Low/no calorie sweetener consumption is safe during pregnancy

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ISA statement in response to study by Cai et al.

Brussels, 18th January 2021: Responding to a new publication by Cai et al.1 on low/no calorie sweetener consumption during pregnancy, the International Sweeteners Association (ISA) points to the opinions of food safety authorities around the world which have repeatedly and consistently confirmed the safety of low/no calorie sweeteners, including during pregnancy.

In fact, for a low/no calorie sweetener to be approved for use on the market, it must first undergo a thorough safety assessment by the competent food safety authority. Such scientific regulatory bodies include the Joint Expert Scientific Committee on Food Additives (JECFA)2 of the United Nations Food & Agriculture Organization (FAO) and of the World Health Organization (WHO), the European Food Safety Authority (EFSA)3 and the US Food and Drug Administration (FDA).4

Furthermore, in a statement published in 2011, EFSA concluded that “there is no evidence available to support a causal relationship between the consumption of artificially sweetened soft drinks and preterm delivery”, in response to claims made in a study by Halldorsson et al.5

In addition, this new publication by Cai et al. is based on low-quality observational data with important limitations. This actually explains the authors’ own evaluation of the evidence analysed in their study as “low” to “very low”. Being primarily a meta-analysis of observational studies, it cannot prove any causal relationship between the prenatal intake of diet drinks and birth outcomes. As for all observational studies, any of the observed associations may be influenced by residual confounding factors and the high possibility of reverse causality.

At a time when obesity and non-communicable diseases including diabetes and dental diseases remain major global health challenges, and in light of current public health recommendations to reduce overall sugar intake, low/no calorie sweeteners can be helpful in creating healthier food environments. They provide a wide choice of sweet-tasting options with low or no calories, and thus can be a useful tool, when used in place of sugar and as part of a balanced diet, in helping reduce overall sugar and calorie intake, as well as in managing blood glucose levels, including for pregnant women who may be at risk of gestational diabetes.6 Low/no calorie sweeteners are also not fermentable by oral bacteria, which means that they do not contribute to tooth demineralisation, which is one of the reasons for tooth decay.6 This can be helpful during pregnancy which often puts a strain on the overall mouth health7,8 and ensuring healthy teeth is all the more important.

  1. Cai C, Sivak A, Davenport MH. Effects of Prenatal Artificial Sweeteners Consumption on Birth Outcomes: A Systematic Review and Meta-Analysis. Public Health Nutrition 2021 Jan 14;1-26. doi:10.1017/S1368980021000173
  2. http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en/
  3. http://www.efsa.europa.eu/en/topics/topic/sweeteners
  4. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners
  5. Statement of EFSA on the scientific evaluation of two studies related to the safety of artificial sweeteners. EFSA 2011, EFSA Journal 2011;9(2):2089: https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2011.2089
  6. EFSA Scientific opinion on the substantiation of health claims related to intense sweeteners. EFSA 2011 Journal 9(6): 2229, and 9(4): 2076 and Commission Regulation 432/2012/EU (OJ L 136 25.5.2012, p. 1): http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:136:0001:0040:en:PDF
  7. CDC Pregnancy and Oral Health: https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html
  8. NHS Teeth and Gums in Pregnancy: https://www.nhs.uk/conditions/pregnancy-and-baby/teeth-and-gums-pregnant/