Other Sweeteners (Sucralose, Stevia, Saccharin)

Pregnancy

Pregnancy research mostly measures artificially or low-calorie sweetened beverages, not a dose of one ingredient. In the Canadian CHILD cohort, Azad et al. (2016) included 3,033 mother-infant pairs and had one-year outcome data for 2,686. Daily artificially sweetened beverage intake was associated with a 0.20-unit higher infant BMI z-score and higher odds of overweight at age one (adjusted OR 2.19). Zhu et al. (2017) studied 918 Danish mother-child pairs; daily beverage intake was associated with large-for-gestational-age birth and overweight or obesity at age seven. A larger Danish National Birth Cohort follow-up published in 2025 used pregnancy beverage reports from 72,821 women and found higher odds of overweight at ages 7, 11, 14 and 18 among offspring of women reporting at least one artificially sweetened beverage daily; the adjusted OR at age 18 was 1.26. These are observational beverage studies and cannot show that a specific sweetener caused an outcome. A 2024 review of 19 studies with 203,706 participants reported an association between pregnancy low-calorie sweetener intake and preterm birth (RR 1.11, 95% CI 1.07 to 1.16). Its gestational-diabetes estimate was imprecise (RR 1.42, 95% CI 0.98 to 2.04). The 2026 umbrella review reported a prenatal artificial-sweetener association with preterm delivery (eOR 1.18, 95% CI 1.03 to 1.36) and shorter gestational age, but classified those observational associations as weak evidence. Primary preterm cohorts also conflict: Halldorsson (2010) and Englund-Ögge (2012) reported associations, while Petherick (2014) found no relationship between daily artificially sweetened cola intake and preterm birth. A 2024 child-health review included 17 studies and found no association between any low-calorie sweetener intake and birth weight or child BMI z-scores; estimates for frequent intake were imprecise. WHO also describes the evidence on birth weight and later offspring weight as inconsistent and very low certainty. WHO's 2023 conditional recommendation concerns using non-sugar sweeteners for weight control or noncommunicable-disease prevention, not the effects of each sweetener under authorized food-use conditions. FDA and EFSA food-use limits address permitted ingredients and exposure, not whether every pregnancy outcome has been studied. Leth-Møller et al. (2023) gave a single sweetened drink before planned cesarean birth to 19 pregnant participants and compared them with nine controls. The study measured acesulfame, cyclamate, saccharin and sucralose in maternal and fetal blood and amniotic fluid. It documented placental transfer, not fetal development or birth outcomes.

Breastfeeding

A 2015 study of 20 lactating volunteers detected saccharin, sucralose and acesulfame-potassium in 65% of participants' milk samples; it did not measure infant health outcomes. In a 2018 study, 34 exclusively breastfeeding women drank one diet soda containing sucralose and acesulfame-potassium, and both sweeteners appeared in milk; infant health outcomes were not collected. Huang et al. (2021) analyzed 682 mother-infant pairs at three months postpartum. Estimated exposure from maternal diet beverages was associated with a 2.78-fold higher risk of reported vomiting (95% CI 1.05 to 7.34), but not with infant BMI-for-age or overweight. The study was cross-sectional and did not identify which sweetener was consumed. LactMed notes that it was not possible to assess effects of specific sweeteners and that their effects on nursing infants are unknown. These findings establish milk exposure and a possible nonspecific symptom association, not a causal ingredient-specific infant effect.

What was tested

The pregnancy cohorts assessed self-reported artificially sweetened beverages and later outcomes; they did not isolate sucralose, stevia or saccharin dose. The placental-transfer study measured concentrations after a single exposure near delivery and did not study clinical outcomes. Lactation studies measured milk concentrations after intake, while the 2021 survey estimated infant exposure from diet-beverage use and breastfeeding intensity. EFSA's 2026 review assessed currently authorized sucralose food uses separately from a proposed extension to fine bakery wares. Its high-temperature concern concerns possible compound formation after prolonged heating and is separate from routine food use.