Potential of Stevia rebaudiana as a Safe Sweetener Alternative for Women with Gestational Diabetes Mellitus

https://doi.org/10.53770/medica.v8i8.1267

Authors

  • Magdalena Martha Tompunuh Poltekkes Kemenkes Gorontalo, Gorontalo, Gorontalo, Indonesia
  • Siti Choirul Dwi Astuti Poltekkes Kemenkes Gorontalo, Gorontalo, Gorontalo, Indonesia
  • Hasnawatty Surya Porouw Poltekkes Kemenkes Gorontalo, Gorontalo, Gorontalo, Indonesia
  • Rabia Zakaria Poltekkes Kemenkes Gorontalo, Gorontalo, Gorontalo, Indonesia
  • Dyah Noviawati Setya Arum Poltekkes Kemenkes Yogyakarta, Yogyakarta, Yogyakarta, Indonesia
  • Munica Rita Hernayanti Poltekkes Kemenkes Yogyakarta, Yogyakarta, Yogyakarta, Indonesia

Keywords

Blood Glucose Diabetes Mellitus Stevia rebaudiana Natural Sweetner Pregnancy

Abstract

Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy and is associated with adverse maternal and fetal outcomes. Dietary modification, particularly reducing the intake of added sugars, is an important component of glycemic management. This study aimed to examine the effect of replacing conventional sugar with Stevia rebaudiana liquid sweetener on fasting blood glucose among pregnant women with GDM. A quasi-experimental pre–posttest control group design was conducted among 120 pregnant women with GDM at Pilolodaa Community Health Center, Gorontalo, Indonesia. Participants were allocated to an intervention group receiving 25 drops of liquid Stevia rebaudiana daily (n = 60) or a control group receiving 25 g of conventional sugar daily (n = 60) for 30 days. The assigned sweetener was used as a replacement for the sweetening component of the participants’ usual diet. Fasting blood glucose was measured in the morning after an overnight fast of at least 8 hours using a calibrated glucometer before and after the intervention. Baseline characteristics were assessed to evaluate comparability between groups. The intervention group showed a reduction in mean fasting blood glucose from 163.5 ± 19.8 mg/dL to 128.7 ± 15.6 mg/dL, whereas the control group decreased from 161.8 ± 20.1 mg/dL to 156.9 ± 18.7 mg/dL. The mean reductions were 34.8 and 4.9 mg/dL, respectively, resulting in a between-group mean difference of 29.9 mg/dL (p < 0.001). Overall, 90.0% of participants in the Stevia rebaudiana group experienced a reduction in fasting blood glucose. These findings indicate that replacing conventional sugar with liquid Stevia rebaudiana was associated with a greater reduction in fasting blood glucose over 30 days among pregnant women with GDM. However, given the quasi-experimental design and the possibility of uncontrolled confounding factors, the observed reduction should not be interpreted as definitive evidence of a specific effect of Stevia rebaudiana. Further studies with randomized designs and longer follow-up are needed to confirm these findings.

Downloads

Download data is not yet available.

References

Agulló, V., García-Viguera, C., & Domínguez-Perles, R. (2022). The use of alternative sweeteners (sucralose and stevia) in healthy soft-drink beverages, enhances the bioavailability of polyphenols relative to the classical caloric sucrose. Food Chemistry, 370, 131051. https://doi.org/10.1016/j.foodchem.2021.131051

Ahmed, K. S., Anwarul Hasan, G. M. M., Satter, M. A., & Sikdar, K. (2023). Making ice cream with natural sweetener stevia: Formulation and characteristics. Applied Food Research, 3(2), 100309. https://doi.org/10.1016/j.afres.2023.100309

Alotaibi, M. O., Alotibi, M. M., Eissa, M. A., & Ghoneim, A. M. (2022). Compost and plant growth-promoting bacteria enhanced steviol glycoside synthesis in stevia (Stevia rebaudiana Bert) plants by improving soil quality and regulating nitrogen uptake. South African Journal of Botany, 151, 306–314. https://doi.org/10.1016/j.sajb.2022.10.010

