Are Artificial Sweeteners and Sugar Substitutes Safe During Pregnancy?

Your morning coffee at home, the bowl of cereal, a snack bar from the vending machine at work — the amount of artificial sweeteners and sugar substitutes in your diet can add up quickly. And it's only 10 a.m.!

Chances are, you already know that eating too much sugar in pregnancy can increase your risk of gaining too much weight or experiencing tooth decay. And monitoring your sugar intake while you're expecting is critical if you have gestational diabetes. But is it safe to replace refined sugar in your diet with foods and drinks that are artificially sweetened?

Here's the lowdown on the low-cal and no-cal sugar substitutes (plus other natural sweeteners) and their place when you're expecting.

What is a sugar substitute?

Sugar substitutes come in many different forms, but they're all designed to sweeten our foods and drinks. Nutritive sweeteners — such as honey, agave, and high-fructose corn syrup — provide energy in the form of carbohydrates and contain calories. 

All those diet and zero-calorie products you see on store shelves? They contain nonnutritive sweeteners, which are very low in calories or contain no calories at all. Think of those "no added sugar" or "reduced-sugar" yogurts and coffee creamers, not to mention low-calorie ice creams, candies and drinks. 

Nutritive and nonnutritive are just one way to distinguish between sweeteners, though.

Categories of sugar substitutes

• Artificial sweeteners: Think of the little pastel packets you often see in diners and coffee shops. Artificial sweeteners are also used in many processed foods and soft drinks. Examples of sugar substitutes approved by the U.S. Food and Drug Administration (FDA) include acesulfame, aspartame, neotame, saccharin and sucralose.
• Natural sweeteners: Think honey, coconut sugar, maple syrup. While they are promoted as "healthier options" over table sugar or other sugar substitutes because they can contain trace minerals or antioxidants, they do contain sugar and, consequently, calories. (Cue image of Buddy the Elf dousing spaghetti in maple syrup.) Of course, natural sugars do have a variety of uses in cooking at home and are often found in processed foods as "added sugars."
• Novel sweeteners: Stevia is the only novel sweetener approved by the FDA. It's low in calories, and some studies even say novel sweeteners can lower blood pressure. What's the catch? The way novel sweeteners are made (i.e. their formula) changes, and they can include other types of sugar substitutes.
• Sugar alcohols (polyols): Technically not sugars, sugar alcohols are carbs that occur naturally in certain fruits and vegetables — although they can also be found in many processed foods. (And despite their name, these sugars are non-alcoholic.) Food labels may use the general term "sugar alcohol" or list the specific name, such as sorbitol. When eaten in large amounts, sugar alcohols can have a laxative effect.

It’s worth knowing that manufacturers are not required to say how much of a sugar substitute is actually in a product, although they are required to list it as an ingredient, so you should always read your food labels carefully.

Which sugar substitutes are unsafe during pregnancy?

Cyclamate was banned in the U.S. in 1970 after being linked to cancer, yet the artificial sweetener is still used in some other countries. Take note if you're traveling internationally! 

Which sugar substitutes are safe during pregnancy?

When used in moderation, most pregnant women can safely use any of the nutritive and nonnutritive sweeteners approved by the FDA.

Still, the truth is that sugar substitutes can be a bit of a mixed bag for pregnant women. Even though they are mostly considered safe, consuming lots of artificial sweeteners now may increase your baby's risk of being overweight later on.

More research is needed to fully understand how artificial sweeteners and sugar substitutes affect a baby’s development in utero. Here's what you need to know about the different types of artificial sweeteners and sugar substitutes you might see on food and beverage labels. They include:

Aspartame (Equal, NutraSweet) during pregnancy

According to the FDA, aspartame is safe for use during pregnancy and while breastfeeding. A packet or two of the blue stuff now and then is fine (so yes, a small piece of sugarless gum is safe).

Just avoid consuming aspartame during pregnancy in large amounts, and steer clear of it altogether if phenylketonuria (PKU), a rare genetic disease, is on your medical chart. Your doctor may also suggest avoiding aspartame if you have high levels of phenylalanine in your blood.

Adventame during pregnancy

Adventame is actually 100 times sweeter than aspartame — a pretty sweet sweetener! In 2014, the FDA approved advantame as a nonnutritive sweetener and flavor enhancer within the U.S. in foods generally, except meat and poultry. It is safe during pregnancy in moderation.

