Research Article: Consumption of Artificially-Sweetened Soft Drinks in Pregnancy and Risk of Child Asthma and Allergic Rhinitis

Date Published: February 27, 2013

Publisher: Public Library of Science

Author(s): Ekaterina Maslova, Marin Strøm, Sjurdur F. Olsen, Thorhallur I. Halldorsson, Susanne Krauss-Etschmann.


Past evidence has suggested a role of artificial sweeteners in allergic disease; yet, the evidence has been inconsistent and unclear.

To examine relation of intake of artificially-sweetened beverages during pregnancy with child asthma and allergic rhinitis at 18 months and 7 years.

We analyzed data from 60,466 women enrolled during pregnancy in the prospective longitudinal Danish National Birth Cohort between 1996 and 2003. At the 25th week of gestation we administered a validated Food Frequency Questionnaire which asked in detail about intake of artificially-sweetened soft drinks. At 18 months, we evaluated child asthma using interview data. We also assessed asthma and allergic rhinitis through a questionnaire at age 7 and by using national registries. Current asthma was defined as self-reported asthma diagnosis and wheeze in the past 12 months. We examined the relation between intake of artificially-sweetened soft drinks and child allergic disease outcomes and present here odds ratios with 95% CI comparing daily vs. no intake.

At 18 months, we found that mothers who consumed more artificially-sweetened non-carbonated soft drinks were 1.23 (95% CI: 1.13, 1.33) times more likely to report a child asthma diagnosis compared to non-consumers. Similar results were found for child wheeze. Consumers of artificially-sweetened carbonated drinks were more likely to have a child asthma diagnosis in the patient (1.30, 95% CI: 1.01, 1.66) and medication (1.13, 95% CI: 0.98, 1.29) registry, as well as self-reported allergic rhinitis (1.31, 95% CI: 0.98, 1.74) during the first 7 years of follow-up. We found no associations for sugar-sweetened soft drinks.

Carbonated artificially-sweetened soft drinks were associated with registry-based asthma and self-reported allergic rhinitis, while early childhood outcomes were related to non-carbonated soft drinks. These results suggest that consumption of artificially-sweetened soft drinks during pregnancy may play a role in offspring allergic disease development.

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It has been hypothesized that diet during pregnancy may modulate child immune system development and later allergic disease. Past studies have examined numerous dietary factors during pregnancy, including fruits and vegetables [1]–[6], fish [1]–[5], [7]–[12] and fish oil [13], butter and margarine [2], [3], [5], [7], nut and peanuts [2], [4], [14], and dairy and milk intake [2]–[5], [14], [15] in relation to allergic disease in the child. We recently conducted an analysis of the relation between milk and yoghurt consumption during pregnancy and wheeze, asthma, and allergic rhinitis in the Danish National Birth Cohort (DNBC) [16]. We found that the strongest and most consistent association was between maternal low-fat yoghurt intake and child asthma and allergic rhinitis. These results suggested a causal agent specific to low-fat yoghurt. We hypothesized that artificial sweeteners could be a plausible candidate as these compounds are often added to low-fat/’light’ products to compensate for flavour or reduce sugar content [17]. The current state of knowledge on the role of artificial sweeteners in allergic disease development is at best limited. A few studies have examined aspartame in relation to inflammation; yet, these results have been inconsistent [18]–[20]. A study from the 1980s [21] examined in vitro immunological properties and found small inhibitory effects on antigen-induced histamine release from cultured mouse mast cells. However, the authors could not explain the origin or meaning of this effect. Other studies have shown improvements in dermatitis with aspartame avoidance [22], [23], while yet others found no elicit allergic reactions [24], [25]. This suggests that improvement in dermatitis is most likely a relatively rare side effect of aspartame avoidance. To our knowledge, there are no epidemiological studies assessing the relation between intake of artificial sweeteners during pregnancy and asthma or other allergic diseases.

In our prospective study of the relation between maternal intake of artificially-sweetened beverages during pregnancy and development of child allergic disease, we found that artificially-sweetened beverages moderately increased risk of asthma and allergic rhinitis both in early and later childhood. These results appeared stronger for carbonated beverages. We did not find similar results for sugar-sweetened beverages, suggesting that artificial sweeteners, rather than other additives and aromatic compounds in soft drinks, may play a role in the development of allergic diseases.