How Much Sugar Is Too Much During Pregnancy?

When asked about sugars during pregnancy, most pregnant women are curious about how many added sugars they can have in their diet. Sugars come from the carbohydrate group, and they come from added sugars in processed foods. We want carbohydrates to make up 45%- 65% of our total daily calories.

 When we talk about sugar limits in pregnancy, we are referring to how many added sugars we can have daily without risking complications for ourselves or our unborn babies. When you feel hungry during pregnancy, you may often reach for a sugary snack or treat to satisfy a craving. Knowing how much-added sugar is in that snack and your daily sugar limits is essential.
According to the World Health Organization^[1] and the American Heart Association^[2], added sugars should be limited to 6%-10% of total calories.

Can You Eat Sugar While Pregnant?

You can have a small amount of added sugar while pregnant. Sugar comes in many forms, but on the label, it usually just reads total sugars. Many added sugars are similar to sugar in regular food, such as fructose, fruit sugar, or lactose in dairy.

Sugars can be healthy when eaten naturally and according to the recommended number of servings for your calorie level. Sugars can be very unhealthy when consumed excessively^[3], such as high-fructose corn syrup, which is added sugar in processed foods. Added sugars include table sugar, syrups, and honey.

Types Of Sugars

 Sugar is found by many names in the list of ingredients and may contain any of the following terms:

• High-fructose corn syrup.
• Corn syrup.
• Fructose.
• Sucrose (anything with an “ose” on the end is a sugar).
• Dextrin.
• Maltodextrin.
• Molasses.
• Honey.
• Dextrose.
• Agave nectar.
• Barley malt.
• Syrups.
• Caramel.
• Concentrated fruit or vegetable juices.

What Happens When Sugar Is Eaten

When you eat sugar or carbohydrates, your pancreas secretes insulin to help carry the glucose to the cells. If the carbohydrate is complex, fiber may be present to slow digestion and release glucose to the cells gradually. If it is a simple carbohydrate, such as juice, with no fiber, the glucose will be released more quickly into the bloodstream, causing a more rapid rise in blood sugar.

What Foods And Drinks Contain The Most Sugar?

Some foods are higher in added sugars than others. Foods to watch out for are:

• Baked goods like cakes, cookies, pies.
• Candy.
• Ice cream.
• Granola bars.
• Cereals.
• Ketchup.
• Sauces.
• Breads.
• Flavored and regular peanut butter.
• Crackers.
• Frozen pizza.

What Happens When Too Much Sugar Is Eaten?

Eating more sugar than your body can use for immediate energy is stored as fat. Fructose is stored as abdominal fat. Too much fructose is associated with^[4] metabolic syndrome, obesity, insulin resistance, impaired cognitive function^[5], altered gut microbiota, and infertility.
Too much sucrose is also associated^[6] with obesity, fatty liver, hyperuricemia, cardiovascular disease, type 2 diabetes, gestational diabetes, metabolic abnormalities, poor maternal/fetal outcomes^[7], and dental caries.

How Much Sugar Is Too Much During Pregnancy?

There are differing opinions on how much sugar is too much. The American Heart Association says that 6% of your calories can come from added sugars, while the World Health Organization cites 10% as excessive. Since sugar has 4 kcal/gram, the number of allowable grams would be calculated from your total calories for your gestational term.

So, for example, if you required 1,500 kcal per day to maintain your weight in the first trimester, you would take .06 x 1,500 = 90 sugar kcal divided by 4 kcal/gram = 22.5 grams if you follow the American Heart Association guidelines.

How Does Sugar Affect My Pregnancy?

Vulnerable population groups associated with excess sugar consumption^[8] have been identified as farmworkers, those living in poverty, the obese and overweight, migrants, ethnically diverse groups, those with disabilities, and those affected by drug addiction.

A high sugar intake may impact gestational weight gain^[9]. It only takes an excess of 250 calories per day to gain an extra half pound per week. A little bit adds up slowly over time, potentially causing a large-for-gestational-age infant or even a low-birth-weight infant^[10].

Excess sugar intake has also been associated with the development of gestational diabetes, hypertension, preeclampsia, and preterm delivery. Preeclampsia^[11] is high blood pressure with characteristics of kidney or liver damage occurring after the 20th week of pregnancy.

The mood is not improved by a high sugar intake, either. Depression in pregnancy affects about^[12] one out of every ten women. It is of great concern, then, that a high intake of sugar is associated^[3] with increased anxiety, memory impairment, and depression.
A high maternal sugar intake^[14] may increase the infant’s preference for sweet foods. Changes caused by sugar consumed preconceptionally by either the mother or father may affect the infant’s health through epigenetic programming^[15], which represents an alteration in the DNA of the germ cell line before conception occurs.

