Taste

Judith

changes
MPH, PhD

during
and Ramses

pregnancy13
B Toma, MPH, PhD

E Brown,

ABSTRACT The ability of pregnant women to discriminate among different concentrations of salt and sucrose solutions, and their preference for the solutions, were assessed to determine if changes in the sense of taste occur during pregnancy. Results of tests with salt solutions showed that pregnant women were significantly less able to correctly identify concentration differences (p <0.005), and preferred significantly stronger solutions (p = 0.004) than did nonpregnant women. The data suggest that a physiological mechanism for increasing salt intake may develop during pregnancy. Am J Cli,, Nuir l986;43:414-418.
KEY

WORDS

Taste, pregnancy,

salt

Downloaded from ajcn.nutrition.org by guest on November 27, 2013

Introduction

mechanisms

appear

to be activated

in response

For approximately two-thirds of women, pregnancy is accompanied by changes in how certain foods taste and smell (1). Aversions and preferences that develop influence dietary intake in that consumption of bad tasting foods tends to decrease while the intake of especially tasty foods tends to increase (2, 3). Why some foods taste and smell different during pregnancy is not known. Hook has suggested that possible factors mediating the development of food aversions and cravings may be changes in taste and olfactory sensitivity, or metabolic changes accompanying the gravid state (3). Noting that estrogen and progesterone administration produced salt appetitite in nonpregnant animals, Denton (4) postulated that changes in taste perception during pregnancy were maternal and hormonal in origin. Results reported here indicate that alterations in the sense of taste for salt may occur during human pregnancy. Changes in taste sensitivity have been reported to occur in humans related to age (5, 6), ethnic background (6, 7), drugs (8), and to conditions such as cystic fibrosis (9), cancer (10, 11), diabetes mellitus (12), and zinc (13), niacin (14), and sodium deficiencies (15, 16). The relationships among sodium deficiency, taste, and food intake behavior have been most thoroughly studied. The development of an appetite for salt in response to sodium need has been described in many animal experiments (4, 17-22). In animals, physiological
414 The American Journal of Clinical

to sodium need that results in an increased appetite for, and intake of sodium (15, 23). Available evidence indicates that the increased intake ofsalt is directed and motivated by the sense oftaste (24). In contrast to the results of animal experiments, whether salt appetite develops in humans is a matter of controversy. In studies involving small numbers of human
subjects,
(25),

Yensen

(15),

Wilkins

and

Richter

McCance (26), and Bertino et al (27) reported changes in salt taste related to sodium deficits. In contrast to the results, Stinebaugh and coworkers (28) failed to observe alterations in taste thresholds for salt among a group of eight, fasted subjects. It is widely held that the development of salt appetite in response to sodium need is adaptive because it helps to avoid the unfavorable events associated with sodium deficiency (2, 3, 16, 23). However, both laboratory rats and humans will consume sodium in excess of apparent physiological need (4, 18, 24). Taste changes for salt and sucrose are of

From of

the Program

Public

Health,

in Public Health Nutrition, School University of Minnesota, Minneapo-

lis, MN.
2Supported in part by Biomedical Research Support Grants, School of Public Health, University of Minnesota. 3Address reprint requests to: DrJudith E Brown, School of Public Health, University of Minnesota, 420 Delaware Street, SE, Minneapolis, MN 55455. Received June 20, 1985. Accepted for publication October 8, 1985.

Nutrition

43: MARCH 1986, pp 414-418. Printed in USA 1986 American Society for Clinical Nutrition

TASTE

AND

PREGNANCY

415

particular interest in pregnancy. Salt is of interest because of the increased requirement for sodium that accompanies pregnancy (18, 29), and because of the long standing but questionable practice of restricting salt intake during pregnancy. Changes in the taste of sucrose could possibly correspond to the increased need for energy during pregnancy. This study was undertaken to assess salt and sucrose solution taste acuity, and simple taste solution preference among a group of pregnant women. Methods
Pregnant and nonpregnant women between the ages of 20 to 35 were recruited for the study by a flyer sent to all academic departments within the School of Public Health. Enrollment ended when 23 pregnant, and 23 nonpregnant women agreed to participate. Taste tests were conducted in a comfortable room free from noise and distraction. Each subject was presented with a tray holding cups with a set of sucrose and salt solutions, and distilled water. Room temperature taste solutions were presented on the tray in random order, with the set of sucrose solutions identified as sucrose, and the set of salt solutions identified as salt. Subjects were given a form on which to record the results of ranking each set ofsolutions from weakest to strongest, and to indicate the sucrose and salt solution they most preferred. A large cup of distilled water, and an empty cup, were provided on the tray and subjects were instructed to sip and spit the taste solutions. Subjects were asked to begin the taste test by rinsing their months with distilled water, and to rinse

