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Recommendations Summary

GDM: Use of Non-Nutritive Sweeteners 2006

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    GDM: Use of Non-Nutritive Sweeteners

    If pregnant women, including those with gestational diabetes mellitus (GDM), choose to consume products containing non-nutritive sweeteners,  the Registered Dietitian (RD) should inform them that only FDA-approved non-nutritive sweeteners should be consumed and that moderation is encouraged.  Research in this area is extremely limited.

    Rating: Consensus

    • Risks/Harms of Implementing This Recommendation

      Nonnutritive sweeteners are generally safe when consumed during pregnancy within the acceptable daily intake (ADI) levels established by the Food and Drug Administration (FDA), with the exception of saccharin due to slowed fetal clearance and aspartame in women with phenylketonuria.

    • Conditions of Application

      This recommendation applies to pregnant women with gestational diabetes mellitus (GDM) who choose to consume non-nutritive sweeteners.

    • Potential Costs Associated with Application


    • Recommendation Narrative

      • While there are recognizable benefits of the use of nonnutritive sweeteners with the maintenance of blood glucose control, to date there is limited evidence to support the use or nonuse of nonnutritive sweetners (NNS) in pregnancy, and even less evidence addressing this issue specifically in gestational diabetes mellitus (GDM).  

      • The FDA has approved aspartame, acesulfame potassium,  sucralose, saccharin and neotame for general use, while stevia has not been approved. 

      • The use of FDA-approved nonnutritive sweeteners during pregnancy is acceptable with the exception of aspartame for pregnant women with hyperphenylalanine in the blood and phenylketonuria (Levy et al, 1983). 

      • The American Medical Association suggests avoiding saccharin during pregnancy due to possible slow fetal clearance (Council on Scientific Affairs of the American Medical Association, 1985).  

      • American Diabetes Association Recommendation:  Sugar alcohols and nonnutritive sweeteners are safe when consumed within the acceptable daily intake (ADI)  levels established by the Food and Drug Administration (Grade A).

    • Recommendation Strength Rationale

      • Conclusion Statement was given Grade IV

    • Minority Opinions

      Consensus reached.