Influence of ultra-processed foods consumption during pregnancy on baby's anthropometric measurements, from birth to the first year of life: a systematic review

Miranda, Cristianny; Souza, Rafaela Cristina Vieira e; Santos, Luana Caroline dos

doi:10.1590/1806-93042021000100002

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REVIEW • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100002 linkcopy

Influence of ultra-processed foods consumption during pregnancy on baby's anthropometric measurements, from birth to the first year of life: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives: to perform a systematic review of studies that investigated the influence of ultra-processed foods (UPF) consumption during pregnancy on child’s anthropometric parameters up to one year of life.

Methods: cohort and cross-sectional studies were researched in BVS, Cinahl, Cochrane, Embase, Pubmed, Scopus and Web of Science databases until March 2020, and the main descriptors were: “Pregnant Women”, “Ultra-processed foods”, “Birth Weight”, “Smallfor Gestational Age”, “Infant”, “Newborn”.

Results: seventeen articles were considered eligible and evaluated the associations between the exposures: ultra-processed dietary patterns; soft drinks, sugar-sweetened beverages, artificially sweetened beverages; fast food, junk food, sweets, snacks and the outcomes: birth weight and its classifications; length and head circumference at birth; birth weight adjustments according to gestational age; weight/age, length/age, body mass index/age and weight/length indices. The results showed: 36 non-significant associations between the exposures and the outcomes; 13 direct associations (outcomes versus ultraprocessed dietary patterns, soft drinks, artificially sweetened beverages, sweets, junk food) and 5 inverse associations (outcomes versus ultra-processed dietary patterns, soft drinks).

Conclusions: most of the evaluated literature did not demonstrate the influence of UPF consumption during pregnancy on the newborn’s anthropometric measurements up to one year of life and denoted a smaller number of direct and inverse associations between the exposures and the outcomes.

Key words:
Ultra-processedfoods; Pregnancy; Birth weight; Child; Food consumption