Results Results of the tests on discriminating solutions by concentration are shown in Table 1. Pregnant women were significantly less likely to rank the salt solutions in the correct order of concentration than were the nonpregnant subjects (x2 8.7, df = 1 p < 0.005). Table 2 shows the molar concentrations of salt and sucrose solutions identified as most preferred by women in each group. Selection of most preferred salt solutions differed between pregnant and nonpregnant subjects. (x2 = 13.6, df = 3, p = 0.004). The mean concentration of salt solutions most preferred by pregnant women was significantly higher than the mean
,

Downloaded from ajcn.nutrition.org by guest on November 27, 2013

concentration
=

for

nonpregnant

women

(t

out their mouths

after testing

each solution.

They were

instructed to repeat the tasting process if needed. All subjects completed the taste tests within 15 mm. Taste solutions were made from distilled water and reagent grade sucrose and sodium chloride. Concentrations employed for the salt solutions were 0.025, 0.05, 0.075, 0.1, and 0.2 M. Sucrose solutions consisted of 0.01, 0.025, 0.05, 0.1, and 0.25 M. The number of solutions and the concentrations used were similar to those employed by Desor et al (6) in taste preferences studies with adults. Differences in the proportionate occurrence of events between groups were assessed using Chi square analysis, and
differences in group means by Students t test (30). For

3.3, p = 0.004). The subgroup of 10 pregnant women that were also tested after pregnancy exhibited the same preference change for salt solutions as was found between the pregnant and the nonpregnant subjects (not shown). The mean concentration of salt solutions most preferred by postpartum women dropped to 0.036 0.46 from a mean of 0.058 0.39 during pregnancy (t = 2.55, p = 0.03). Differences in sucrose solution preference results between pregnant and nonpregnant women and between the 10 subjects tested during and after pregnancy, were not significant. Discussion
Pregnancy related changes in taste and food have been the subjects of a number In 1691, Christion of Frankfort de-

preferences of reports.

the Students t tests, means and standard deviations of most preferred molar concentrations were calculated from log concentrations exponentiated. Information on sociodemographic and health statuses was collected by a pretested questionnaire.

TABLE

1 Number of pregnant and nonpregnant subjects correctly and incorrectly ranking salt and sucrose solutions by concentrations
Results of ranking Pregnant subjects (k) Nonpregnant subjects (&

Women

enrolled

in the study were all between

the ages

of 23 to 34, half were pregnant and all were white. Most of the pregnant subjects (65%) were in their third trimester of pregnancy, 22% were in their second, and 13% in their first trimester. One pregnant woman had been placed on a reduced sodium diet and one nonpregnant woman smoked cigarettes. Two subjects could not identify most preferred solutions during the taste tests. All subjects reported that they were in good health and not taking medications. Ten of the 23 pregnant women enrolled were available for retesting 5 to 7 mo postpartum.

Salt solutions Correct

12

21

Incorrect
Sucrose solutions

11
15

2
20

Correct

Incorrect
#{149} =

8
8.7,df= l,p<0.005.

416 TABLE
Molarity preferred

BROWN

AND

TOMA

2
of sucrose and salt solutions identified by pregnant and nonpregnant subjects
Solution identified

as most

as most preferred Nonpregnant subjects (n)

Molar conixniration

Pregnant ()

subjects

Salt solutions 0.025

3t
11

15
4

0.05
0.075 0.1 0.2 overall SD of most preferred solution Sucrose
solutions

2 4 2

0.061

O.55t

0.035

0.56

0.01
0.025 0.05

3
2 9

5
6 4

0.1
0.25

5
4
of

3
4

overall SD most preferred solution

0.059

0.95

0.042

1.11

#{149} NOTE: The standard deviations are large because means were calculated from log concentrations exponentiated.

