Sugar substitutes during pregnancy

Acesulfame potassium

Acesulfame potassium is a high-intensity sweetener used in food, beverages, oral hygiene products, and a number of pharmaceutical products.¹¹ There is limited research on the safety of acesulfame potassium during pregnancy, but studies have found that the sweetener does cross the placenta.¹¹ An animal study reported that fetuses exposed to acesulfame potassium through the amniotic fluid had an increased preference for sweet solutions and acesulfame potassium solution in adulthood when compared with those in the control group.¹¹ However, these results were reported for concentrations of acesulfame potassium that were substantially greater than typical human exposure.

Aspartame

Aspartame is one of the most common artificial sweeteners used in food and drink. In the small intestine, aspartame breaks down into aspartic acid, phenylalanine, and methanol at levels that are nontoxic to adults, children, and fetuses.¹² Several animal studies do not suggest concerns with use of aspartame during pregnancy.¹³ Human studies found that the breakdown products of aspartame cross the placenta.¹⁴ However, a dose of 200 mg/kg of aspartame (4 to 5 times the ADI) did not lead to toxicity, such as methanol poisoning or increase in fetal blood phenylalanine levels to the range associated with mental retardation in offspring.¹⁴ Based on available data, consumption of aspartame during pregnancy is not expected to be a concern when staying within the acceptable daily limit.¹⁵ It is important to note that women with phenylketonuria should avoid aspartame owing to its breakdown into phenylalanine.³

Neotame

Neotame is a sparsely used chemical derivative of aspartame that is much sweeter.⁷ Thus far, there are limited data on any potential effects of neotame consumption during pregnancy.

Saccharin

Until recently, saccharin was banned as a sweetener in Canada.^4,5 The compound crosses the human placenta at term.¹⁶ In a study conducted in rhesus monkeys, fetal elimination of saccharin was much slower than on the maternal side, suggesting that repeated ingestion of saccharin by the mother could lead to a considerable accumulation of the substance in the fetus.¹⁷ However, animal data that report exposure with doses 100 to 400 times the human ADI do not suggest a risk of malformations.¹⁸ A case-control study reported no increased risk of spontaneous abortions in women who consumed saccharin.¹⁹

Stevia

Stevia was approved by Health Canada as a food additive in 2012.⁴ It is becoming increasingly popular as a natural alternative to artificial sweeteners. The compound originates from the leaves of the Stevia rebaudiana plant, and is used as a noncaloric sweetener.⁴ In animal studies, Stevia did not increase toxicity in rat embryos, nor did it affect fertility or pregnancy outcomes.²⁰ However, there are no data on the outcomes of use of Stevia during human pregnancies.

Sucralose

Sucralose is another common artificial sweetener. Animal studies report no increased risk of malformations or other adverse fetal effects with exposure to high-dose levels of sucralose during pregnancy.²¹

Polyols and polydextrose

Polyols are compounds that occur naturally but they are manufactured for use commercially.²² Canada’s Food and Drug Regulations indicate approval for the use of the following sugar alcohols: “hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, maltitol syrup, mannitol, sorbitol, sorbitol syrup, xylitol and erythritol.”²² Limited evidence exists on the effects of polyols during pregnancy. However, owing to the presence of polyols in both maternal and fetal samples from normal pregnancy,²³ it is likely that these compounds are safe when consumed in moderation.

Polydextrose is another compound that is approved as a food additive. Unlike polyols, polydextrose supplements texture without adding sweetness to foods.²² It is a synthetic indigestible glucose polymer and is classified as a dietary fibre; therefore, it is not expected to be a concern.²⁴

Thaumatin

Thaumatin is a sweet protein derived from the Thaumatococcus daniellii plant.⁷ Although little evidence exists on the effects of thaumatin during pregnancy, the protein is processed in the body similarly to other dietary proteins⁷ and therefore is not expected to have adverse effects during pregnancy.