Chakma, A., Afrin, F., Rasul, M. G., Maeda, H., Yuan, C., & Shah, A. K. M. A. (2023). Effects of extraction techniques on antioxidant and antibacterial activity of stevia (Stevia rebaudiana Bertoni) leaf extracts. Food Chemistry Advances, 3, 100494. https://doi.org/10.1016/j.focha.2023.100494

El-Solimany, E. A., Abdelhamid, A. A., Thabet, M. A., & Gad, M. A. (2024). Effective and eco-friendly botanical insecticidal agents against Spodoptera frugiperda (Noctuidae: Lepidoptera) using the essential oil of Stevia rebaudiana. Journal of Natural Pesticide Research, 10, 100103. https://doi.org/10.1016/j.napere.2024.100103

Eldken, Z. H., Safwat, S. M., Sakr, N. H., El Nashar, E. M., Eissa, H., Gouda, S. I., Hassan, A. H., Alshehri, M. H., Al-Zahrani, N. S., & Abdel Ghaffar, D. M. (2023). The possible effects of the aqueous extract of Stevia Rebaudiana on autophagic clearance and sympathetic nerve density in pancreatic β cells of type 2 diabetic rats. Journal of Functional Foods, 110, 105822. https://doi.org/10.1016/j.jff.2023.105822

Farid, A., Hesham, M., El-Dewak, M., & Amin, A. (2020). The hidden hazardous effects of stevia and sucralose consumption in male and female albino mice in comparison to sucrose. Saudi Pharmaceutical Journal, 28(10), 1290–1300. https://doi.org/10.1016/j.jsps.2020.08.019

Formigoni, M., Milani, P. G., da Silva Avíncola, A., dos Santos, V. J., Benossi, L., Dacome, A. S., Pilau, E. J., & da Costa, S. C. (2018). Pretreatment with ethanol as an alternative to improve steviol glycosides extraction and purification from a new variety of stevia. Food Chemistry, 241, 452–459. https://doi.org/10.1016/j.foodchem.2017.09.022

Forouzi, A., Ghasemnezhad, A., & Nasrabad, R. G. (2020). Phytochemical response of Stevia plant to growth promoting microorganisms under salinity stress. South African Journal of Botany, 134, 109–118. https://doi.org/10.1016/j.sajb.2020.04.001

Gibbons, C., Beaulieu, K., Almiron-Roig, E., Navas-Carretero, S., Martínez, J. A., O’Hara, B., O’Connor, D., Nazare, J. A., Le Bail, A., Rannou, C., Hardman, C., Wilton, M., Kjølbæk, L., Scott, C., Moshoyiannis, H., Raben, A., Harrold, J. A., Halford, J. C. G., & Finlayson, G. (2024). Acute and two-week effects of neotame, stevia rebaudioside M and sucrose-sweetened biscuits on postprandial appetite and endocrine response in adults with overweight/obesity—a randomised crossover trial from the SWEET consortium. EBioMedicine, 102, 105005. https://doi.org/10.1016/j.ebiom.2024.105005

Haider, I., & ur Rehman, H. (2022). The impact of different seed priming agents and priming durations on stand establishment and biochemical attributes of Stevia rebaudiana Bertoni. Saudi Journal of Biological Sciences, 29(4), 2210–2218. https://doi.org/10.1016/j.sjbs.2021.11.040

Hu, Z., Qu, W., Yang, H., Fan, X., Zhan, S., Hou, K., Xu, D., Feng, D., Xu, Z., & Wu, W. (2025). Genome-wide identification, expression analysis of the MYC gene family in Stevia rebaudiana and the functional identification of SrMYC8 in SGs biosynthesis. Industrial Crops and Products, 230, 121002. https://doi.org/10.1016/j.indcrop.2025.121002

