Stevia is a popular, calorie-free sugar alternative derived from the leaves of the Stevia rebaudiana plant, native to South America. The sweetness comes from compounds called steviol glycosides, primarily Rebaudioside A, which are significantly sweeter than table sugar. The commercial products found on grocery shelves are highly refined extracts, not the whole, unprocessed leaf. Since this sweetener is widely consumed, its safety during gestation is a common concern.
Is Stevia Linked to Miscarriage Risk?
Current scientific and medical literature does not support a causal link between the consumption of highly purified steviol glycosides and an increased risk of miscarriage, birth defects, or fetal harm. Regulatory bodies have reviewed extensive data, including reproductive and developmental toxicity studies conducted in animal models. These studies found no evidence that refined Stevia extracts increase toxicity in embryos or negatively affect fertility and pregnancy outcomes.
The reason for this safety profile lies partly in the metabolism of the compounds within the human body. Steviol glycosides are poorly absorbed in the small intestine, passing largely undigested into the colon. There, gut bacteria metabolize the glycosides into a compound called steviol, which is then absorbed and quickly excreted in the urine. This rapid metabolism and excretion limit the systemic exposure, meaning very little, if any, reaches the developing fetus.
Unrefined, whole-leaf stevia and crude extracts are generally advised against during pregnancy. This caution is due to a lack of sufficient toxicological data to establish their safety, as well as historical concerns regarding their potential effects on the reproductive system and blood sugar regulation. Medical guidance deems the highly purified extracts safe for consumption in moderation throughout pregnancy.
Official Safety Status of Stevia Extracts
The highly purified steviol glycosides have been extensively reviewed by international and national food safety authorities. In the United States, the Food and Drug Administration (FDA) has granted high-purity Stevia extracts the status of “Generally Recognized As Safe” (GRAS). This designation is based on a consensus among qualified experts that the substance is safe for its intended use in food. The GRAS status specifically applies to the highly refined extracts, typically those containing at least 95% total steviol glycosides.
Global organizations, such as the Joint FAO/WHO Expert Committee on Food Additives (JECFA), have also confirmed the safety of these purified extracts for the general population, including pregnant individuals. JECFA established an Acceptable Daily Intake (ADI) for steviol glycosides, expressed as 4 milligrams per kilogram of body weight per day, calculated as steviol equivalents.
This safety limit incorporates a significant safety factor, typically 100-fold, to account for potential differences in sensitivity between animal test subjects and humans, as well as variations within the human population. The ADI represents the amount that can be consumed safely every day over a lifetime without posing an appreciable health risk. Conversely, the whole-leaf Stevia and crude extracts remain unapproved for use as a food additive due to insufficient data to confirm their safety under the GRAS standard.
Stevia Compared to Other Pregnancy-Safe Sweeteners
Stevia is one of several non-nutritive sweeteners generally considered safe for moderate consumption during pregnancy, falling into a category that includes sucralose, aspartame, and acesulfame potassium. Sucralose, marketed as Splenda, is approved for use during pregnancy, and animal studies showed no increased risk of birth defects even at high exposure levels. Aspartame, found in Equal and NutraSweet, is considered safe for most pregnant women, though individuals with the rare genetic disorder phenylketonuria (PKU) must strictly avoid it.
Acesulfame potassium, often used in combination with other sweeteners, also holds a safety approval for moderate use during gestation. These sweeteners offer an alternative to sugar without contributing calories, which can be beneficial for managing weight gain or gestational diabetes.
One sweetener often singled out for caution during pregnancy is saccharin. Experts advise limiting or avoiding saccharin because studies indicate it can cross the placenta and may remain in fetal tissues for a prolonged period due to slow clearance.
Sugar Alcohols
Sugar alcohols like xylitol and erythritol are considered safe alternatives. However, they are known to cause gastrointestinal discomfort, such as bloating or diarrhea, in some individuals when consumed in large quantities.