Research Article: Sugar sweetened beverage consumption during pregnancy is associated with lower diet quality and greater total energy intake

Date Published: April 25, 2019

Publisher: Public Library of Science

Author(s): Ryan J. Gamba, Cindy W. Leung, Lucia Petito, Barbara Abrams, Barbara A. Laraia, Jonathan Pearson-Stuttard.


Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0.

Repeated Cross Sectional Study.

United States.

SSB consumption was estimated from 1–2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999–2006 National Health and Nutrition Examination Survey.

Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P).

The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. 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 (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0.

SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women.

Partial Text

Sugar sweetened beverages (SSBs) are the single largest contributor of added sugars to the American diet, accounting for 45% of all added sugars consumed [1]. SSBs include non-diet soft drinks, energy drinks, sweetened frozen coffee drinks, fruitades, smoothies, sports drinks, sweetened fruit drinks and sweetened beverages, but not natural juices that may be high in sugar. The 2015–2020 Dietary Guidelines Advisory Committee recommended limiting added sugar intake to <10% of total energy intake, however the average American intake is close to 15% [1,2]. In non-pregnant populations, SSB consumption has been associated with poor diet quality [3, 4], weight gain [5], obesity [6, 7], cardiovascular disease and some cancers [8]. Among pregnant women, SSB consumption has been associated with an elevated odds for preterm delivery [9], greater weight-for-age at birth [10], and offspring obesity [11]. Despite the potentially harmful health effects of consuming SSBs both before and during pregnancy, the amount of SSBs being consumed and the correlates of consumption during pregnancy are unknown. This cross-sectional study used 1999–2006 data from NHANES; an ongoing multistage survey administered by the National Center for Health Statistics that selects a nationally representative sample of the noninstitutionalized U.S. civilian population [21]. The data underlying this study are publicly available via the Centers for Disease Control website. Please see S1 File for details regarding the construction of the dataset analyzed in the present study. Waves 1999–2006 were selected because NHANES oversampled pregnant women during these cycles to ensure better estimates of this subpopulation [21]. We excluded four pregnant women because they had implausible daily total energy intakes (>6,000 calories), and two pregnant women because they had implausible SSB intakes (>10 12 oz. servings per day). The remaining pregnant women in NHANES waves 1999–2006 with complete dietary data were included in this study (n = 1,154). This secondary data analysis was considered exempt by the University of California Berkeley Institutional Review Board.

Table 1 describes the study sample and the relationships between unadjusted SSB consumption and the covariates. On average, women were 27 ± 6 years of age. Fifty-three percent of the sample was non-Hispanic White, 17% were Mexican American, 17% were non-Hispanic Black, 5% were Other Latino and 8% were of another race or multicultural. Seventy-eight percent of the women were born in the U.S. and 72% were married or living with a partner. Pregnant women in the United States consumed an average of 1.3 ± 1.5 12 ounce unadjusted servings of SSBs per day, or 15.6 oz. SSB consumption declined from 1999–2006 from 1.4 (95% CI: 1.1–1.8) to 1.1 (0.8–1.4) servings per day (Table 1). A sensitivity analysis analyzing adjusted measures of SSB intake produced consistent results.

Pregnant women were found to consume more SSBs on average than women who were not pregnant. On average, pregnant women consumed 15.6 oz. of SSBs per day, which equates to approximately 176 calories. A report analyzing survey data from NHANES 2005–2006 found women aged 20–39 consumed an average of 138 calories, or roughly 13 oz. of sugar drinks (defined similarly to SSBs) per day, which is about 2.6 oz. less than observed in this sample [29]. Although pregnant women typically need to consume additional calories during pregnancy, the observed increase in SSB consumption during pregnancy is worrying considering the adverse health effects associated with SSB consumption [8–10, 30, 31] and the importance of diet during pregnancy [14, 16, 22, 32].