dietary recall | Gestational diabetes mellitus | Pregnant women in the highest tertile of “high added sugar and organ meats; low fruits, vegetables and seafood” intake showed higher risk of GDM (OR 21.1; 95% CI 4.0–109.8) compared to those in the lowest tertile. |
| Donazar-Ezcurra et al. [45] | Prospective and dynamic cohort, n = 3396 | Women that have notified at least one pregnancy between December 1999 and March 2012. | A validated 136-item semi-FFQ | Gestational diabetes mellitus | Consumption of ≥ 2 SSB servings/week was strongly associated with the risk of GDM at the beginning of pregnancy (adjusted OR: 2.03; 95% CI 1.25–3.31; p for trend: 0.006). There were no statistical associations between sugar-free soft drink intake and GDM risk. |
| Ley et al. [46] | Prospective Canadian cohort study, n = 205 | Women with singleton pregnancies and without preexisting type 1 or type 2 diabetes. Aged ≥20 years and 24–28 week of gestation. | Validated FFQ | Gestational diabetes mellitus | Added sugar in coffee and tea were individually associated with increased fasting glucose (both p ≤ 0.02) |
| Borgen et al. [47] | Prospective Norwegian study, n = 32,933 | Nulliparous women, in gestational weeks 18–22 | A semi-quantitative FFQ | Preeclampsia | Sugar-sweetened carbonated and non-carbonated beverages (>= 125 mL/day) were significantly associated with higher risk of preeclampsia (OR = 1.27; 95% CI 1.05–1.54), both independently and combined compared to non-consumers. |
| Schoenaker et al. [48] | Australian Longitudinal Study on Women’s Health, n = 3582 | Women were not pregnant at baseline (age: 25–30 years). Women who reported at least one live birth from different date of survey: 28–33 years, age: 31–36 y and age: 34–39 years Follow-up: 9 years |
Validated FFQ | Hypertensive disorders of pregnancy | The Mediterranean-style dietary pattern was inversely associated with risk of developing hypertensive disorders of pregnancy (quartile 4 compared with quartile 1: RR = 0.58; 95% CI 0.42–0.81). No association was found between sugar dietary pattern and the risk of hypertensive disorders of pregnancy. |
| Clausen et al. [49] | Prospective, population-based cohort study, n = 3133 | Norwegian pregnant women in the second trimester | Quantitative FFQ | Preeclampsia | Sucrose intake (>25% of total energy) was directly associated with the risk of preeclampsia (OR = 3.8, 95% CI 1.5–9.8, p = 0.01) compared with lower intake (≤8.5%). |
| Englund-Ögge et al. [50] | Large prospective cohort study, n = 60,761 | Norwegian pregnant women at gestational weeks 17–18 | Semiquantitative FFQ | Risk of preterm delivery | A high consumption of ASB and SSB (>1 serving/day) were associated with higher risk of preterm delivery (OR = 1.11; 95% CI 1.00–1.24 and OR = 1.25; 95% CI 1.08–1.45, respectively). |
| Petherick et al. [51] | Longitudinal multi-ethnic birth cohort study, n = 8914 | Pregnant women at 26–28 weeks of gestation at which time a baseline questionnaire was completed. | Consumption of ASB (cola) and SSB (cola): none, one, two, three or four or >4 cups per day (each cup measuring 200 mL). | Risk of preterm delivery | No relationship was observed between daily AS cola beverage consumption and PTD. Women who drank ≥4 cups per day of SS cola beverages had higher risk of PTD compared to non-consumers or <1 cup per day participants. |
| Voerman et al. [52] | Meta-analysis of 37 cohorts, n = 162,129 mothers and their children | Mothers with singleton live-born, before 20 weeks of gestation, that had information available on maternal pre- or early pregnancy BMI and at least 1 offspring measurement (birth weight or childhood BMI) | Self-reported maternal and childhood BMI | Excessive GWG on the development of offspring obesity | Childhood overweight/obesity was associated with higher maternal pre-pregnancy BMI and gestational weight gain. This association was stronger at later ages. |
| Litvak et al. [53] | Systematic review of longitudinal, observational studies, n = 21 | Healthy pregnant women and offspring body size | Assessing dietary patterns, macronutrients, foods, and beverages. | Offspring body size from 6 months to 18 years | Following a balanced diet, during pregnancy, together with a reduction of refined carbohydrate intake showed a positive effect on offspring adiposity at between 6 and 18 months after birth. Inconclusive or null findings associations of n-3 polyunsaturated fatty acids, protein, SSB artificially sweetened beverage intake and offspring body size were found. |
| Dodd et al. [54] | Randomized clinical trial, n = 2212 | Women with a singleton pregnancy, between 10 + 0 and 20 + 0 weeks’ gestation, and BMI ≥25. | A comprehensive dietary and lifestyle intervention vs. standard care | Incidence of infants born large for gestational age (birth weight ≥90th centile for gestation and sex). | Overweight or obese women assigned to the intervention group did not reduce the risk of delivering large-for-gestational-age babies in comparison to the control arm (RR = 0.90; 95% CI 0.77–1.07; p = 0.24). |
