Hi there - I am 15 weeks pregnant with twins

Patient

Q: Hi there - I am 15 weeks pregnant with twins - in the last week eaten about 350g liquorice in total over the week (about 200g black liquorice sweets from supermarket about 150g of salty liquorice). This is the equivalent of around two big bags and the reason I have eaten so much is it helps my nausea. While the NHS explicitly states liquorice is fine, I have just found lots of countries advise against it based on a 2010 study stating that consumption of lots of liquorice, especially in the second trimester is very bad for a child's brain development - significantly affecting IQ and behaviour http://www.livestrong.com/article/518232-can-pregnant-women-eat-black-licorice/#page=1. I now feel concerned and guilty! I have stopped eating all liquorice but can you tell my why the NHS has advised liquorice is ok (ie is this study discredited) and whether one week of consumption would be enough to cause a problem. Thank you for your help!

Doctor

A:   Hello,
Thank you for your query at AskTheDoctor.com
I understand your concern.
Liquorice can be consumed safely up to 4 weeks irrespective of pregnancy. If consumed more than 4 weeks continuously, it does cause side effects like hypertension, mood changes, neurological symptoms, gastric upset as well as electrolyte disturbances.

Yes, it is not the preferred medicine, and seeing the side effect profile, a lot of studies as well as countries ban liquorice and consider it unsafe. We don't have sufficient studies in our literature to show up to what amount can be consumed. But NHS has stated that liquorice in moderate amounts, not more than 100 grams per week, for 4 weeks, does not cause any side effects. But anything more than that can cause fetal problems as well as early delivery or miscarriage. Considering you took around 350 grams, I will advise you to stop any further consumption, as one week is not enough to cause any severe damage. I would have been worried if you continued it for 2-3 weeks.

So, in absence of conclusive evidence, I will suggest you abstain from any further consumption, as I will once again reinstate that one week of liquorice consumption is not likely to cause any damage to the growing foetus.
I can understand you did it to control nausea, so you can't blame yourself for it. But if you stop it right now, it won't harm you in any way.

Hope this was helpful,
Regards.

Comments / Follow Ups

Patient: Hi there - thank you for your additional comments via email that don't appear here. It was good to see you were reassured both by the short timeframe in which I ate the liquorice and the fact that it was not 'pure liquorice' but rather a range of confectionary which included a range of ingredients including liquorice extract.
While researching the ingredients I found out that one of the bags of salty liquorice confectionary that I ate (a small bag of 80g) included ammonium chloride rather than salt as I had thought. I couldn't find too much information on sodium hydroxide but I didn't find any negative articles associated with pregnancy. However, I wanted to get your opinion as to whether I should be concerned, follow up or take action following eating it. My guess at the MAXIMUM quantity of ammonium chloride eaten would be approx 6g over 4 days (based on an article stating the maximum amount of ammonium chloride in sweets is approximately 8%). So to reiterate, is there anything to be concerned about or follow up on here. Thank you for your help. I am usually incredibly careful about what I eat when pregnant and had no such issues with my first pregnancy - I just had no sense that what I saw as a packet of sweets could include anything harmful and have been suffering from morning sickness and so appreciated the relief the liquorice gave me. Obviously, I won't be eating any more liquorice and will now be double checking everything before I eat and drink! Thanks again.

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