Author and year/country	Design	Sample (n)/Mean age in years (SD)	Method to acess Consumption / Exposure	Anthropometric measurements assessed / Measured/Self-reported	Adjustments of the variables	Main results
Gunther et al.,²⁴ 2019, Germany	Prospective cohort	2,286/NM	FFQ/Soft drinks intake, fast food, sweets and snacks	Birth weight, LBW, weight at birth >4,000g, SGA and LGA/Measured	Pre-pregnancy BMI, age, parity and ^agroup assignments.	Up to the 12^th gestational week: maternal daily consumption of a glass (200mL) of soda reduced birth weight in 10.90g (CI95% = -18.17--3.64; p=0.003). After the 29th gestational week: reduction of 8.19g (CI95% = -16.26--0.11; p=0.047) for each glass of soda..
Englund- Ogge et al.,⁸ 2019, Norway	Prospective cohort	65,904/NM	FFQ/Dietary Pattern	SGA, LGA and birth weight /Measured	Maternal age, energy intake, pre-pregnancy BMI, height, parity, smoking, alcohol intake, total family income, level of schooling, chronic diseases and eating disorders (nausea during pregnancy).	"High prudent" pattern: lowest birth weight (β=- 0.041; CI95%= -0.068--0.01 3), higher chances of SGA (OR=1.25; CI95%= 1.02-1.54) and lower chances of LGA (OR= 0.84; CI95%= 0.75-0.94), compared to "high Western" pattern.
Alves-Santos et al.,⁵ 2019, Brazil	Prospective cohort	193/NM	FFQ/ Dietary Pattern	LGA and birth length >percentile 90/Measured	Maternal age, smoking, alcohol intake, level of schooling, first- trimester leisure time physical activity.	"Fast food and candies"pattern: higher chances of LGA (OR = 4.38; CI95%= 1.32-14.48) and birth lenght >percentile 90 (OR=4.81; CI95% = 1.77-13.07).
Gomez Roig et al.,²⁵ 2017, Spain	Cross-sectional	127 / 31.10 (0.38)	FFQ/Intake of colabased soft drinks	SGA and AGA/ Measured	Smoking	Higher cola-based soft drinks intake among the mothers of group SGA (p=0.004) and cola-based diet soft drinks among the mothers of group AGA (p=0.03).
Grundt et al.,²² 2017, Norway	Prospective cohort	50,280/NM	FFQ/Sweetened carbonated soft drinks	Birth weight and birth weight >4,500g/ Measured	Maternal height, prepregnancy BMI, age, pa rity, level of schooling, income, exercise, smoking, volume of alcohol intake per occasion prior to pregnancy, intake of artificially sweetened beverages, natural birth and baby's birth year, gestational diabetes, glycosuria, preeclampsia and hypertension.	Intake of 100mL of sweetened carbonated soft drinks: reduction of 7.8g (CI95% = -10.3--5.3) in birth weight and lower chances of birth weight >4,500g (OR = 0.94; CI95%= 0.90-0.97).
Martin et al.,17 201 6, United States	Prospective cohort	389/NM	FFQ/ Dietary Pattern	BMI/A z-score/ Measured	Maternal age, race, level of education, income, marital status, parity, smoking and prepregnancy BMI, pre-pregnancy diabetes, chronic hypertension, gestational diabetes and pregnancy-induced hypertension.	No association between the "latent class1" pattern (mostly contains ultra-processed foods) on pregnancy and z-score of birth BMI/A, 6 months and 1 year [(β=-0.12 (CI95%= -0.39-0.14); β = 0.05 (CI95%= -0.23-0.34); β = 0.03 (CI95%= -0.24-0.30, respectively) compared to pattern 2 (mostly contains in natura and minimally processed food).
Abubakari e Jahn,²⁶ 2016, Gana	Cross-sectional	578/NM	FFQ/Dietary Pattern	Birth weight/ Measured	Gestational age	Non-healthly conscious diet" pattern: no association with birth weight [OR=1.04; CI95% = 0.65-1.67; p=0.95]
Azad et al.,²⁷ 2016, Canada	Prospective cohort	3,033/32.50 (4.60)	FFQ/Artificially sweetened beverages and sugar-sweetened beverages	BMI/A in z-score/Measured	Maternal BMI, maternal energy intake, points at bhealthy eating index, level of schooling, smoking and gestational diabetes, breastfeeding duration, baby's sex, introduction to solid foods before 4 months old.	Daily intake of artificially sweetened beverages: higher z-scores of BMI/A (β^a = 0.2 2; CI95% = 0.02-0.41) and intake of sugar-sweetened beverages: no association with BM I/A in z-score (β^a=0.07; CI95%= -0.06-0.19), both 1 year, for daily consumers vs non-consumers.
Colón-Ramos et al.,¹⁸ 2015, United States	Prospective cohort	1,151/NM	FFQ/Dietary Pattern	Birth weight birth and length W/A, length by age, weight/ length and head circunference/Measured	Age, race, pre-pregnancy BMI, level of schooling, alcohol intake, gestational weight gain.	"Processed" pattern: no association with birth outcomes (p>0.05).
Moss and Harris,¹⁹ 2014, United States	Prospective cohort	372/24.40 (0.25)	Questionnaire elaborated by the authors/Fast food consumption	Birth weight /Self- reported	Age, race, level of education, wellness feeling, immigrant or not, baby's sex, trimester in which started prenatal, parity, period between the interview and the conception and marital status.	Fast food consumption during pregnancy: no association with birth weight (p=0.93).
Grieger et al.,²³ 2014, Australia	Cross-sectional	309/26.60 (5.40)	FFQ/Dietary Pattern	LBW, SGA, birth length/N M	Maternal age, maternal BMI, smoking, socioeconomic status, presence of asthma, parity and ethnicity.	"high-fat/sugar/takeaway" pattern: no association with LBW and SGA (p>0.05). Incresase of 1 SD in the points of this standard: shorter birth length (β^a=- 0.5cm; CI95%= -0.8--0.1; p=0.004) compared to the other patterns
Wen et al.,¹¹ 2013, Australia	Prospective cohort	368/NM	FFQ/Frequent intake of foods from the "junk food" pattern	Birth weight >4,000g / Measured	Maternal nutritional status (normal weight, underweight, overweight, obesity) and gestational age.	"Junk food" pattern during pregnancy: mothers who did not follow this pattern were less willing to have a newborn weighing >4,000g (OR=0.36; CI95%= 0.14-0.91; p=0.03) compared to those who did.
Bouwland-Both et al.,²⁸ 2012, Netherlands	Prospective cohort	847/31.70 (4.0)	FFQ/Dietary Pattern	Birth weight/Measured	Duration of the last menstrual cycle, maternal age, maternal and paternal height and BMI, baby's sex, parity, level of schooling, smoking, folic acid supplementation, diastolic and systolic blood pressure average, and ^ccrown-rump length of the fetus.	"Energy-rich dietary"pattern:no association with birth weight [β=0.02; CI95% = -0.05-0.09)]. .
Phelan et al.,²⁰ 2011, United States	Prospective cohort	363/NM	FFQ/Intake of soft drinks and sweets	W/A, LGA and birth weight >4.000g / Measured	Baby's sex, intervention and control group, gestational age, drecruiting clinic, gestational weight gain. The analyses at 6 months old were additionally adjusted by breastfeeding.	Overweight/Obese mothers: higher % of kcal from sweets during pregnancy: higher birth W/A (β=0.19; p= 0.004), higher chance of birth weight >4,000g (OR = 1.1; CI95%= 1.0-1.2; p=0.004), LGA (OR=1.2; 95% CI 1.1-1.3; p=0.002) and higher W/A at 6 months (β=0.30; p=0.002). Normal weight mothers: higher intake of soft drinks: higher birth W/A(β=0.16; p=0.04).
Thompson et al.,²⁹ 2010, New Zealand	Cross-sectional	1,714/NM	FFQ/Dietary Pattern	SGA/ Measured	Gestational age, baby's sex, smoking during pregnancy, pre-pregnancy height and weight, parity, ethnicity and maternal hypertension..	"Junk food" pattern: no association with SGA (OR = 1.01; CI95%= 0.88-1.17).
Northstone et al.,³⁰ 2008, England	Prospective cohort	12,053/NM	FFQ/Dietary Pattern	Birth weight/Measured	Energy intake	"Processed" and "confectionery"patterns: no association with birth weight: [β=0.09; 95% CI - 0.67-0.85) and β= -0.42; CI95%= -1.21-0.38, respectively].
Wolff et al.,²¹ 1995, United States	Prospective cohort	549/24.20 (5.40)	FFQ/Dietary Pattern	Birth weight/Self- reported	NM	Nutrient Dilute" pattern: no association with birth weight (p=0.05).

