Is it safe to consume diet soda during pregnancy?

Diet Soda During Pregnancy: Safety Considerations

Diet soda should be avoided during pregnancy due to potential risks associated with artificial sweeteners and lack of established safety thresholds.

Artificial Sweeteners in Pregnancy

• The FDA has approved several nonnutritive sweeteners for use in the United States (acesulfame potassium, aspartame, neotame, saccharin, and sucralose), which have undergone safety evaluations 1.
• However, despite FDA approval, specific concerns exist for pregnant women:
  • The American College of Obstetricians and Gynecologists specifically recommends avoiding saccharin during pregnancy as it can cross the placenta and remain in fetal tissues 1.
  • Daily consumption of artificially sweetened beverages during pregnancy has been associated with a 0.20-unit increase in infant BMI z-score and a 2-fold higher risk of infant overweight at 1 year of age 2.

Research Findings on Artificial Sweeteners in Pregnancy

• A prospective cohort study of 59,334 Danish pregnant women found an association between intake of artificially sweetened carbonated and noncarbonated soft drinks and increased risk of preterm delivery 3.
• Women who consumed ≥1 serving of artificially sweetened carbonated soft drinks daily had an adjusted odds ratio of 1.38 for preterm delivery compared to women with no intake 3.
• The risk increased further for women consuming ≥4 servings daily (adjusted odds ratio: 1.78) 3.
• Approximately 30% of pregnant women report intentional consumption of non-nutritive sweeteners 4.

Safety Guidelines

• Because no safe threshold of alcohol use during pregnancy has been established, women who are pregnant, planning a pregnancy, or at risk for pregnancy should be advised not to drink alcohol 5.
• Similarly, no specific safety thresholds have been established for artificial sweeteners during pregnancy, suggesting a cautious approach 4.
• During pregnancy, cyclamate, saccharin, and crude stevia leaf should be specifically avoided, as well as stevia infusions or extracts of the whole leaf 6.

Recommended Alternatives

• A balanced diet resulting in appropriate weight gain generally supplies all vitamins and minerals needed during pregnancy 7.
• Pregnant women should focus on consuming:
  • Fresh fruits and vegetables 5
  • Lean meats, poultry, and fish (being mindful of mercury content) 5
  • Fat-free or low-fat milk and milk products 5
  • Whole grains 5
• Water is the safest beverage choice during pregnancy, with fruit juices (in moderation) being a better alternative to diet sodas 5.

Common Pitfalls to Avoid

• Many women turn to diet sodas to manage weight gain during pregnancy, but this strategy may have unintended consequences for infant development 2.
• Pregnant women should not attempt weight loss diets, but rather focus on appropriate weight gain through nutritious food choices 6.
• There is a concerning disconnect between scientific data and general recommendations provided to pregnant mothers by some obstetricians regarding potentially harmful substances 8.

Practical Recommendations

• If a pregnant woman is concerned about caloric intake and weight gain, she should consult with a healthcare provider or nutritionist for personalized dietary guidance rather than relying on diet sodas 1.
• For women with gestational diabetes who need to limit sugar intake, water flavored with fresh fruit or herbs provides a safer alternative to artificially sweetened beverages 1.
• Women should be informed that animal studies show artificial sweetener consumption during pregnancy may alter offspring's sweet taste preference and cause metabolic dysregulations 4.