Coconut sugar during pregnancy

Coconut sugar, a natural sweetener, is safe during pregnancy as a sugar substitute. It’s also called coconut palm sugar and looks a lot like brown sugar with small lumps. It may have small amounts of minerals and antioxidants, but at the end of the day, it's not that different from cane sugar.

Fruit juice concentrates during pregnancy

Fruit juice concentrates are found in all kinds of commercial products — including cookies, cereals, granola bars, toaster pastries, yogurt and soft drinks — and they're safe to consume during pregnancy.

Since they're liquid, substituting fruit juice concentrates for granulated sugar in recipes takes a little know-how — but it’s definitely safe to do it. You'll need to choose recipes that call for a substantial amount of liquid, then sub the juice concentrate for that liquid, as well as for the sugar. White grape juice concentrate, for example, has a sweeter, less fruity taste, and will bake up to taste most like sugar.

Neotame (Newtame) during pregnancy

Neotame is a nonnutritive sweetener approved by the FDA in 2002 for use as a "general purpose sweetener and flavor enhancer" in foods (except in meat and poultry). It is used as a sugar substitute in some baked goods, and there is no evidence of risks for pregnant women.

Mannitol during pregnancy

Mannitol may provide fewer calories than sugar, but it is poorly absorbed by the body. Like sorbitol, it is safe in moderation, although too much can cause stomach upset.

Monk fruit extract during pregnancy

Monk fruit is a small green gourd from Southern China. It's classified by the FDA as "generally recognized as safe," or GRAS. It’s 150 to 200 times sweeter than sugar and contains zero calories.

Saccharin (Sweet 'N Low, Necta Sweet) during pregnancy

Even though the FDA considers saccharin to be safe for the general public, some countries have banned the artificial sweetener. 

The Academy of Nutrition and Dietetics (AND) says that saccharin can cross the placenta and stay in the baby's tissues, and the long-term effects, if any, are unknown. Pregnant women may want to avoid this artificial sweetener, if possible.

Sorbitol during pregnancy

Sorbitol, a nutritive sweetener and sugar alcohol, is fine for women during pregnancy. But while it can't hurt your baby, it can have unpleasant gastrointestinal effects on you. In large doses, sorbitol can cause an upset stomach and diarrhea — something no pregnant woman wants to have. Diarrhea during pregnancy, besides being uncomfortable, can interfere with the absorption of vital nutrients and lead to dehydration.

Sucralose (Splenda) during pregnancy

The FDA says sucralose is safe for everyone to consume, including pregnant women. It's sugar, sort of. At least it starts out that way, before it's chemically processed into a form that your body can't absorb, making it calorie-free. 

It's approved for use in baked goods, making it ready to fulfill your pregnancy cravings of sugar-free chocolate cake. You’ll also find it in non-alcoholic beverages, chewing gum, coffee and tea products, frostings, frozen dairy desserts, fruit juices and sweet sauces. Before you leap to consume all these tasty treats, remember everything in moderation.

Stevia during pregnancy

Stevia is a zero-calorie sweetener derived from a South American shrub. In packet, drops or even plant form, it’s a dietitian favorite frequently used in soft drinks and juices. The FDA says that steviol glycosides — chemicals derived from the stevia leaf and used as novel sweeteners — are generally recognized as safe, but stevia has not been approved by the FDA as a nonnutritive sweetener; it’s considered a dietary supplement. 

Although experts say stevia may not increase sugar cravings the way that other artificial sweeteners do (it does not raise your blood sugar or have adverse effects on your taste buds), your best bet is to check with your doctor before using it.

Tagatose during pregnancy

Tagatose is also considered a novel sweetener because of how it’s made. It’s manufactured from the lactose in dairy products. (Get where the "tose" comes from now?) 

The FDA categorizes tagatose as a "generally recognized as safe" (GRAS) substance, which means it has been determined to be safe for everyone — including pregnant women.

Xylitol during pregnancy

Xylitol, a sugar alcohol, is commonly found in chewing gum, toothpaste and candies, and is considered safe during pregnancy in moderate amounts. So, a few pieces of xylitol-sweetened gum a day is fine — but you might not want to chew through five. 

Xylitol does have 40 percent fewer calories than pure sugar (sucrose) and has been shown to prevent tooth decay — a good thing if it is included in your toothpaste!