Association between low-calorie sweetener consumption during pregnancy and child health: A systematic review and meta-analysis

We examined the association between low-calorie sweeteners (LCS) consumption during preconception, pregnancy, and breastfeeding and child health outcomes. A systematic search of electronic databases in PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, the Cochrane Library, Scopus, Web of Science, PsycINFO, ProQuest Health and Medical, , and Google Scholar was conducted up to 21 September 2023. A random effects model with restricted maximum likelihood estimation was used for the meta-analysis. Seventeen eligible studies were included. The standardised mean difference (SMD) and 95% confidence interval (CI) in birth weight between those who frequently consumed LCS (>= 1 serve/day) during pregnancy and those who did not consume LCS was 0.04 (0.00, 0.08) (four cohort studies). Any LCS consumption during pregnancy compared with no consumption was not associated with birth weight [SMD (95% CI) = 0.03 (-0.03, 0.08)] (four cohort studies). Any LCS consumption during pregnancy was not associated with body mass index z-scores. The weighted mean difference (95% CI) was 0.00 (-0.05, 0.06) at birth, 0.06 (-0.29, 0.40) at 6 months, -0.04 (-0.19, 0.10) at 1 year, 0.00 (-0.16, 0.17) at 3 years, and 0.10 (-0.15, 0.34) at 7 years of the child age, compared with no intake (five cohort studies). The odds of being overweight at 1 year among children exposed to LCS during pregnancy was 1.19 (OR [95% CI]: 1.19 [0.81, 1.58]) compared with unexposed children (two cohort studies). The effect sizes were not precise for all the outcomes as the 95% CI indicated the effect estimates could range from small protective to a higher risk. The effect of LCS consumption on child behaviour and cognition was inconsistent. There is not enough evidence to confirm LCS consumption during pregnancy affects birth weight and risk of overweight in children. However, frequent consumption increased birth weight and the risk of overweight at different ages, though the effects were imprecise. More robust research evidence is required as the quality of evidence is low. Consumption of any amount of low-calorie sweeteners (LCS) during pregnancy was not associated with birth weight and offspring risk of overweight later in life. Frequent consumption of LCS (>= serving/day) was found to increase birth weight and the risk of overweight at different ages in childhood, though the effect estimates were imprecise. The effect of LCS consumption on child behaviour and cognition was limited and inconsistent. image Evidence regarding the effect of perinatal low-calorie sweeteners (LCS) consumption and child health is limited and inconclusive. Our systematic review and meta-analysis showed that any LCS consumption during pregnancy was not associated with birth weight and the risk of overweight in childhood. However, frequent LCS consumption during pregnancy was associated with a small but imprecise increase in birth weight and body mass index z-score at different ages. Evidence regarding the effect of maternal LCS consumption on child behaviour, cognition, and the risk of other chronic disease is limited. The overall quality of the evidence remains low, warranting further high-quality research.