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Artificial Sweeteners And Telling Pregnant Women “In Moderation”

I can already tell that this pregnancy is different from my first. When I was pregnant with Little Isis, I drank no caffeine and took no over-the-counter medication. I remember having a few headaches and Mr. Isis fighting with me to take a headache pill. I would then proclaim dramatically, “But I can’t! What if it hurts the baby?!”

This morning, now pregnant with my second, I washed down a Zyrtec and two Tylenol with a cup of coffee. The little bugger is going to have to grow up with Little Isis. He might as well start building up his tolerance to exogenous substances at some point. I figure, now that its got a closed neural tube and a beating heart, we might as well begin.

Still, you can’t blame a pregnant woman for being a bit neurotic. The feeling that one is solely responsible for the well-being of a developing creature, combined with often contradictory advice, is enough to make anyone nuts. Most online advice is completely and utterly useless. Take this answer from Russell Turk, M.D. on the popular pregnancy website BabyCenter in response to the common question, “Is it safe to drink diet soda during pregnancy?” He answers:

Diet sodas often contain both caffeine and an artificial sweetener. There are several types of artificial sweeteners you may see on nutrition labels:

Aspartame (NutraSweet): Seems to be okay when consumed in moderation (the amount found in one or two 12-ounce servings of soda per day).

Saccharin (Sweet’n Low): Saccharin was found to cause birth defects in laboratory rats when consumed in very high amounts. Because its safety in smaller amounts is hard to prove, I would advise avoiding it.

Sucralose (Splenda): This relatively new sweetener, a modified form of regular table sugar, appears to be safe. But because it hasn’t been extensively studied, it’s best used in moderation.

It’s generally bad advice and leaves one wondering: “What is moderation? Will one soda hurt my baby? Will two sodas hurt my baby? How about three?” The default answer when we don’t know seems to be to tell women to do things in “moderation.” This places the sole responsibility on her to know what moderation means, and allows her to feel the guilt if something goes wrong. I think that these imprecise answers leave many women feeling helpless and afraid.

With regards to this question, there really isn’t sufficient data to guide physicians in answering the question, and telling women to only do something “in moderation” is a cop-out. In a single prospective study of 59,334 pregnant women, an association was found between daily consumption of articficially-sweetened drinks and pre-term delivery. However, as critics of this paper point out, the sample size examined is huge and the increased risk associated with artificial sweetener consumption in carbonated drinks is low (odds ratio 1.15-1.65 for a single drink per day).

It is possible that the enormous sample in this study allowed for the finding of a significant effect? Artificial sweeteners were only considered in drinks and their presence in other food items were not quantified. Furthermore, the authors seperated carbonated drinkers from noncarbonated drinkers. When these are combined, their findings are less robust. This leaves me to wonder if there is something about the women who drank carbonated drinks compared to those who drank noncarbonated drinks that explains the mildly increased risk of pre-term delivery. 

As an explanation for their findings, the authors of this paper propose that drinking the artificial sweetener aspartame (which is not seperated from the others in this paper) leads to the production of methanol. This methanol causes hypertension, leading to pre-term delivery. However, they found no association between pre-eclampsia and artificial sweetener use. They also neglected to mention that the amount of methanol produced from the metabolism of a single artificially-sweetened drink is six times less than the amount produced from the metabolism of a glass of tomato juice.

But, I digress. Beyond this, the evidence is poor. A Web-of-knowledge search for “aspartame and pregnancy” yields only ten results. Of those ten, three are reviews or commentary, two seem to be unrelated to the question, and three are animal studies using large exposures. Searching “sucralose and pregnancy” yields two results. A search for “saccharin and pregnancy” yields only 17 results, despite its bad reputation.

All of this leads me to wonder how any physician can come to any conclusion on the safety of artificial sweeteners. It also leads me to wonder why we can’t simply tell pregnant women “we don’t know” instead of telling them to do everything “in moderation.”

*This blog post was originally published at The Brain Confounds Everything*

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