Artificial sweeteners linked with pre-term delivery

Of all the foodstuffs that have limited nutritional value and the potential to cause harm, I put soft drinks near the top of the list. The sugar contained in regular beverages has been linked with a range of adverse effects on health including weight gain, metabolic syndrome, type 2 diabetes and cardiovascular disease. And artificial sweeteners such as aspartame also appear to have considerable potential to harm human health. See here for more about this.

One time when the hazardous effects of foodstuffs has particular relevance is during pregnancy. Foods and drink provides the basic building blocks of the growing foetus, and at the same time can exert toxic affects that can affect the pregnancy and future health of the child. I was interested to read a study published this week which looked at the relationship between soft drink consumption and pregnancy outcome in almost 60,000 Danish women [1]. The pregnancy outcome assessed in this study was ‘pre-term delivery’ – defined as delivery before 37 weeks of gestation (normal gestation is 40 weeks).

For sugar-sweetened beverages, there was no relationship between level of consumption and risk of pre-term delivery (in other words, higher levels of sugary soft drink consumption were not associated with an increased risk of pre-term delivery).

It was a different story for artificially sweetened drinks though:

Compared to those drinking no artificially sweetened drinks, those having 1 or more servings of artificially sweetened drinks a day were found to be at a 38 per cent increased risk of pre-term delivery. Consumption of 4 or more servings a day was associated with an increased risk of 78 per cent.

So-called ‘epidemiological’ studies of this nature cannot be used to conclude that artificially sweetened drinks cause pre-term delivery. However, as the authors of the study point out, length of gestation may be affected by exposure to methanol [2,3]. Methanol is a known nerve toxin, which can be metabolised in the body to form formic acid (another never toxin), as well as formaldehyde (which is what is used to preserve dead bodies). It’s also a constituent of aspartame (the most ubiquitous artificial sweetener).

It’s unlikely that we’ll ever know if artificial sweeteners worsen pregnancy outcomes. However, given their ability for a myriad of toxic effects within the body, my advice would be to avoid them like the plague (pregnant or not).


1. Halldorsson TI, et al. Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study of 59,334 Danish pregnant women. Am J Clin Nutr 30 June 2010 [epub ahead of print]

2. Burbacher TM, et al. Chronic maternal methanol inhalation in nonhuman primates (Macaca fascicularis): reproductive performance and birth outcome. Neurotoxicol Teratol 2004;26:639-50

3. Trocho C, et al. Formaldehyde derived from dietary aspartame binds to tissue components in vivo. Life Sci 1998;63:337-49

17 Responses to Artificial sweeteners linked with pre-term delivery

  1. Nancy LC 2 July 2010 at 8:50 pm #

    Why are all non-caloric sweeteners always lumped into one category and treated as if they’re all bad? They’re are many and some are pretty natural, like Stevia and erythritol, Lo Han extract and others.

    You’d be better off saying “Aspartame linked with pre-term delivery”. This says nothing about the dozens of other, non-aspartame, sweeteners out there.

  2. Dr. Philip Domenico 2 July 2010 at 8:52 pm #

    Experts tend to lump artificial sweeteners into one category, which I think is illogical. If you want to talk about aspartame, talk about aspartame. But don’t use the artificial sweetener catch-phrase to scare people away from all sugar alternatives. Sugar and HFCS are among the most toxic elements in our food, far outweighing anything that artificial sweeteners do to make people sick. Next time, include the data on sucralose and saccharin when you use the term artificial sweetener, and stop being so misleading.

    Dr. Pill

  3. Aziz 2 July 2010 at 9:09 pm #

    I was just going to post a reply when I saw Nancy saying exactly what I wanted to say.

    Saying artificial sweeteners linked with pre-term delivery is like saying beverages linked to diabetes. In beverages you find water, tea, soft drinks, fruit juices, milk, etc. The same way, in artificial sweeteners studies need to start differentiating between different ones and the three that Nancy mentioned are exactly the ones I would not consider harmful (I consider all the other ones harmful one way or another)

  4. Dr John Briffa 2 July 2010 at 11:07 pm #

    Dr Pill

    What evidence do you have the “Splenda, Sweet-N-Low or even Stevia” are safe in pregnancy and do not cause pre-term delivery? Studies please (not value judgments).

  5. Dr John Briffa 2 July 2010 at 11:23 pm #

    Nancy and Dr Pill

    The study did not look at aspartame, but artificially sweetened soft drinks which includes ones containing aspartame. I mentioned aspartame specifically because the authors mention is specifically, and because it’s the most ubiquitous sweetener.

    Dr Pill – the title of this blog and the blog itself refers to artificial sweeteners because, well, that’s what the study was about (not aspartame). I don’t believe there’s anything misleading about this. Can you clarify?

  6. Dr. Philip Domenico 2 July 2010 at 11:39 pm #

    First of all, I appreciate what you do, and read your blog regularly. So, we’re basically on the same side. However, I think you should consider how your readers might respond to these missives. When people see me putting Splenda or Sweet-N-low or even Stevia in my tea, they believe I’m eating neurotoxins, and question my expertise in nutrition. I have to clarify that only aspartame (Nutrasweet) has been linked to neurotoxicity. Nowhere in your report did you make that distinction, or emphasize that point. You used “artificial sweeteners” as a catch-all phrase. Like Nancy LC says, you should stop doing that because it is totally misleading.

