What types of lozenges should be avoided by pregnant women, particularly those with pre-existing medical conditions such as gestational diabetes or hypertension?

Lozenges to Avoid During Pregnancy

Pregnant women should avoid lozenges containing artificial sweeteners (particularly saccharin), herbal ingredients, high doses of menthol, and any medications contraindicated in pregnancy such as NSAIDs or aspirin-containing formulations.

Artificial Sweetener-Containing Lozenges

Saccharin

• Saccharin-containing lozenges should be avoided by pregnant women and young children due to safety concerns 1
• High consumption of artificial sweeteners including saccharin is associated with increased risk of gestational diabetes mellitus (GDM), with an odds ratio of 2.66 (95% CI: 1.48-1.78) 2
• Daily intake of artificially sweetened products may increase the risk of preterm delivery, with women consuming ≥1 serving daily having an adjusted odds ratio of 1.38 (95% CI: 1.15,1.65) for preterm delivery 3

Aspartame

• Aspartame should be avoided by phenylketonuric individuals, which is particularly important during pregnancy 1
• High aspartame consumption is linked to increased GDM risk, similar to other artificial sweeteners 2

General Artificial Sweetener Concerns

• The GDM incidence was significantly higher (56.90%) in the high artificial sweetener consumption group compared to low consumption (43.10%) 2
• Women consuming ≥4 servings of artificially sweetened carbonated beverages daily had an odds ratio of 1.78 (95% CI: 1.19,2.66) for preterm delivery 3

Special Considerations for Women with Pre-existing Conditions

Gestational Diabetes

• Women with gestational diabetes have increased risk of pregnancy-associated hypertension compared to non-diabetic women 4
• Insulin resistance may be the common link between GDM and hypertensive disorders, making artificial sweetener avoidance even more critical in this population 4, 5
• Strict glycemic control is essential, with target fasting glucose <95 mg/dL and 1-hour postprandial <140 mg/dL 6

Hypertension

• Women with pre-existing hypertension may be predisposed to developing gestational diabetes due to shared insulin resistance mechanisms 4, 5
• Blood pressure target during pregnancy should be 110-135/85 mmHg 7, 8

Medication-Containing Lozenges to Avoid

Contraindicated Medications

• Any lozenges containing ACE inhibitors, angiotensin receptor blockers, or statins must be avoided, as these are potentially harmful and contraindicated in pregnancy 6, 9
• These medications can cause fetal renal dysplasia, oligohydramnios, pulmonary hypoplasia, and intrauterine growth restriction 6

NSAIDs and Aspirin

• Lozenges containing NSAIDs or high-dose aspirin should be avoided (low-dose aspirin 100-150 mg/day is recommended for preeclampsia prevention starting at 12-16 weeks, but not in lozenge form) 6, 9

Common Pitfalls to Avoid

• Do not assume "sugar-free" lozenges are safe - they often contain artificial sweeteners that may increase GDM and preterm delivery risk 2, 3
• Check all over-the-counter throat lozenges for artificial sweetener content, particularly saccharin and aspartame 1
• Be aware that the association between artificial sweeteners and adverse outcomes is observed in both normal-weight and overweight women 3
• The risk increases with higher consumption, with stronger associations for early and moderately preterm delivery than late-preterm delivery 3

Safe Alternatives

• Natural sugar-containing lozenges may be preferable to artificially sweetened versions, though should be used in moderation, particularly in women with or at risk for gestational diabetes 1
• For women with diabetes, insulin remains the preferred treatment rather than relying on artificial sweeteners for glycemic control 6, 8