Non-nutritive sweeteners (NNS) are food additives that have been used as a possible tool to reduce energy and sugar intake. There is a scientific debate around the real benefits of their use. NNS are substances widely evaluated in the scientific literature. Their safety is reviewed by international regulatory health agencies. Health professionals and consumers often lack education and objective information about food additives based on the best scientific evidence. NNS have been used as a substitute for sucrose, especially by people with diabetes mellitus and obesity. However, concerns related to their possible association with preterm birth have been raised, and also with their use during pregnancy and lactation because of the possibility of metabolic or other consequences in both the mother and offspring. This analysis of the evidence in gynecology and obstetrics presents a review of the most commonly asked questions regarding this matter by health professionals and their patients. This document evaluates a diversity of scientific publications under the sieve of evidence based medicine and the regulatory framework for food additives to elucidate whether the use of NNS in women in these critical stages of pregnancy and breastfeeding represents a potential risk.
The present review by a group of scientific experts in Mexico and Latin America pointed to the importance of proper weight gain and overall weight control in pregnant women in order to avoid complications of excess weight gain such as gestational diabetes, preterm delivery and birth defects. In this context, one of the strategies to avoid excessive weight gain could be the substitution of sugars with low/no calorie sweeteners.
Regulatory authorities around the world confirm that approved low/no calorie sweeteners are safe for all population groups including for pregnant and lactating women. Overall, current evidence suggests no grounds for concern about the use of low/no calorie sweeteners during pregnancy in relation to birth effect, preterm birth or risk of developing allergies. Also, the authors state that as a healthy weight gain is a key recommendation for pregnant women, the replacement of sugar with low/no calorie sweeteners might be helpful to avoid excess weight increase. The authors note that due to ethical aspects of research in women during pregnancy and lactation, evidence from experimental human studies is scarce and, therefore, data come primarily from animal research, observational studies and clinical studies in other population groups. Regarding limited data reporting the presence of very small amounts of acesulfame-K and sucralose, as well as saccharin, in breast milk, the expert group’s evaluation is that the reported concentrations represent potential levels of intake that are below the ADI levels.