  7. Chris 3 July 2010 at 2:11 am #

    In readiness for my boy moving up to secondary school we went to visit one of the prospective schools. It was a formal open evening with examples of pupils work to view etc.
    Along with other ‘mini experiments’ set up in a lab was a tub of water in which were placed two cans of popular brand of cola. One was regular, and one was ‘diet’. One can floated and one sank. The exercise was set up to demonstrate how much sugar is in the regular can of cola.
    I do hope that no inference was ever put before a class of pupils that one can constituted a preferable choice over the other. I had the impression that the exercise intended to convey that ‘diet’ should be preferred to regular. Of course, neither is desirable. I doubt that point was made clear. God help us.

  8. Chris 3 July 2010 at 3:13 pm #

    Dr Pill,

    We live in a complex world (now largely of our own making) and when we try to make sense of self created challenges humanity finds the tools available are not always up to the job. Parties can pursue much the same interests and for much the same motives yet find a lot to disagree about within the detail and the approach.

    Consider the archeo-anthropological effort to define the branch of evolution that has led to homo sapiens. People pursue a common cause but yet are divided as ‘lumpers’ and ‘splitters’.

    Fats and oils, and an evolving dietary dietary profile of the composition of fats and oils in the diet, are almost certainly crucial in evolution somewhere along the line from Australopithecus to modern human. Almost certainly such changes assisted the evolutionary growth in the brain and very likely have a role in fine tuning physiology and energy metabolism.
    More modern changes to the composition of fats in the human diet are almost certainly attributable to the extent that industrially denatured and processed fats and oils have become a robust component in the food provision chain and if these denatured oils, including but not limited to (industrially produced) trans fats, are not a significant aggregating factor contributing to the proliferation of western ailments then I’m wasting my efforts. Fats are numerous and not a little complicated so it is common to apply the principles of ‘lumping’. (Monounsaturated, Polyunsaturated, Saturated) There are times when ‘lumping’ can be helpful, and occasions when it can be a hindrance. Take polyunsaturates for eg. It is not unusual to see a product declare “High in polyunsaturates”. Is a consumer to accept this is a healthy benefit? The psychology determines that the majority will, yet, “this .. claim lumps together different types of fatty acids that need to be separated, some that are heart-toxic with others that are heart-healthy.” [1]

    As it is within this blog and thread is an exchange of views on artificial sweeteners stemming from opinion regarding whether it is appropriate to ‘lump’ or ‘split’. Just as knowledge can be advanced from ‘splitting’ so can insight be advanced from ‘lumping’.

    I think Dr Briffa is entirely justified to report on this study from a stance of ‘lumping’ because, for one, that’s what the study did. And he is entirely justified to mention an artificial sweetener by name, aspartame, for the reasons stated. Moreover he has invited contributions that would advance matters from a ‘splitters’ approach.

    Artificial sweeteners are brought to market not necessarily because they are health alternative to sucrose (table sugar) but because they are economically expedient for manufacturers. Artificial sweeteners have in common that they are a ‘novel’ introduction to the human diet, there is no precedent of co-evolution with these compounds and that is reason enough to be suspicious about potential deleterious effects. Likewise there is no precedent of co evolution with ‘denatured’ carbohydrates such as refined sugar and that, compounded with what is known about the health implications of diets of high GL, is reason enough for a rational person to want to cut back on refined sugar.

    If I became aware my GP smoked I would question his/her judgment and would likely elect to register with another. For all that I respect your training and qualifications I have to remark that I think those of your patients you refer to are really quite perceptive, even if they are ‘lumpers’.

    If you are really so wise about nutrition as you may profess the most rational thing you could do would be to address your sweet tooth by incrementally re-educating your palette.

    “Two lumps or one, .. none, maybe?”

    A truly masterful piece of writing appeared in the Guardian of 01/07/2010 [link][2].
    Debunking ill health at a population level is not purely about appropriate nutritional wisdom. The misappropriation (or inept use) of knowledge and the profit agenda play a significant part.

    1, Scientific Flaws in the EC Draft Regulation in Nutrition Claims; 22 international scientists and clinicians petitioning EFSA (European Food Safety Authority) September 2009.


  9. Dr. Philip Domenico 4 July 2010 at 5:35 pm #


    All well and good, but lumping and splitting have little to do with the science. Call out aspartame, but don’t scare people away from alternatives to sugar that may keep them from getting sick. Calling on someone to stop sweeteners all together is a much bigger hurdle, and misses the point, which is to sort out what’s toxic and what’s not. Just because it’s artificial has no bearing on that question, despite the fact that “natural” sounds more appealing. Often it is not. Science, my man, is our only recourse, not a bunch of words to rationalize why people do what they do.

  10. Dr John Briffa 4 July 2010 at 5:53 pm #

    Yes, Dr Pill, do tell us what ‘science’ shows about the safety of artificial sweeteners in pregnancy with regard to pre-term delivery?

