Skip to main content

Advertisement

SpringerLink
Log in

Intake of sucrose-sweetened soft beverages during pregnancy and risk of congenital heart defects (CHD) in offspring: a Norwegian pregnancy cohort study

  • PERINATAL EPIDEMIOLOGY
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Studies report increased risk of congenital heart defects (CHD) in the offspring of mothers with diabetes, where high blood glucose levels might confer the risk. We explored the association between intake of sucrose-sweetened soft beverages during pregnancy and risk of CHD. Prospective cohort data with 88,514 pregnant women participating in the Norwegian Mother and Child Cohort Study was linked with information on infant CHD diagnoses from national health registers and the Cardiovascular Diseases in Norway Project. Risk ratios were estimated by fitting generalized linear models and generalized additive models. The prevalence of children with CHD was 12/1000 in this cohort (1049/88,514). Among these, 201 had severe and 848 had non-severe CHD (patent ductus arteriosus; valvular pulmonary stenosis; ventricular septal defect; atrial septal defect). Only non-severe CHD was associated with sucrose-sweetened soft beverages. The adjusted risk ratios (aRR) for non-severe CHD was 1.30 (95% CI 1.07–1.58) for women who consumed 25–70 ml/day and 1.27 (95% CI 1.06–1.52) for women who consumed ≥ 70 ml/day when compared to those drinking ≤ 25 ml/day. Dose–response analyses revealed an association between the risk of non-severe CHD and the increasing exposure to sucrose-sweetened soft beverages, especially for septal defects with aRR = 1.26 (95% CI 1.07–1.47) per tenfold increase in daily intake dose. The findings persisted after adjustment for maternal diabetes or after excluding mothers with diabetes (n = 19). Fruit juices, cordial beverages and artificial sweeteners showed no associations with CHD. The findings suggest that sucrose-sweetened soft beverages may affect the CHD risk in offspring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dolk H, Loane M, Garne E. Congenital heart defects in Europe. Circulation. 2011;123(8):841–9.

    Article  Google Scholar 

  2. Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890–900.

    Article  Google Scholar 

  3. Botto LD, Lin AE, Riehle-Colarusso T, Malik S, Correa A, National Birth Defects Prevention S. Seeking causes: classifying and evaluating congenital heart defects in etiologic studies. Birth Defects Res A Clin Mol Teratol. 2007;79(10):714–27.

    Article  CAS  Google Scholar 

  4. Liu S, Joseph KS, Lisonkova S, Rouleau J, Van den Hof M, Sauve R, et al. Association between maternal chronic conditions and congenital heart defects: a population-based cohort study. Circulation. 2013;137(5):583–9.

    Article  Google Scholar 

  5. Wilson PD, Loffredo CA, Correa-Villaseñor A, Ferencz C. Attributable fraction for cardiac malformations. Am J Epidemiol. 1998;148(5):414–23.

    Article  CAS  Google Scholar 

  6. Fung A, Manlhiot C, Naik S, Rosenberg H, Smythe J, Lougheed J, et al. Impact of prenatal risk factors on congenital heart disease in the current era. J Am Heart Assoc. 2013;2(3):e000064.

    Article  Google Scholar 

  7. Stoll C, Alembik Y, Roth MP, Dott B, De Geeter B. Risk factors in congenital heart disease. Eur J Epidemiol. 1989;5(3):382–91.

    Article  CAS  Google Scholar 

  8. Wilson PD, Correa-Villaseñor A, Loffredo CA, Ferencz C. Temporal trends in prevalence of cardiovascular malformations in Maryland and the District of Columbia, 1981–1988. Epidemiology. 1993;4(3):259–65.

    Article  CAS  Google Scholar 

  9. Lisowski LA, Verheijen PM, Copel JA, Kleinman CS, Wassink S, Visser GHA, et al. Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. Herz. 2010;35(1):19–26.

    Article  Google Scholar 

  10. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.

    Article  CAS  Google Scholar 

  11. Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology. 2001;64(2):98–106.

    Article  CAS  Google Scholar 

  12. Sulo G, Igland J, Vollset SE, Nygǻrd O, Øyen N, Tell GS. Cardiovascular disease and diabetes mellitus in Norway during 1994–2009 CVDNOR—a nationwide research project. Norsk Epidemiol. 2013;23(1):101–7.

    Article  Google Scholar 

  13. Wren C, Birrell G, Hawthorne G. Cardiovascular malformations in infants of diabetic mothers. Heart. 2003;89(10):1217.

    Article  CAS  Google Scholar 

  14. Øyen N, Diaz LJ, Leirgul E, Boyd HA, Priest J, Mathiesen ER, et al. Pre-pregnancy diabetes and offspring risk of congenital heart disease: a nation-wide cohort study. Circulation. 2016;137(5):2243–53.

