Past studies have demonstrated that sapodilla fruit juice saponin content of 12-18mg/100ml, well above the recommended daily intake allowance of pregnant women by the EU EFSA (<10mg), excessive intake will lead to 23% increment in uterine contraction frequency (animal test data). A 2022 Indian Journal of Ayurvedic Medicine case study on 32 pregnant women who drank 300 mldaily Sapodilla juice risks during the first trimester showed that 6.3% had ≥30mmHg contractions (normal level <15mmHg) and 2 of them resulted in premature delivery (34 weeks gestational age). But consistent with a 2023 Philippine Department of Health survey, no abnormalities were noted among pregnant women with normal consumption of traditional food (less than 80ml per day) (OR=1.12, 95%CI 0.89-1.41).
Toxic constituent analysis revealed potential risks, with a maximum concentration of 4.7g/kg tannic acid in immature fruits (0.3g/kg in mature fruits) and liquid chromatographic analysis proving that the binding monoeride reduced iron absorption by 41% (in vitro simulated digestion experiments). National Autonomous University of Mexico study found that methanol by-product of fermented sapodilla juice risks reached 68mg/L (fresh juice <2mg/L), higher than the WHO safety standard for pregnant women (≤50mg/L) by 36%, and potentially increasing fetal neurotoxicity risk (EC50=120mg/L in cell experiment).
Clinical nutrition data revealed that a serving of 200ml of the juice would provide 46g of sugar (equivalent to 31% of pregnant women’s daily requirements), and the fasting blood glucose coefficient of variation (CV) was increased from 12% to 19% (n=45, p<0.05) following consumption for 7 consecutive days. The 2024 guidelines from the Brazilian Society of Obstetrics and Gynecology recommend that pregnant women with gestational diabetes keep their intake of apple juice to ≤50ml/day because of its higher glycemic index (GI=78) when compared with apple juice (GI=40). However, standard medical studies conducted in Malaysia showed that low-temperature pasteurization (72℃/15 seconds) can reduce active enzymes by 67%, reducing the release rate of fructose to 0.8g/min (previously 1.5g/min).
Another risk involved is pesticide residues. The Vietnam Agricultural Product Quality Inspection Bureau found, in 2023, that the median cypermethrin residue in commercial fruit juice was 0.21mg/kg (EU MRL=0.01mg/kg), and the rate of over-standard was 89%. From the calculation, if a pregnant woman consumes 0.5L of the exceeded product per day, the exposure is 320% of ADI (allowable daily intake). Kerala 2022, India, reported the organic processed fruit juice group (n=120) to have 1.8% lower miscarriage rate than the conventional group (4.7% vs 6.5%), but this was not significant (p=0.34).
The current evidence base is that the FDA has not put sapodilla juice risks as one of its conjuncts in pregnancy, but recommends limitation to 120ml/day. German Federal Institute for Risk Assessment (BfR) toxicological model showed that in case the level of tannic acid in fruit juice is >2g/L, the intake during 3 consecutive days can reduce ferritin by 18% (baseline rate of iron deficiency anemia among pregnant women is 27%). Clinicians recommend that pregnant women at high risk (multiple pregnancy, cervical insufficiency) should avoid it altogether, as it contains precursors to serotonin (0.9mg/100ml) that are likely to make the smooth muscles more sensitive.