Ilias, N., Hamzah, H., Ismail, I. S., Mohidin, T. B. M., Idris, M. F., & Ajat, M. (2021). An insight on the future therapeutic application potential of Stevia rebaudiana Bertoni for atherosclerosis and cardiovascular diseases. Biomedicine and Pharmacotherapy, 143, 112207. https://doi.org/10.1016/j.biopha.2021.112207

Jain, P., Farooq, B., Lamba, S., & Koul, B. (2020). Foliar spray of Moringa oleifera Lam. leaf extracts (MLE) enhances the stevioside, zeatin and mineral contents in Stevia rebaudiana Betoni. South African Journal of Botany, 132, 249–257. https://doi.org/10.1016/j.sajb.2020.03.026

Khatun, M. C. S., Muhit, M. A., Hossain, M. J., Al-Mansur, M. A., & Rahman, S. M. A. (2021). Isolation of phytochemical constituents from Stevia rebaudiana (Bert.) and evaluation of their anticancer, antimicrobial and antioxidant properties via in vitro and in silico approaches. Heliyon, 7(12), e08475. https://doi.org/10.1016/j.heliyon.2021.e08475

Kundu, A., Chakma, A., Dulal, M. A., Rasul, M. G., Mondal, M. N., & Shah, A. K. M. A. (2024). Effects of stevia (Stevia rebaudiana Bertoni) leaf extracts on the quality and shelf life of refrigerated catla (Gibelion catla) fillets. Journal of Agriculture and Food Research, 15, 101058. https://doi.org/10.1016/j.jafr.2024.101058

Kurek, J. M., Mikołajczyk-Stecyna, J., & Krejpcio, Z. (2023). Steviol glycosides from Stevia rebaudiana Bertoni mitigate lipid metabolism abnormalities in diabetes by modulating selected gene expression – An in vivo study. Biomedicine and Pharmacotherapy, 166, 115424. https://doi.org/10.1016/j.biopha.2023.115424

Liu, C., Wang, Y., Yang, X., Xu, Y., Wang, M., Yuan, P., Li, P., Yang, J., Chen, K., Wang, G., & Shao, T. (2024). Benefits of Stevia rebaudian root inulin on mice health in long-term exposure study. Journal of Functional Foods, 112, 105943. https://doi.org/10.1016/j.jff.2023.105943

Malakootian, M., Asadzadeh, S. N., Mehdipoor, M., Kalantar-Neyestanaki, D., & Firouzeh, N. (2024). Stevia rebaudiana leaf extract mediated green synthesis of cerium oxide nanoparticles for antibacterial activity and photocatalytic degradation of tetracycline. Desalination and Water Treatment, 317, 100126. https://doi.org/10.1016/j.dwt.2024.100126

Medeot, D. B., Nilson, A., Miazzo, R. D., Grosso, V., Ferrari, W., Jofré, E., Soltermann, A., & Peralta, M. F. (2023). Stevia as a natural additive on gut health and cecal microbiota in broilers. Veterinary and Animal Science, 22, 100322. https://doi.org/10.1016/j.vas.2023.100322

Moongngarm, A., Sriharboot, N., Loypimai, P., & Moontree, T. (2022). Ohmic heating-assisted water extraction of steviol glycosides and phytochemicals from Stevia rebaudiana leaves. Lwt, 154, 112798. https://doi.org/10.1016/j.lwt.2021.112798

Nabi, I., Bachir, Y. N., Djellouli, S., Smain, M., & Hadj-Ziane-Zafour, A. (2023). In vivo antidiabetic effect and antioxidant potential of Stevia Rebaudiana mixed with Tragacanth gum in orange nectar. Food Hydrocolloids for Health, 4, 100147. https://doi.org/10.1016/j.fhfh.2023.100147

Nawaz, S., Kaur, P., Konjengbam, M., Kumar, V., Gupta, R. C., Dwivedi, P., Patni, B., Pandey, B., Dey, A., & Pandey, D. K. (2022). Screening of elite germplasms for industrially valuable medicinal crop Stevia rebaudiana for stevioside and rebaudioside A production: An HPTLC-linked chemotaxonomic assessment. South African Journal of Botany, 150, 1159–1167. https://doi.org/10.1016/j.sajb.2022.09.004

