Sugar or sweetener? A difficult decision for pregnant women

"Check your weight". It is the first "order" you receive the first time you visit the gynecologist after seeing the two rays in the predictor. The reason is that pouring many kilos at pregnancy increases the risk of gestational diabetes, preeclampsia, cesarean or premature delivery, high blood pressure, neural tube defects in the fetus (i.e., in the brain, spine and spinal cord)... We have been told to the full, so the vast majority of pregnant women know that "eating for two" is a fallacy. Very aware that care must be taken, and at the risk of taking a scolding from the specialist in the next review, those who cannot live without sugaring the coffee choose to replace sucrose with non-caloric sweeteners. They do so even on medical advice, and the remedy may be worse than the disease,

Currently there are no scientific studies with humans that ensure safe consumption of these sweeteners non-caloric among pregnant women or who are breastfeeding their baby, although it is also true that those that have been made in animals nor can they confirm that there is a real danger. But they do raise some doubts. The issue raises some controversy and uncertainty because, as much as scientific studies do not end up being conclusive, they do provide evidence that the fetus is much more susceptible than an adult in exposure to these substances

. "h3 lang"zxx" xml:lang"zxx">What rodents reveal about sweeteners

Sweeteners, like all food additives, are subject to strict safety control, and products that reach the lines of Spanish supermarkets, authorised by the European Food Safety Authority ( EFSA and the European Union Committee on Human Food can be consumed with peace of mind. That is provided that its consumption is within the appropriate levels of permissible daily intake. What is happening is that there are credible studies that have questioned the safety of non-caloric sweeteners based on possible microbiota alterations in healthy individuals, and more recently the focus has been placed on nursing babies and pregnant,

Precisely an article published this summer in the journal Frontiers in Microbiology analyzed how sucralose and acesulfame-k affect newborns, The first is mainly used in soft drinks and sweet drinks, and has a sweetening potential of 385 to 650 times greater than sugar, while the latter is used for desserts, fruit nectars and sweet sauces, used as a table sweetener or dairy products and ti ene sweetening power 200 times greater than table sugar,

In a study with rodents, which were supplied with the two sweeteners in doses equivalent to the maximum recommended amount, it was found, after analysing their urine, faeces and blood, that mother transmitted the sweeteners to the fetus before birth and that newborns were exposed to them through breastfeeding, This, according to the researchers, would alter the metabolism of small rodents, since both sucralose and acesulfame-k compromise liver function and, therefore, liver tissue would not remove from all toxins transported by the blood


But in addition to the metabolic changes in the body of rodents, they also detected in the intestines of newborns the absence of bacteria (called Akkermansia muciniphila) that are responsible for maintaining the healthy intestinal tract, and detected the presence of others (the firmicutes) whose presence in the microbiota is related to the development of type 2 diabetes and obesity.

What if they got to breast milk?

Miguel Angel Martínez Olmos, member of the Nutrition area of the Spanish Society of Endocrinology and Nutrition (SEEN), confirms that the use of non-caloric sweeteners in pregnancy or lactation is a topic that raises certain doubts. "Some of the alarms regarding these compounds come from research in animals with extremely high doses of sweeteners, well above the permissible daily intake, and are therefore not extrapolable to human consumption. On the other hand, the evidence available on this topic is scarce, presents disparate results and the design of the studies is not the most suitable for establishing causal relationships. For example, Most studies on the possible adverse effects of sweeteners on maternal-fetal health do not take into account aspects such as the presence of obesity or diabetes in the mother, which it associates with problems in pregnancy. And it may be that, precisely these populations, tend to a higher consumption of sweeteners (to avoid consuming sugars), therefore it would be necessary to carry out studies that control these aspects that can generate confusion", defends the specialist.

Endocflowering adds, in relation to Frontiers in Microbiology research, that the presence of small concentrations of these sweeteners in breast milk is well known, but not so its clinical implications. "As these are small amounts, well below the permissible daily intake, there would be no evidence to contraindicate its consumption in lactation, although it should not be recommended for widespread use either. It has been speculated that these sweeteners may modify the sweetness of breast milk (especially in the case of sucralose) and promote a taste for sweet taste in the infant, which could have a negative impact on the future metabolic health of that child, but at the moment there are no studies that can corroborate this," says Martínez Olmos. As long as the amount of a food additive in milligrams per kilo of body weight that can be consumed daily, throughout life, without appreciating any risk to health, the sweeteners that have been approved by the different regulatory bodies at the international level are safe, including pregnant women.

"The key is moderation, in avoiding consumption by abusing quantities. However, it should be remembered that they are foods of low caloric and nutritious intake that should not be the basis of feeding in pregnancy or in lactation. The diet must perform several functions in this biological period: to meet the usual energy requirements of the mother, provide the right nutrients for fetal growth and development, prepare the body for childbirth and facilitate breastfeeding Maternal. Thus, the basis of healthy eating during pregnancy and lactation should be foods of high nutritional quality, including preferential consumption of fruits and vegetables, whole grain cereals, low-fat dairy and assorted protein foods", the expert stresses. On the basis of the fact that products containing non-caloric sweeteners should not be recommended as a fundamental or necessary part of food, it must be said that sporadic and prudent consumption also does not appear to be a risk to maternal-fetal health, but there differences between the different sweeteners studied:

Sacarina: if there is an alternative, it is wise not

to take it

Saccharin, which has a sweetening power 300 times greater than sucrose, has the ability to cross the placenta, although it is also true that it has been shown that its consumption does not produce malformations in the fetus, as a study suggests which exposed rodents to a saccharin dose of 100 to 400 times the human permissible daily intake, which is 2.5 milligrams per kilo of body weight per day


"In some animal studies it has been seen that intrauterine exposure to saccharin can be problematic because of its ability to cross the placenta. For example, research conducted with monkeys showed that its removal is slower in fetal tissues, with a greater tendency to build up than in an adult's body . However, in a human study, the use of saccharin was not associated, as had been speculated, with miscarriage. Even so, with alternatives with less doubt in terms of safety, I think it seems reasonable to avoid it in pregnancy," concludes Martínez Olmos.

The cyclamamate and its relationship to the decreased weight of the fetus

Cyclamate, which, in addition to the use of table sweetener, is found in syrups, energy drinks and fruit juices, is prohibited in some countries and, although the World Health Organization discourages its consumption in pregnant women, in Europe is authorised as long as no more than 11 milligrams per kilo per day is consumed. SEEN endocrine is discouraged for use in pregnant women, as it "crosses the placental barrier and has been linked to a decrease in placental size and fetal weight". 

The stiletto glycosides, the safest

These are the chemical compounds that give the sweet taste to Stevia (that's why the sweetener is known by the generic name of stevia) and, despite being a naturally occurring sweetener, since it is created from the purification of the leaf of this origi plant Paraguay, has a very intense sweetening power, between 200 and 400 times sweeter than sugar. Although of all sweeteners is considered to be the safest, both Martínez Olmos and EFSA and different scientific studies, to consume it safely it is recommended not to pass the 4 milligrams per kilo of body weight per day.

"However, the raw leaf or the entire stevia leaf extract, are low purity compounds and may contain substances potentially toxic to the mother or fetus, so they should also be avoided in pregnancy," explains endocrine. The U.S. food security agency the country does not allow the use of this raw leaf or extract, as it is proven that those substances it contains are not approved by them, having, as indicated, the scientific literature, serious effects on the cardiovascular, renal and reproductive health of its consumers,