| Phelan et al. [55] | Randomized clinical trial, n = 132 | Healthy pregnant women at gestational age between 10 to 16 weeks | Intervention based on promoting a healthy weight gain by dietary and physical activity advice | Impact of excessive gestational weight gain, maternal eating and exercise on offspring weight status | High intake of sugar-rich foods was associated with large-for-gestational-age infants (β = 0.19, p = 0.004), macrosomia (OR = 1.1; 95% CI 1.0–1.2) and high birth weight (<90th percentile at birth) (OR = 1.2; 95% CI 1.1–1.3). |
| Chen et al. [56] | Cohort study, n = 910 | Asian mother–child dyads | 24h recall | Infant BMI | Higher maternal intake of SSBs was associated with higher offspring BMI z score at 24 and 48 months of age (0.07 SD; 95% CI 0.02–0.12 and 0.05 SD; 95% CI 0.004–0.09 respectively). |
| Quah et al. [57] | Cohort study, n = 1247 | Asian mother–child dyads | Self-administered FFQ | Adiposity measures (BMI and skinfold thickness) and overweight/obesity status in children at 6 years of age. | An increment of 100 mL/day of SSB intake was associated with higher BMI (0.09 SD units; 95% CI 0.02–0.16), higher sum of skinfold thickness (0.68 mm; 95% CI 0.06–1.44) and increased risk of overweight/obesity (OR 1.2; 95% CI 1.07–1.23) at age 6 years. |
| Gillman et al. [58] | Prospective cohort study, n = 1078 | Massachusetts mother–child dyads | FFQ | Childhood BMI, FMI and waist circumference | Maternal SBB intake during pregnancy was associated with higher BMI z scores (0.07 U; 95% CI −0.01–0.15), FMI (0.15 kg/m2; 95% CI −0.01–0.30) and waist circumference (0.65 cm; 95% CI 0.01–1.28). |
| Jen et al. [59] | Prospective cohort study, n = 3312 | Netherland mother–child dyads | FFQ | Children BMI trajectories and body composition parameters | Maternal SSB intake during pregnancy was associated with higher BMI at ≤6 years of age children (per SSBs serving per day: 0.04 SD score; 95% CI 0.00–0.07). |
| Hu et al. [60] | Prospective cohort study, n = 1257 | Tennesseans healthy mother–child dyads | The Block FFQ | Offspring growth and overweight/obesity risk from birth to age four years | Maternal dietary patterns rich in fried foods and SSBs were associated with higher risk of increase the BMI during growth (OR = 1.32; 95% CI 1.07–1.62) and higher risk of becoming overweight/obese children at 4 years of age (OR = 1.31, 95% CI 1.11–1.54). |
| Azad et al. [61] | Cohort study, n = 3033 | Canadian mother–infant dyads | Modified FFQ to address usual food intakes during pregnancy | Infant BMI in the first year of life | Daily consumption of ASBs was associated with a 0.20-unit increase in infant BMI z score (95% CI 0.02–0.38) and a 2-fold higher risk of overweight at 1 year of age (adjusted OR = 2.19; 95% CI 1.23–3.88). |
| Zhu et al. [62] | Cohort study, n = 918 | Danish mother–singleton child dyads in pregnancies complicated by gestational diabetes mellitus | Self-administrated FFQ | Offspring growth and the risk of overweight/obesity in childhood. | ASB intake during pregnancy was positively associated with offspring large-for-gestational age and overweight/obesity at 7 years compared to never consumption (adjusted RR = 1.57; 95% CI 1.05–2.35 at birth and adjusted RR = 1.93; 95% CI 1.24–3.01 at 7 years) |
| Cohen et al. [63] | Cohort study, n = 1234 | Pregnant women and children aged 3.3 to 7.7 years | Self-administered FFQ | Child with child cognition outcomes | Excessive sugar intake (mean 49.8 g/day) was associated with reduced cognitive skills in children, as in the mid-childhood Kaufman Brief Intelligence Test (KBIT-II), non-verbal scores and early or mid-childhood scores. |
| Bédard et al. [64] | Longitudinal study, n = 8964 | Pregnant women and children aged 7 to 9 years | FFQ | Respiratory and atopic outcomes | Higher mater intake of simple sugar during pregnancy increased the risk of atopic asthma (OR for highest vs. lowest quintile of simple sugar intake; OR = 2.01; 95% CI 1.23–3.29) and atopy (OR = 1.38; 95% CI 1.06–1.78). |
AHEI: Alternate Healthy Eating Index diet; BMI: body mass index; ASBs: artificially sweetened beverages; CI: confidence interval; DASH: Dietary Approaches to Stop Hypertension diet; D+PA: hypocaloric Mediterranean type of diet and physical activity intervention; FFQ: food frequency questionnaire; FMI: fat mass index; GDM: gestational diabetes mellitus; Gestational hypertension: GHD; GWG: gestational weight gain; HR: hazard ratio; i-WIP: The International Weight Management in Pregnancy Collaborative Group; MedDiet: Mediterranean Diet; NHANES: National Health and Nutrition Examination; OR: Odds ratio; PA: physical activity intervention alone; PE: preeclampsia; PTD: preterm delivery; RCT: randomized control trial; SSB: sugar-sweetened beverage; RR: relative risk; TLC: Therapeutic Lifestyle Changes.