What is Gestational Diabetes?

The percentage of women diagnosed with gestational diabetes mellitus or GDM  increased^[16] from 6% in 2016 to 8.3% in 2021. The diagnosis of GDM is made when any degree of glucose intolerance^[17] is discovered in a pregnant woman and is the most common complication in pregnancy. The diagnosis of diabetes is associated with greater maternal and fetal risks, chronic complications, and comorbidities.

How Is GDM Diagnosed?

Testing for this type of diabetes^[18] generally happens between your 24th and 28th week of pregnancy. If you have a high risk for developing GDM, the doctor may order the test when you find out you are pregnant. The test ordered may be the glucose challenge test or the oral glucose tolerance test, or OGTT while fasting.

The glucose challenge or screening test involves drinking a sweet liquid and taking your blood one hour later. Fasting is not required for this test. If the blood sugar result is 140 mg/dl, an Oral Glucose Tolerance Test or OGTT may be ordered for further diagnostic confirmation. If your test shows a blood sugar of 200 mg/dl or more, you may have type 2 diabetes.

An 8-hour fast is required before the OGTT can be done. After the fast, you drink another sugar-containing beverage, and your blood sugar is measured every hour for two to three hours. If you exhibit a high blood sugar level two or more times when checked fasting, whether for one hour, two hours, or three hours, then you are considered to have gestational diabetes. 

How Is GDM Treated?

The first step in treatment is an individualized assessment by a Registered Dietitian for medical nutrition therapy. The doctor will prescribe individual insulin therapy as needed.

Both fasting and postprandial blood glucose^[19] monitoring are recommended. Glycemic targets are achieved through insulin therapy and medical nutrition guidance. Fasting glucose should remain less than 95 mg/dl, one-hour glucose should be less than 140 mg/dl, and two-hour levels should be less than 120 mg/dl.

The medical nutrition approach is a balanced diet adequate but not excessive in calories with a minimum of 175 grams of carbohydrates (35% of a 2000 kcal diet), 71 grams of protein, and 28 grams of fiber. Mono and polyunsaturated fats should be emphasized over saturated fats. Simple carbohydrates will yield higher blood sugar values.

Foods with added sugars should be limited or avoided due to their impact on blood sugar levels. These foods have their place in treating low blood sugar reactions caused by insulin therapy or poor meal timing. Carbohydrate intake should be consistent with the type of insulin prescribed and eaten regularly, according to a meal plan tailored by a Registered Dietitian.

All women with GDM should receive nutritional counseling on carbohydrate counting, be instructed in blood glucose measurement, and increase their physical activity to 150 minutes weekly^[20]. In addition, they need to be instructed on their risk^[21] for type 2 diabetes and cardiovascular disease at follow-up when they get their postnatal glucose test.

What Are The Complications Associated With GDM?

Women who have been diagnosed with GDM have an increased risk^[22] of developing type 2 diabetes postnatally, increased fetal/maternal morbidity, and long-term complications in mothers and their offspring. Mothers had an increased risk^[23] for C-section and preterm delivery; infants had low Apgar scores at birth, had a higher rate of respiratory infections, and were admitted to the neonatal ICU at a higher rate.

In addition, infants born to mothers with GDM are at risk of low blood sugar at birth and macrosomia (large for age).

Conclusion

Sugar comes in many forms and is ubiquitous in processed foods, such as high-fructose corn syrup. While sugar can be consumed in moderation during pregnancy, the exact limits are not universally agreed upon and may differ for those with gestational diabetes. Gestational diabetes is a form of carbohydrate intolerance, where added sugars only make managing blood sugar tougher.

GDM is associated with macrosomia, C-sections, preterm delivery, and infant health problems. It is more difficult to control blood sugar when you have GDM and consume added sugars. Follow your individualized meal plan and count your carbohydrates as instructed by your dietitian. 

Too much sugar in pregnancy can lead to maternal/fetal complications and adverse outcomes that may not stop at birth. Excess sugar intake can affect your infant’s preference for sweets and risk for obesity as growth occurs. Excessive sugar intake can also cause dental caries, excess gestational weight gain, preterm birth, depression and anxiety, metabolic syndrome, hypertension, preeclampsia, and gestational diabetes. 

So, limit sugar intake to 6%- 10% of calories while pregnant, and stay within your carbohydrate allowance if you have gestational diabetes. Be sure to include adequate fiber-rich carbohydrates, healthy fats, and protein in your balanced diet for the best pregnancy journey.