Given access, these animals will consume more salt than nonpregnant animals, and their intakes ofsalt will exceed their calculated need for sodium (4, 18). Contreas and Frank (33) have reported that neural (chorda tympani) responses to salt solutions are reduced in sodium deficient rats. Presumably, the reduced neural response results in a diminished salt taste (33). Concentrations ofsalt that were aversive in the sodium sufficient state may not be perceived as undesirable during sodium deficiency (24). The consequences of sodium deficiency during pregnancy in rats are dramatic. Rats subjected to sodium restriction develop hypovolemia, hyponatremia, hyperkalemia, altered renin-aldosterone mechanisms for sodium conservation (17, 18), anorexia, and deliver smaller litters containing fewer live births than nondeficient animals (19). Hyponatremia associated with low sodium diets has been reported to develop in human pregnancy (34, 35). Results of these, and other studies mdicating that routine sodium restriction may exvoluntarily

been

reported.

Downloaded from ajcn.nutrition.org by guest on November 27, 2013

acerbate

the condition

it is intended

to prevent

tx2
t
=

13.6,df=
3.3, df
=

3,p=0.004.
22, p
=

0.004.

the case of a pregnant women who by actual count, over 1,400 salted herrings during her pregnancy (4). Schmidt (31) described the case of a pregnant woman who experienced an almost complete loss of taste and smell. Although these senses returned to normal function after delivery, the intrigue stimulated by the case led Schmidt to study taste acuity during pregnancy. Among 28 pregnant and an equal number of nonpregnant women, the pregnant women were found to have substantially increased thresholds for salt, sour, bitter, and sweet solutions (31). The threshold for salt solutions increased by the largest amount while that for sweet increased the least. In a study of similar design, Hansen and Langer (32) also found that taste thresholds for these four basic tastes were increased during pregnancy. The authors of both studies
consumed,

scribed

suggested

that

pregnancy

cravings

could

per-

haps be due to reduced sensitivity to taste qualities. The development of salt appetite during pregnancy in rats (18, 20) and rabbits (4) has

(1 7, 34, 36-4 1) has led to the general advice that pregnant women be allowed to consume salt to taste (40, 42). Although speculative, it is plausible that changes in salt sensitivity and preference are related to the increased need for sodium in human pregnancy. It has been suggested that differences in preference for sucrose may be related to caloric need (6). However, such a relationship has not been clearly established. Bruera et al (1 1) cxamined glucose thresholds in malnourished cancer patients and found that the thresholds were higher in the patients than in the control group. In a study of taste solution preference among 9 to 15 year old subjects and adults, Desor et al (6) found that the youths preferred stronger concentrations of sucrose than did adults. Grinker et al (43) were unable to identify changes in intensity and pleasantness ratings of sweet tasting foods between normal weight and overweight subjects. Although it appears that humans are brought into the world with an innate preference for sucrose (44), it is not clear if this preference motivates food or sucrose consumption in response to energy deficits. Richter and Barelare (20) examined taste preference for sucrose and salt in pregnant rats.

TASTE

AND

PREGNANCY

417

In agreement with the results of this research, rats did not show an increased preference for sucrose, but did exhibit an increased preference for salt. Dippel and Elias (45), however, noted a change in sucrose preference of pregnant women. In contrast to the results reported here, pregnant women in their study preferred weaker concentrations ofsucrose solution than did oral contraceptive users and nonpregnant women. Sucrose preference ratings were not
influenced by trimester of pregnancy. Molar

5. Schiffman 55, Hornack K, Reilly D. Increased taste thresholds of amino acids with age. Am J Clin Nutr l979;32: 1622-7. 6. Desor J, Green LS, Maller 0. Preferences for sweet and salty in 9 to 15 year old and adult humans. Science l975;l90:686-7. 7. Moskowitz HW, Kumaraiah V, Sharma KN, Jacobs

