Sugar-sweetened beverage taxes and perinatal health: A quasi-experimental study
Jackson K, Hamad R, Karasek D, White J (2023) American Journal of Preventative Medicine Mar 24;S0749-3797(23)00158-7 doi: 10.1016/j.amepre.2023.03.016
Abstract:
Introduction: One in five pregnant individuals report consuming sugar-sweetened beverages (SSBs) at least once per day. Excess sugar consumption during pregnancy is associated with several perinatal complications. As SSB taxes become increasingly common public health measures to reduce SSB consumption, evidence on the downstream effects of SSB taxes on perinatal health remains limited.
Methods: This longitudinal retrospective study examines whether SSB taxes in five US cities were associated with decreased risk of perinatal complications, leveraging 2013-2019 US national birth certificate data and a quasi-experimental difference-in-differences approach to estimate changes in perinatal outcomes. Analysis occurred from April 2021 through January 2023.
Results: The sample included 5,324,548 pregnant individuals and their live singleton births in the US from 2013 through 2019. SSB taxes were associated with a 41.4% decreased risk of GDM (-2.2 percentage points [pp]; 95%CI -4.2, -0.2), a -7.9% reduction in weight-gain-for-gestational-age z-score (-0.2 standard deviations; 95%CI -0.3, -0.01), and decreased risk of infants born small-for-gestational-age (-4.3 pp; 95%CI -6.5, -2.1). There were heterogenous effects across subgroups, particularly for weight-gain-for-gestational-age z-score.
Conclusions: SSB taxes levied in five US cities were associated with improvements in perinatal health. SSB taxes may be an effective policy instrument for improving health during pregnancy, a critical window during which short-term dietary exposures can have lifelong consequences for the birthing person and child.
FAB RESEARCH COMMENT:
Diets high in 'free' sugars (i.e. those that are not an intrinsic part of foods, like the sugars found in whole fruits, sweet vegetables or milk) increase risks for obesity, diabetes and many other physical health conditions. They are also linked with a wide range of conditions involving impairments of mood, behaviour and cognition, including depression, dementia and ADHD. Sugars consumed in liquid form - i.e. in sweetened drinks - are particularly strongly linked with these health risks.For mothers before and during pregnancy, high-sugar diets - and maternal obesity and/or diabetes, with which these are linked - also appear to raise lifetime risks for obesity and related health conditions in the unborn child - including behaviour problems like ADHD.
To reduce sugar consumption and the associated health problems, taxes on sugary drinks have now been introduced in some countries - although evidence of their effectiveness has been limited - not least by the impossibility of conducting randomised controlled clinical trials.
This new study, involving more than 5 million pregnant US women, compared health outcomes for those living in cities with and without taxes on sugar-sweetened drinks, found that where these taxes were in place, there were
- 40% fewer cases of diabetes during pregnancy, and
- significantly better outcomes for the newborn child in terms of being born underweight or small for gestational age
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