Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus

  1. Liwei Chen, MD, PHD1,
  2. Frank B. Hu, MD, PHD2,3,4,
  3. Edwina Yeung, PHD5,
  4. Walter Willett, MD, DRPH2,3,4 and
  5. Cuilin Zhang, MD, PHD5
  1. 1Department of Epidemiology, School of Public Health, Louisiana State University Health Science Center, New Orleans, Louisiana;
  2. 2Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts;
  3. 3Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;
  4. 4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts;
  5. 5Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
  1. Corresponding authors: Liwei Chen, lchen{at}, and Cuilin Zhang, zhangcu{at}


OBJECTIVE Consumption of sugar-sweetened beverages (SSBs) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged populations. Studies on SSB consumption and glucose intolerance among pregnant women, however, are lacking. We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS This was a prospective study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses' Health Study II. GDM was self-reported and validated by medical record review in a subsample. Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk.

RESULTS During 10 years of follow-up, 860 incident GDM case subjects were identified. After adjustment for age, parity, race, physical activity, smoking, alcohol intake, prepregnancy BMI, and Western dietary pattern, intake of sugar-sweetened cola was positively associated with the risk of GDM, whereas no significant association was found for other SSBs and diet beverages. Compared with women who consumed <1 serving/month, those who consumed ≥5 servings/week of sugar-sweetened cola had a 22% greater GDM risk (relative risk 1.22 [95% CI 1.01–1.47]).

CONCLUSIONS Findings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola (≥5 servings/week) is associated with an elevated GDM risk, whereas no significant association with GDM risk was observed for other SSBs and diet beverages.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • See accompanying editorial, p. 2314.

    • Received May 11, 2009.
    • Accepted July 28, 2009.
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