    Article  Google Scholar 

  15. Åberg A, Westbom L, Källén B. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev. 2001;61(2):85–95.

    Article  Google Scholar 

  16. Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, et al. Noninherited risk factors and congenital cardiovascular defects: current knowledge. Circulation. 2007;115(23):2995.

    Article  Google Scholar 

  17. Meyer-Wittkopf M, Simpson JM, Sharland GK. Incidence of congenital heart defects in fetuses of diabetic mothers: a retrospective study of 326 cases. Ultrasound Obstet Gynecol. 1996;8(1):8–10.

    Article  CAS  Google Scholar 

  18. Mohammed OJ, Latif ML, Pratten MK. Diabetes-induced effects on cardiomyocytes in chick embryonic heart micromass and mouse embryonic D3 differentiated stem cells. Reprod Toxicol. 2017;69:242–53.

    Article  CAS  Google Scholar 

  19. Ramos-Arroyo MA, Rodriguez-Pinilla E, Cordero JF. Maternal diabetes: the risk for specific birth defects. Eur J Epidemiol. 1992;8(4):503–8.

    Article  CAS  Google Scholar 

  20. Group THSCR. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.

    Article  Google Scholar 

  21. Priest JR, Yang W, Reaven G, Knowles JW, Shaw GM. Maternal midpregnancy glucose levels and risk of congenital heart disease in offspring. JAMA Pediatrics. 2015;169(12):1112–6.

    Article  Google Scholar 

  22. Blue GM, Kirk EP, Sholler GF, Harvey RP, Winlaw DS. Congenital heart disease: current knowledge about causes and inheritance. Med J Aust. 2012;197(3):155–9.

    Article  Google Scholar 

  23. Lee AT, Reis D, Eriksson UJ. Hyperglycemia-induced embryonic dysmorphogenesis correlates with genomic DNA mutation frequency in vitro and in vivo. Diabetes. 1999;48(2):371–6.

    Article  CAS  Google Scholar 

  24. Norwegian Directorate of Health. Utviklingen i norsk kosthold. 2015. Available online at www.helsedirektoratet.no/publikasjoner.

  25. Øverby NC, Lillegaard ITL, Johansson L, Andersen LF. High intake of added sugar among Norwegian children and adolescents. Public Health Nutr. 2004;7(2):285–93.

    Article  Google Scholar 

  26. Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ Brit Med J. 2015;351:p.h3576.

    Article  Google Scholar 

  27. Malik VS, Popkin BM, Bray GA, Després J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356.

    Article  Google Scholar 

  28. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274–88.

    Article  CAS  Google Scholar 

  29. Henriksen T. Nutrition and pregnancy outcome. Nutr Rev. 2006;64(Suppl 2):19–23.

    Article  Google Scholar 

  30. Martínez-Frías ML, Frías JP, Bermejo E, Rodríguez-Pinilla E, Prieto L, Frías JL. Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes. Diabet Med. 2005;22(6):775–81.

    Article  Google Scholar 

  31. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics. 2003;111(Supplement 1):1152–8.

    PubMed  Google Scholar 

  32. Leirgul E, Brodwall K, Greve G, Vollset SE, Holmstrøm H, Tell GS, et al. Maternal diabetes, birth weight, and neonatal risk of congenital heart defects in Norway, 1994–2009. Obstet Gynecol. 2016;128(5):1116–25.

    Article  Google Scholar 

  33. Parker SE, Werler MM, Shaw GM, Anderka M, Yazdy MM. Dietary glycemic index and the risk of birth defects. Am J Epidemiol. 2012;176(12):1110–20.

    Article  Google Scholar 

  34. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, et al. Hyperglycemia and adverse pregnancy outcome. N Engl J Med. 2008;358:1991–2002.

    Article  Google Scholar 

  35. Magnus P, Irgens LM, Haug K, Nystad W, Skjærven R, Stoltenberg C, et al. Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa). Int J Epidemiol. 2006;35(5):1146–50.

    Article  Google Scholar 

  36. Magnus P, Birke C, Vejrup K, Haugan A, Alsaker E, Daltveit AK, et al. Cohort profile update: the Norwegian Mother and Child Cohort Study (MoBa). Int J Epidemiol. 2016;35(5):1146–50.

    Article  Google Scholar 

  37. Irgens LM. The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta Obstet Gynecol Scand. 2000;79(6):435–9.

    Article  CAS  Google Scholar 

  38. Leirgul E, Fomina T, Brodwall K, Greve G, Holmstrøm H, Vollset SE, et al. Birth prevalence of congenital heart defects in Norway 1994–2009—a nationwide study. Am Heart J. 2014;168(6):956–64.

    Article  Google Scholar 

  39. Hagemo PS. BERTE—a database for children with congenital heart defects. Stud Health Technol Inf. 1994;14:98–101.

    CAS  Google Scholar 

  40. Øyen N, Poulsen G, Boyd HA, Wohlfahrt J, Jensen PKA, Melbye M. National time trends in congenital heart defects, Denmark, 1977–2005. Am Heart J. 2009;157(3):467-73.e1.

