Clinical Opinion| Volume 223, ISSUE 2, P211-218, August 2020

Consumption of non-nutritive sweeteners during pregnancy

Published:April 07, 2020DOI:
      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.

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        American Journal of Obstetrics & GynecologyVol. 227Issue 2
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          We read with interest the recent article published by Gilroy et al.1 In this retrospective study, including 2,576,192 births, the authors analyzed the effect on obstetrical practices, in the United States: of The Randomized Trial of Induction Versus Expectant Management (ARRIVE) trial,2 a randomized control trial designed to assess neonatal outcomes after elective induction of low-risk nulliparous women at 39 weeks of gestation, which suggested a 4% reduction in the cesarean delivery (CD) rate among the induction group with similar neonatal outcomes.
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      • Statistical significance and clinical utility
        American Journal of Obstetrics & GynecologyVol. 227Issue 2
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          The authors thank Drs Vouga and Desseauve for their interest in our recent publication (manuscript number: L22-055). The reduction in cesarean delivery rate seen in the A Randomized Trial of Induction Versus Expectant Management (ARRIVE) trial may have been facilitated by the circumstances of an academic-based, well-funded, tightly regulated randomized controlled trial.1 It has been documented that participants in randomized trials have better outcomes than those not participating in trials.2 Thus, the main objective of our study was to determine if the findings of the ARRIVE trial influenced obstetrical practices in the “real world.” We found, at least in 2019, a higher rate of inductions with a lower rate of cesarean deliveries.
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      • Letter to the editors regarding the article “Consumption of non-nutritive sweeteners in pregnancy”
        American Journal of Obstetrics & GynecologyVol. 223Issue 5
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          This is a letter from the International Sweeteners Association in response to an article by Palatnik et al1 regarding the effects of the consumption of nonnutritive sweeteners (NNSs) during pregnancy on maternal and child health. The authors claim that emerging evidence from animal studies warns against the consumption of NNSs. This assertion is not supported by regulatory food safety authorities worldwide, including the Joint FAO/WHO Expert Scientific Committee on Food Additives of the United Nations Food and Agriculture Organization and of the World Health Organization, the European Food Safety Authority, and the US Food and Drug Administration, who confirm that NNSs are safe, including the consumption of NNSs during pregnancy and lactation.
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      • Consumption of non-nutritive sweeteners during pregnancy
        American Journal of Obstetrics & GynecologyVol. 223Issue 6
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          The paper by Palatnik et al,1 “Consumption of non-nutritive sweeteners during pregnancy,” purports to be a review but causes some concerns for several reasons.
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 223Issue 6
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          We thank Dr Ayoob for his interest in our Clinical Opinion paper entitled “Consumption of non-nutritive sweeteners during pregnancy” and his comments.
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