Added Sugar Intake among Pregnant Women in the United States: National Health and Nutrition Examination Survey 2003-2012

Published:January 09, 2018DOI:



      Despite associations of dietary added sugar with excess weight gain and chronic disease risk, intake among most Americans exceeds the recommended limits (<10% total energy). Maternal diet plays an important role in pregnancy-related outcomes, but little is known about the extent of added sugar intake during pregnancy.


      To assess intake and identify the top sources of added sugars in the diets of pregnant vs nonpregnant women in the United States.


      Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), 2003-2004 to 2011-2012.


      Four thousand one hundred seventy-nine pregnant and nonpregnant women (aged 20 to 39 years) who completed a dietary recall.

      Statistical analyses performed

      Survey-weighted analyses were used to estimate means (95% CIs) in total grams and as percentage of total energy for added sugar intake by pregnancy status and by demographic subgroup and to identify leading sources of added sugar.


      Added sugar intake trended toward being higher in pregnant compared with nonpregnant women in absolute grams, 85.1 g (95% CI: 77.4 to 92.7) vs 76.7 g (95% CI: 73.6 to 79.9), respectively (P=0.06), but was lower among pregnant women when total energy intake was accounted for, 14.8% (95% CI: 13.8 to 15.7) vs 15.9% (95% CI: 15.2 to 16.6) of total energy, respectively (P=0.03). Among pregnant women, added sugar intake was similar among demographic subgroups. However, in multivariable regression, pregnancy status significantly modified the associations of education and income with added sugar intake, whereby less educated and lower-income women who were pregnant had lower added sugar intakes compared with those who were not pregnant, but more educated or higher-income women did not exhibit this pattern. The top five sources of added sugar for all women were sugar-sweetened beverages; cakes, cookies, and pastries; sugars and sweets; juice drinks and smoothies; and milk-based desserts.


      Although pregnant women had higher energy intakes, this was not attributed to higher intakes of added sugar. Although education and income affected consumption during pregnancy, intake of added sugar among all women, regardless of pregnancy status, exceeded recommendations.


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      C. E. Cioffi is a registered dietitian and a doctoral candidate, Laney Graduate School, Emory University, Atlanta, GA.


      J. Figueroa is a biostatistician, Strong4Life Initiative, Children’s Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.


      J. A. Welsh is an assistant professor, Department of Pediatrics, Emory University School of Medicine, and research director, Strong4Life Initiative, Children's Healthcare of Atlanta, Atlanta, GA.