		Anthropometric measurements assessed
Exposures	Association with the outcomes	BW	LBW	BW>400g	BL	BL>p90	HC	SGA	AGA	LGA	Birth BMI/A	BMI/A 6 months	BMI/A 1 year	Birth W/A at birth	W/A 6 months	Birth W/L at birth	Birth W/L at birth
UP pattern (n=10)	Direct	1				1				2
	Inverse				1			1
	NS	6	1		1		1	2			1	1	1	1		1	1
Soft drinks, ASB, SSB (n = 5)	Direct							1	1				1	1
	Inverse	2		1
	NS		1	2				1		2			1		1
"fast food", "junk foods", sweets and snacks (n=4)	Direct			2						1				1	1
	Inverse
	NS	3	2	2				2		2

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[TFN1] AGA = adequate for gestational age; β^a: adjusted beta; β: beta; BMI= body mass index; BMI/A = BMI/Age; CI= confidence interval; FFQ= food frequency questionnaire; LGA = large for gestational age; LBW = low birth weight; NM = not mentioned; OR= odds ratio; S GA= small for gestational age; W/A= weight by age; Vs= versus

Note: ^agroup assignments: 1. Group case: part of the sample received intervention in a previous study for gestational weight control; 2. Control group: no intervention; ^bThe Healthy Eating Index is a measurement of dietary quality in agreement with the Dietary Guidelines of 2010 from the United States Department of Agriculture; 12 components address the adequacy of the diet (9 components) and moderation (3 components), the highest score being 100; ^ccrown-rump length of the embryo/fetus: it is the estimated length of the embryos and human fetus from the top of its head to the bottom of torso; ^drecruiting clinic-women were recruited at the moment of their first prenatal appointment at one of the six obstetrics clinics, covering a socioeconomic and ethnically diverse population in Providence, Rhode Island, from 2006 to 2008.