  11. Chris 5 July 2010 at 1:46 am #

    ” .. .. don’t scare people away from alternatives to sugar that may keep them from getting sick.”
    Yes, in the period between aspartame coming to market and the subsequent emergence of the research into longer term effects that labeled it as a nuerotoxin one might have used the same argument in defense of aspartame?

    As it is the company is in agreement that aspartame ought not to be so ubiquitous in the food chain – the real scandal is that it is not outlawed from the marketplace by the authorities.
    Of course lumping and splitting have no pertinence to the pure science but has every pertinence to how science is delivered to wider knowledge economy. Science isn’t always pure [1] and by its nature it isn’t always complete. Whereas the list of unintended consequence is almost as long as the list of ‘novel’ products.

    “Dr. Phil Domenico .. .. now works as a consultant for supplement companies and the food industry.” (bold emphasis mine (if the tag works!))

    1, The course and advancement of science is perverted by the corporate agenda, research that holds the promise of commercial expediency and a return upon investment receives funding resources far in excess of research that may highlight or develop low-input solutions, and conflicts of interest seem commonplace in regulatory authorities and think-tanks.

  12. Dr John Briffa 5 July 2010 at 3:24 pm #


    “Dr. Phil Domenico .. .. now works as a consultant for supplement companies and the food industry.”

    Mmmm, perhaps you’ve managed to elucidate why Dr Pill urges us to put our faith in science, but repeatedly fails to provide the science that supports the safety of non-aspartame sweeteners in pregnancy.

  13. Dana 11 July 2010 at 12:47 am #

    The worst I have heard about sucralose is the following:

    1. It contains a chlorine atom

    So does salt. Then again, they’re telling pregnant women to cut back on salt. Sodium deprivation in the fetus be damned, and never mind that the reason given is *to* avoid sodium–chloride or chlorine has nothing to do with it. No one ever cites chlorine as a reason to avoid salt. I’m confused why it matters with sucralose.

    2. It causes the thymus to shrink

    Your thymus is supposed to shrink. Sex hormones and aging shrink it, whether you consume sucralose or not. I suggest joining the Hemlock Society if you’re that worried about your thymus.

    Less often I hear this one:

    3. It messes about with gut flora

    Apparently not enough evidence exists for people to get very excited about this one. Besides, it could likely be alleviated or altogether prevented with enough fermented foods in the diet.

    Look, I know the risks of sugar intake. But nobody can come out with a solid risk for sucralose. Canada’s outlook on health is more similar to that of Europe than it is to ours, and sucralose was legal in that country for years before it was approved here. I realize they might just have stacked Canada’s equivalent of the FDA with industry insiders, as we do with our FDA here, but then again, maybe they didn’t.

    Stevia’s nasty most of the time, I can’t really taste erythritol, I don’t trust saccharin, and occasionally I do like something sweet, though I’d like to note that before I took up low-carbing I was more a starches girl than a sweets girl, and even less of a sweets girl now. I like it in my coffee, that’s about it. Water’ll do me for the rest of the day.

    So I think I’ll keep using sucralose. Given my body’s reaction to actual sugar, there are worse things to consume.

    Hope you don’t take prescription meds. Those are about as fake as it gets.

  14. Dana 11 July 2010 at 12:49 am #

    By the way, even if the research study you cite isn’t bad science in itself, the researchers may be accused of bad writing. They need to be very clear and specific which artificial sweeteners they used and in which quantities and this needs to be part of the information they release to the media. I cannot make informed decisions based on half-baked essays.

  15. Dana 11 July 2010 at 12:55 am #

    And one more thing because I just thought of it. I’ve been pregnant twice. It drives me apes?!t the way everybody puts you in jail when you are pregnant, as if you are going to miscarry when you sneeze.

    No one ever told me I needed to be eating things like liver and fish and raw milk when I was pregnant, either time. In fact they frequently, in the latter pregnancy especially, expected me to get by on cheap grain foods.

    But they would have fits if, for instance, there was a party at work and I wanted to try one chocolate liqueur candy that was maybe an inch in diameter because, God forbid, I might get less than an ounce of alcohol in my system.

    I avoided alcohol all right. And artificial sweeteners.

    And both my kids were born with permanent physical problems.

    Quit getting hysterical over everything a reproducing woman does. Start giving her information that is actually useful–and then TREAT HER LIKE AN ADULT and let her make her own decisions.

  16. Nicole 21 September 2010 at 1:01 am #

    Methanol is found in much higher quantities in tomato juice and also found in orange juice too aroudn the same as articifical sweeteners. How is methanol from aspartame different to that in these out of interest? Would appreciate your comments, something that always interests me.

  17. John Briffa 21 September 2010 at 11:14 am #


    Aspartame contains a methyl group which is cleaved off during digestion and converts to methanol (a known neurological toxin) which can be metabolised to other things including formaldehyde (embalming fluid). Fruits and vegetables do indeed contain methanol, but the difference is in this case it’s bound to pectin, and we do not have the capacity to split the methanol from the pectin. Still bound to pectin, the methanol is essentially harmless.

Leave a Reply