Abstract
Little is known about possible effects of maternal non-nutritive sweetener (NNS) consumption on the metabolic health of a child. Animal models of maternal NNS consumption during pregnancy or weaning have yielded widely varying results, and there appears to be no clear consensus on the consequences for offspring body weight, glycaemic control or sweet preference choices. Moreover, heterogeneity in study design has hampered a clear focus for future research relevant to human health. In an effort to bring clarity, we have conducted a systematic review and meta-analysis (protocol no: CRD42018109509) in animal models (rat or mouse) of maternal NNS feeding (compared to water or basal diet) during pre-gestation, pregnancy or lactation. Four databases were searched from inception to 15th September 2018: PubMed, EMBASE, SCOPUS and Web of Science. We present maternal and offspring data from 24 included studies, which have been quantitatively analysed after study quality assessment, to identify relationships between maternal diet and offspring body weight (BW), feeding behaviour and glycaemic control. In 11 data sets, exposure to NNS reduced maternal BW during pregnancy, with no effect on litter outcomes. Meta-analyses on offspring BW during weaning (1123 offspring) and adulthood (646 offspring) identified small decreases in BW for both sexes. Subgroup analyses revealed reductions in BW of rat, but not mouse models. High dosage appears to be a potential factor for reduced palatability that could influence BW results; however, a lack of reported data limited our ability to confirm. Despite this, and the fact many papers were predisposed to bias, the balance of evidence suggests a maternal NNS diet during pregnancy or lactation did not increase the body weight in offspring.
Summary
This systematic review and meta-analysis of animal studies concludes that the balance of evidence suggests that maternal exposure to low/no calorie sweeteners in the diet diet during pregnancy or lactation does not increase the body weight in offspring.
This is a meta-analysis of controlled interventional studies in animal models (rat or mouse) testing maternal feeding of low/no calorie sweeteners (compared to water or basal diet) during pre-gestation, pregnancy or lactation and effects on the metabolic health of the offspring. It has been noted that the sweetener dosage in most studies exceeded human Acceptable Daily Intake (ADI) by several hundred fold and the majority of experiments were classified as toxicology studies.
In relation to effects of maternal consumption of low/no calorie sweeteners on offspring birth weight, no significant effect was observed. Meta-analyses on offspring body weight during adulthood showed that maternal exposure to sweeteners during pre-pregnancy, pregnancy and/or lactation was associated with a significant reduction in offspring body weight in adulthood. The authors explain that, while meta-analyses results suggest maternal low/no calorie sweeteners consumption during gestation and/or lactation reduced body weight in their adult offspring, it could not be determined if this was a physiological effect or if unpalatable, high concentrations contributed to this reduced weight gain.
The authors conclude that the bulk of evidence suggests when aggregated together, low/no calorie sweeteners do not increase offspring body weight in rodents exposed during prenatal life. The findings of this systematic review and meta-analysis of animal studies provide no grounds for the notion that low calorie beverage consumption during pregnancy may be associated with an increased risk of infant obesity and elevated BMI, as suggested in the past in some observational studies.