    Article  Google Scholar 

  41. Strand BH, Dalgard OS, Tambs K, Rognerud M. Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry. 2003;57(2):113–8.

    Article  Google Scholar 

  42. Hastie T, Tibshirani R. Generalized additive models. 1st ed. Boca Raton: Chapman & Hall/CRC; 1990.

    Google Scholar 

  43. R CT. R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/2017.

  44. Yoshida M, McKeown NM, Rogers G, Meigs JB, Saltzman E, D’Agostino R, et al. Surrogate markers of insulin resistance are associated with consumption of sugar-sweetened drinks and fruit juice in middle and older-aged adults. J Nutr. 2007;137(9):2121–7.

    Article  CAS  Google Scholar 

  45. Schaefer EJ, Gleason JA, Dansinger ML. Dietary fructose and glucose differentially affect lipid and glucose homeostasis. J Nutr. 2009;139(6):1257–62.

    Article  Google Scholar 

  46. Rippe JM, Angelopoulos TJ. Sucrose, high-fructose corn syrup, and fructose, their metabolism and potential health effects: what do we really know? Adv Nutr. 2013;4(2):236–45.

    Article  CAS  Google Scholar 

  47. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in african american women. Arch Intern Med. 2008;168(14):1487–92.

    Article  Google Scholar 

  48. Olafsdottir AS, Thorsdottir I, Gunnarsdottir I, Thorgeirsdottir H, Steingrimsdottir L. Comparison of women’s diet assessed by FFQs and 24-Hour recalls with and without underreporters: associations with biomarkers. Ann Nutr Metab. 2006;50(5):450–60.

    Article  CAS  Google Scholar 

  49. Brantsaeter AL, Haugen M, Alexander J, Meltzer HM. Validity of a new food frequency questionnaire for pregnant women in the Norwegian Mother and Child Cohort Study (MoBa). Matern Child Nutr. 2008;4(1):28–43.

    Article  Google Scholar 

  50. Popkin BM, Nielsen SJ. The sweetening of the world’s diet. Obes Res. 2003;11(11):1325–32.

    Article  Google Scholar 

Download references

Acknowledgements

MTGD has received funding from an unrestricted grant from Oak Foundation, Geneva, Switzerland. The study sponsors were not involved in the study design; analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. This work was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme, Project No. 262700. Dr. Øyen was funded by grants from Research Council of Norway (190858/V50) and Western Norway Regional Health Authorities (911734). Tatiana Fomina, Department of Global Health and Primary Care, University of Bergen, Norway, did the quality assurance of data and programmed the algorithm that maps congenital heart defects into embryologically-related defect phenotypes. We thank all the participating families in Norway who took part in this cohort study.

Author information

Authors and Affiliations

  1. Department of Child Health, Norwegian Institute of Public Health, Post Box 4404, 0403, Nydalen, Oslo, Norway

    Maria T. Grønning Dale

  2. Department of Psychology, University of Oslo, Oslo, Norway

    Maria T. Grønning Dale

  3. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway

    Per Magnus & Håkon K. Gjessing

  4. Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway

    Elisabeth Leirgul, Håkon K. Gjessing, Kristoffer Brodwall, Camilla Stoltenberg & Nina Øyen

  5. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Elisabeth Leirgul

  6. Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway

    Henrik Holmstrøm

  7. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Henrik Holmstrøm

  8. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway

    Kristoffer Brodwall

  9. Norwegian Institute of Public Health, Oslo, Norway

    Margaretha Haugen & Camilla Stoltenberg

  10. Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway

    Nina Øyen

Authors
  1. Maria T. Grønning Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Per Magnus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabeth Leirgul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henrik Holmstrøm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Håkon K. Gjessing
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kristoffer Brodwall
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Margaretha Haugen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Camilla Stoltenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nina Øyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MTGD, NØ and PM designed the study. MTGD and HG analyzed the data and MTGD drafted the paper. Authors participated in project meetings at which the analysis plan and data interpretation were discussed. All authors were responsible for interpretation of data and critically revised the article for important intellectual content.

Corresponding author

Correspondence to Maria T. Grønning Dale.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

Written informed consent was obtained from all participating women, and the study has been approved by the Regional Committee for Ethics in Medical Research and the Data Inspectorate.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dale, M.T.G., Magnus, P., Leirgul, E. et al. Intake of sucrose-sweetened soft beverages during pregnancy and risk of congenital heart defects (CHD) in offspring: a Norwegian pregnancy cohort study. Eur J Epidemiol 34, 383–396 (2019). https://doi.org/10.1007/s10654-019-00480-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-019-00480-y

Keywords

Search

Navigation