Pfeiffer, T. Ž., Katanić, Z., Krstin, L., Koraca, I., Varga, M., Klapan, D., & Čamagajevac, I. Š. (2023). Antioxidative response of Stevia leaves to night chilling temperature. South African Journal of Botany, 154, 232–238. https://doi.org/10.1016/j.sajb.2023.01.025

Poothong, S., Khen, T., & Chumphukam, O. (2018). In vitro mineral nutrition for improving growth and multiplication of stevia. Agriculture and Natural Resources, 52(5), 477–483. https://doi.org/10.1016/j.anres.2018.11.007

Rizwan, F., Rashid, H. U., Yesmine, S., Monjur, F., & Chatterjee, T. K. (2018). Preliminary analysis of the effect of Stevia (Stevia rebaudiana) in patients with chronic kidney disease (stage I to stage III). Contemporary Clinical Trials Communications, 12, 17–25. https://doi.org/10.1016/j.conctc.2018.08.007

Rizwan, F., Yesmine, S., Banu, S. G., Chowdhury, I. A., Hasan, R., & Chatterjee, T. K. (2019). Renoprotective effects of stevia (Stevia rebaudiana Bertoni), amlodipine, valsartan, and losartan in gentamycin-induced nephrotoxicity in the rat model: Biochemical, hematological and histological approaches. Toxicology Reports, 6, 683–691. https://doi.org/10.1016/j.toxrep.2019.07.003

Rizwan, F., Yesmine, S., Chowdhury, I. A., Banu, S. G., & Chatterjee, T. K. (2020). Dataset concerning effects of stevia (Stevia rebaudiana bertoni), amlodipine, losartan, and valsartan on water consumption, blood glucose and heart tissue in gentamycin-induced nephrotoxicity in the rat model. Data in Brief, 31, 105965. https://doi.org/10.1016/j.dib.2020.105965

Roudbari, M., Barzegar, M., Sahari, M. A., & Gavlighi, H. A. (2024). Formulation of functional gummy candies containing natural antioxidants and stevia. Heliyon, 10(11), e31581. https://doi.org/10.1016/j.heliyon.2024.e31581

Sakthivel, M. A., & Kumar, S. R. (2025). Stevia (Stevia rebaudiana Bertoni): Sweet medicine for a healthier world. Journal of Agriculture and Food Research, 21, 101980. https://doi.org/10.1016/j.jafr.2025.101980

Samakradhamrongthai, R. S., Nortuy, N., Sangsee, O., Srichan, P., Sangpimpa, W., Jannu, T., Supawan, T., Chanakun, P., Yimkaew, Y., & Renaldi, G. (2024). Effect of stevia syrup, okra fruit powder, and Thai white chili on physicochemical properties and sensory qualities of confectionery jam. Lwt, 194, 115797. https://doi.org/10.1016/j.lwt.2024.115797

Samuel, P., Ayoob, K. T., Magnuson, B. A., Wölwer-Rieck, U., Jeppesen, P. B., Rogers, P. J., Rowland, I., & Mathews, R. (2018). Stevia Leaf to Stevia Sweetener: Exploring Its Science, Benefits, and Future Potential. Journal of Nutrition, 148(7), 1186S-1205S. https://doi.org/10.1093/jn/nxy102

Sardar, H., Waqas, M., Naz, S., Ejaz, S., Ali, S., & Ahmad, R. (2022). Evaluation of different growing media based on agro-industrial waste materials for the morphological, biochemical and physiological characteristics of stevia. Cleaner Waste Systems, 3, 100038. https://doi.org/10.1016/j.clwas.2022.100038

