In an effort to reduce sugar consumption to prevent diabetes mellitus and cardiovascular diseases, “sugar-free” or “no added sugar” products that substitute sugar with non-nutritive sweeteners (NNSs) (eg, Splenda, Sweet’N Low, and Stevia) have become increasingly popular. The use of these products during pregnancy has also increased, with approximately 30% of pregnant women reporting intentional NNS consumption. In clinical studies with nonpregnant participants and animal models, NNSs were shown to alter gut hormonal secretion, glucose absorption, appetite, kidney function, in vitro insulin secretion, adipogenesis, and microbiome dysbiosis of gut bacteria. In pregnant animal models, NNS consumption has been associated with altered sweet taste preference later in life and metabolic dysregulations in the offspring (eg, elevated body mass index, increased risk of obesity, microbiome dysbiosis, and abnormal liver function tests). Despite the accumulating evidence, no specific guidelines for NNS consumption are available for pregnant women. Furthermore, there are limited clinical studies on the effects of NNS consumption during pregnancy and postpartum and long term outcomes in the offspring.
The literature review by Palatnik et al suggests that emerging evidence from animal studies warns against the consumption of low/no calorie sweeteners in pregnancy, a claim not supported by the most prominent scientific regulatory bodies around the world who have consistently confirmed that low/no calorie sweeteners are safe for use, also during pregnancy.
The authors’ conclusions are based on selected studies in pregnant animal models and in-vitro experiments, missing to consider the collective research that is the fundamental basis for regulatory approval and confirmation that low/no calorie sweeteners are safe to use during pregnancy and lactation. Comments by the International Sweeteners Association (ISA) in response to the review by Palatnik et al have been published in the American Journal of Obstetrics & Gynecology in a Letter to the Editors by V.Pyrogianni.
Also, an ISA statement in response to the study by Palatnik et al is available on the ISA website by clicking here.