Can pregnant individuals consume sugar?

Can Pregnant People Have Sugar?

Yes, pregnant people can and should consume carbohydrates (including sugar), but the amount, quality, and timing require careful attention to maintain optimal glucose control and support both maternal and fetal health. 1

Carbohydrate Requirements During Pregnancy

Pregnant women need at least 175 g/day of carbohydrates to meet the glucose demands of the maternal brain, fetal brain, and placental metabolism. 2 Recent evidence suggests this may need to be revised upward to 220 g/day when accounting for placental glucose consumption (36 g/day), which was not included in original recommendations. 2

• The placenta requires glucose as its dominant energy substrate and is as dependent on maternal glucose as the brain itself. 2
• Carbohydrate intake below these thresholds may compromise fetal and placental metabolic needs. 2

Quality Over Quantity: What Type of Carbohydrates Matter

Nutrition counseling should promote an eating pattern including fruits, vegetables, legumes, whole grains, nuts, seeds, fish, and other lean protein, which provides a balance of macronutrients. 1

• The quality of carbohydrates consumed is critical—pregnant women should focus on high-fiber, nutrient-dense sources rather than simple sugars. 1
• Studies show that pregnant women's diets are often characterized by high-fat, low-fiber, and poor-quality carbohydrate intakes, which should be improved. 1
• Added sugar intake among pregnant women in the United States averages 85.1 g/day (approximately 15% of total energy), which exceeds the recommended limit of <10% of total energy. 3

For Women With Diabetes or Gestational Diabetes

Pregnant women with preexisting diabetes or gestational diabetes must carefully monitor and distribute carbohydrate intake throughout the day to match insulin dosing and avoid hyperglycemia or hypoglycemia. 1

Specific Glucose Targets:

• Fasting glucose: 70-95 mg/dL (3.9-5.3 mmol/L) 1
• 1-hour postprandial: 110-140 mg/dL (6.1-7.8 mmol/L) for type 1/type 2 diabetes; <140 mg/dL for GDM 1
• 2-hour postprandial: 100-120 mg/dL (5.6-6.7 mmol/L) for type 1/type 2 diabetes; <120 mg/dL for GDM 1

Carbohydrate Distribution Strategy:

• Distribute carbohydrate intake across 3 meals and 2-3 snacks throughout the day to maintain stable glucose levels. 1
• A carbohydrate-containing evening snack is encouraged to suppress hepatic gluconeogenesis and achieve lower fasting blood glucose levels. 1
• Pregnant women with diabetes should eat consistent amounts of carbohydrates to match insulin dosage. 1

Timing Considerations: An Emerging Gap in Guidelines

Glucose tolerance varies throughout the day in pregnant women, with reduced tolerance in the afternoon compared to morning, regardless of diabetes status. 1

• Current guidelines for carbohydrate distribution fail to consider circadian regulation of glucose homeostasis. 1
• In non-pregnant populations, late-night eating is associated with higher postprandial glucose and metabolic disturbances, but data specific to pregnancy remain limited. 1
• Extending the overnight fasting period may reduce eating episodes and improve glucose metabolism, though more research is needed. 1

Sugar Substitutes: A Cautious Option

Sugar substitutes can be consumed during pregnancy in moderate amounts, adhering to acceptable daily intake standards, though their long-term effects on fetal development remain uncertain. 4

• Approximately 24% of pregnant women in the United States consume low-calorie sweeteners, with prevalence increasing by 50% from 1999-2014. 5
• Available data do not suggest adverse effects in pregnancy, but research on effects of early-life exposure on taste preferences, weight trajectory, and metabolic disease risk is needed. 5, 4

Critical Pitfalls to Avoid

Do not restrict carbohydrates excessively during pregnancy, even in women with diabetes, as this fails to meet fetal and placental metabolic needs and can perpetuate ketosis. 6

• In pregnant women with type 1 diabetes and diabetic ketoacidosis, dextrose must be administered alongside insulin to meet continuous fetal carbohydrate demands. 6
• Losing weight during pregnancy is not recommended due to increased risk of small-for-gestational-age infants. 1

Practical Implementation

Referral to a registered dietitian is essential for pregnant women with diabetes to establish a food plan, determine insulin-to-carbohydrate ratios, and set appropriate weight gain goals. 1

• Self-monitoring of blood glucose (fasting and postprandial) is the primary tool for achieving optimal glycemic control, with A1C serving only as a secondary measure. 1, 7
• Continuous glucose monitoring can improve outcomes in type 1 diabetes pregnancy by improving time in range without increasing hypoglycemia. 7