Scott, C., Au-Yeung, F., Strom, N., Wolever, T., Chakrabarti, A., Kwok, D., Lam, C., & Hutton, T. (2023). PTFS08-02-23 Comparison of a Daily Stevia Beverage vs. a Sucrose Sweetened Beverage on the Human Gut Microbiome, Cardiometabolic Functions and Anthropometric Measurements. Current Developments in Nutrition, 7, 101447. https://doi.org/10.1016/j.cdnut.2023.101447

Silva, C. E., Carhuancho, N., Zacarias, E. R., Quiñonez, G. H., Ramos, O. F., & Mallma, N. S. (2024). Optimization of a mixture using coffee parchment, Jamaica flower and Stevia for functional infusions - hypoglycemic and antioxidant. Applied Food Research, 4(2). https://doi.org/10.1016/j.afres.2024.100548

Sun, Y. Ming, Huang, X. Lei, Zhang, T., Yang, Y. Heng, Cheng, X. Fang, Xu, X. Yang, & Yuan, H. Yan. (2021). Potassium deficiency inhibits steviol glycosides synthesis by limiting leaf sugar metabolism in stevia (Stevia rebaudiana Bertoni) plants. Journal of Integrative Agriculture, 20(11), 2932–2943. https://doi.org/10.1016/S2095-3119(20)63472-4

Taak, P., Koul, B., Chopra, M., & Sharma, K. (2021). Comparative assessment of mulching and herbicide treatments for weed management in Stevia rebaudiana (Bertoni) cultivation. South African Journal of Botany, 140, 303–311. https://doi.org/10.1016/j.sajb.2020.05.016

Tang, M., Zhao, J., Wu, Y., Yu, C., Peng, C., Liu, H., Cui, Y., Lan, W., Lin, Y., Kong, X., & Xiong, X. (2024). Improving gut functions and egg nutrition with stevia residue in laying hens. Poultry Science, 103(2), 103324. https://doi.org/10.1016/j.psj.2023.103324

Thakur, B. K., Mahajan, M., Shivani, Singh, S., & Pal, P. K. (2025). Evaluation of Stevia rebaudiana (Bertoni) accessions for agro-morphological, physiological and biochemical traits in a mild-temperate environment. Scientia Horticulturae, 339, 113850. https://doi.org/10.1016/j.scienta.2024.113850

Wen, K., Zhang, K., Gao, W., Bai, S., Wang, J., Song, W., Zeng, Q., Peng, H., Lv, L., Xuan, Y., Li, S., Xu, M., & Ding, X. (2024). Effects of stevia extract on production performance, serum biochemistry, antioxidant capacity, and gut health of laying hens. Poultry Science, 103(1), 1–10. https://doi.org/10.1016/j.psj.2023.103188

Ye, Q., Wu, Y., Kuang, D., & Ye, H. (2025). Phytochemical analysis and molecular mechanisms of anticancer activity of Stevia rebaudiana extract in gastric cancer cells: In silico docking and functional assays on apoptosis and cell migration. Kuwait Journal of Science, 52(3), 100420. https://doi.org/10.1016/j.kjs.2025.100420

Yu, H., Liu, W., Zhou, X., Lv, H., Nakano, T., Liu, H., Zhao, Q., & Yang, G. (2024). Effect of Stevia rebaudiana stem waste extract on lipid oxidation of salted-dried Pacific saury during chilled storage. Lwt, 200, 116180. https://doi.org/10.1016/j.lwt.2024.116180

Downloads

Published

2026-08-31

How to Cite

Tompunuh, M. M., Astuti, S. C. D., Porouw, H. S., Zakaria, R., Arum, D. N. S., & Hernayanti, M. R. (2026). Potential of Stevia rebaudiana as a Safe Sweetener Alternative for Women with Gestational Diabetes Mellitus. MEDICA (International Medical Scientific Journal), 8(8), 799–815. https://doi.org/10.53770/medica.v8i8.1267

Issue

Vol. 8 No. 8 (2026): MEDICA (International Medical Scientific Journal)

Section

Articles

License

Copyright (c) 2026 MEDICA (International Medical Scientific Journal)

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.