Artificial Sweeteners, Pregnancy, and Maternal Glucose Metabolism: A Review

Abstract

Non-nutritive sweeteners are increasingly consumed during pregnancy through diet beverages,
tabletop sweeteners, sugar-free foods, dairy products, desserts, chewing gum, and ultra-processed
low-calorie products. Their use is clinically important because pregnancy is a naturally insulin-
resistant state in which maternal glucose homeostasis, lipid metabolism, inflammatory tone, gut
microbial ecology, and placental nutrient signaling change progressively across gestation. This
review synthesizes evidence on the relationship between artificial sweetener exposure and maternal
glucose tolerance, insulin sensitivity, gestational diabetes mellitus, and offspring metabolic outcomes.
The available literature indicates that approved non-nutritive sweeteners generally do not acutely
raise blood glucose when consumed alone and within acceptable daily intake limits. However,
pregnancy-specific observational studies have reported associations between frequent or high intake
of artificially sweetened products and gestational diabetes risk, insulin resistance markers,
dyslipidemia, infant adiposity, and microbiome-related outcomes. Mechanistic evidence supports
plausible pathways involving intestinal sweet taste receptors, incretin signaling, glucose transport
regulation, gut microbiome shifts, inflammation, placental transfer, lactational exposure, and
developmental metabolic programming. At present, the evidence does not prove that approved
sweeteners directly cause gestational diabetes or adverse fetal metabolic outcomes, because residual
confounding, reverse causality, exposure misclassification, and limited biomarker-based pregnancy
trials remain major barriers. The most balanced interpretation is that occasional intake within
regulatory limits is unlikely to acutely impair maternal glycemia, whereas habitual high intake during
pregnancy should not be assumed metabolically neutral, especially among women with obesity,
previous gestational diabetes, polycystic ovary syndrome, family history of diabetes, or other insulin-
resistant phenotypes. Future research must move from broad beverage-frequency categories toward
compound-specific, dose-responsive, biomarker-validated, multi-omics, and longitudinal pregnancy
designs. Clinical guidance should emphasize moderation, water and unsweetened beverages as
default choices, whole-food carbohydrate quality, and individualized counseling rather than routine
reliance on either added sugars or artificial sweeteners.