Is soft drink consumption associated with gestational hypertension? Results from the BRISA cohort.

H Bettiol,G Kac,M A Barbieri,R C Cavalli,V M F Simões,C C C Ribeiro,J M A Barbosa,A A M Da Silva

doi:10.1590/1414-431x202010162

Abstract

It is still unknown whether excessive consumption of sugar-sweetened beverages may be linked to gestational hypertensive disorders, other than preeclampsia. This study investigated the association between soft drink consumption and hypertension during pregnancy, analyzing the relationship from the perspective of counterfactual causal theory. Data from pregnant women of the BRISA cohort were analyzed (1,380 in São Luis and 1,370 in Ribeirão Preto, Brazil). The explanatory variable was the frequency of soft drink consumption during pregnancy obtained in a prenatal interview. The outcome was gestational hypertension based on medical diagnosis, at the time of delivery. A theoretical model of the association between soft drink consumption and gestational hypertension was constructed using a directed acyclic graph. Marginal structural models (MSM) weighted by the inverse of the probability of soft drink consumption were also employed. Using Poisson regression analysis, high soft drink consumption (≥7 times/week) was associated with gestational hypertension in São Luís (RR=1.48; 95%CI: 1.03-2.10), in Ribeirão Preto (RR=1.51; 95%CI: 1.13-2.01), and in the two cohorts combined (RR=1.45; 95%CI: 1.16-1.82) compared to lower exposure (<7 times/week). In the MSM, the association between high soft drink consumption and gestational hypertension was observed in Ribeirão Preto (RR=1.63; 95%CI: 1.21-2.19) and in the two cohorts combined (RR=1.51; 95%CI: 1.15-1.97), but not in São Luís (RR=1.26; 95%CI: 0.79-2.00). High soft drink consumption seems to be a risk factor for gestational hypertension, suggesting that it should be discouraged during pregnancy.

Highlights

Hypertensive disorders of pregnancy (HDP) include: 1) chronic hypertension; 2) gestational hypertension (high blood pressure (BP) after 20 weeks of gestation in the absence of preeclampsia); 3) preeclampsia-eclampsia; and 4) chronic hypertension with superimposed preeclampsia [1]
In the Poisson regression analysis, soft drink consumption X7 times per week was associated with gestational hypertension in São Luís (RR=1.48; 95%CI: 1.03–2.10; P=0.030), in Ribeirão Preto (RR=1.51; 95%CI: 1.13–2.01; P=0.005), and in the two cohorts combined (RR=1.45; 95% CI: 1.16–1.82; P=0.001) (Supplementary Table S2)
In the Marginal structural models (MSM), soft drink consumption X7 times per week was significantly associated with hypertension in the Ribeirão Preto cohort (RR=1.63; 95%CI: 1.21–2.19; P= 0.001) and in the two cohorts combined (RR=1.51; 95% CI: 1.15–1.97; P=0.002), but not in the São Luís cohort alone (RR=1.26; 95%CI: 0.79–2.00; P=0.328) (Table 2)

Summary

Introduction

Hypertensive disorders of pregnancy (HDP) include: 1) chronic hypertension (of any cause that precedes pregnancy); 2) gestational hypertension (high blood pressure (BP) after 20 weeks of gestation in the absence of preeclampsia); 3) preeclampsia-eclampsia (high BP after 20 weeks of gestation with proteinuria or any of the severe features of preeclampsia); and 4) chronic hypertension with superimposed preeclampsia (chronic hypertension in association with preeclampsia) [1]. High scores of the Healthy Eating Index adapted for use in pregnant women have been shown to protect against preeclampsia (OR=0.87; 95%CI: 0.76–1.00) [3]. A meta-analysis concluded that women with high energy intake were at higher risk of developing preeclampsia compared to their counterparts [4]. The main source of energy intake during pregnancy is excessive sugar consumption, especially soft drinks [5]. High soft drink consumption has been associated with overweight/obesity, metabolic syndrome, and type II diabetes [6]. All these metabolic disorders are associated to HDP [7].

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