HL, Sharma

SD. Cross-cultural

differences

in simple

concentrations ofthree ofthe four sucrose solutions employed by Dippel and Elias were substantially stronger than those used in the current study. Few women indicated a preference for the two strongest solutions offered (0.6 and 1.2 M) (44). Conclusions Results ofthis research showed powerful effects of pregnancy on taste for salt solutions. Pregnant women were less able to discriminate among different concentrations of salt solution, and preferred stronger salt solutions than did nonpregnant women. Among a subset of women tested during and after pregnancy, the preference for stronger salt solutions identified during pregnancy disappeared after delivery. The strengths of the effects observed for salt solutions suggest that tests using larger numbers of women would reveal similar results. Weak effects of pregnancy on sucrose solution sensitivity and preference however, may be identified in studies that utilize a large number of pregnant women. The data suggest that physiological mechanisms for increasing sodium intake may develop during pregnancy.
The authors thank Dr Zata Vickers for her thorough review of the manuscript and Ms Kathleen Morrisey, research assistant, for her careful work on the project.

taste preferences. Science l975;190:1217-8. 8. Schiffman SS. Taste and smell in disease (First of two parts). N Engl J Med l983;308:1275-9. 9. Solomons NW. Zinc nutrition and taste acuity in patients with cystic fibrosis. Nutr Res 198 l;l:l3-24. 10. Gallagher P. Tweedle DE. Taste threshold and acceptability of commercial diets in cancer patients.

JPEN

l983;7:36

1-3.

I 1. Bruera E, Carraro 5, Roca E, Cedaro L, Chac#{243}n R. Association between malnutrition and caloric intake, emesis, phychological depression, glucose taste, and tumor mass. Cancer Treat Rep l984;68:873-6. 12. Hardy SL, Brennand CP, Wyse BW. Taste thresholds

Downloaded from ajcn.nutrition.org by guest on November 27, 2013

of individuals
subjects.

with diabetes mellitus and of control

198 1;79:286-9.

J Am Diet Assoc

13. Buzina R, Jusic M, Sapunar J, Milanovic N. Zinc nutrition and taste acuity in school children with impaired growth. Am J Clin Nutr 1980;33:2262-7. 14. Green RF. Subclinical pellagra and idiopathic hypogeusia.JAMA l97l2l8:l303. 15. Yensen R. Some factors affecting taste sensitivity in man: II. Depletion of body salt. Q J Exp Phychol

l959;l

1:230-8.
Ri, Hatton Gl. Gustatory adaptation as an for dietary-induced sodium appetite.
l975;l5:569-76.

16. Contreras explanation

Physiol Behav

17. Pike RL, Gursky DS. Further evidence of deleterious effects produced by sodium restriction during pregnancy. Am J Clin Nutr 1970;23:883-9. 18. Pike RL, Yao C. Increased sodium chloride appetite
during pregnancy in the rat. J Nutr 197 l;lOl:169-

76. 19. Bursey RG, Watson ML. The effect ofsodium restriction during gestation on oflpring brain development in rats. Am J Clin Nutr l983;37:43-5l. 20. Richter CP, Barelare B. Nutritional requirements of pregnant and lactating rats studied by the self-selection method. Endocrinology l938;23: 15-24. 21. Richter CP. Increased salt appetite in adrenalectomized rats. Am J Clin Nutr l936;l 15:151-61.

22. Schulkin AU, Leibman D, Ehrman RN, Norton NW, Ternes JW. Salt hunger in the rhesus monkey. Behav
Neurosci l984;98:753-6. 23. Vander AJ. Control of renin release. Physiol Rev l967;47:359-64. 24. Beauchamp GK, Bertino M, Moran M. Sodium regulation: sensory aspects. J Am Diet Assoc l982;80: 40-5. 25. Wilkins L, Richter CP. A great craving for salt by a child with cortico-adrenal insufficiency. JAMA 1940;
114:866.

References
1. Taggert N. Food habits in pregnancy. Proc Nutr Soc 196l20:35-40. 2. LittleRE, Schultz FA, Mandell W. Drinking during

pregnancy.
3. Hook EB.

J Studies
Dietary

on Alcohol

1976;37:375-9.

26.

cravings and aversions during pregnancy. Am J Clin Nutr l978;3l:l355-62. 4. Denton DA. The hunger for salt. An anthropological, physiological and medical analysis. Berlin:SpringerVerlag, 1982:427-35.

McCance RA. ciency in man. 245-68.

Experimental sodium chloride defiProc R Soc London Ser B l936;l 19:

27.

Bertino M, Beauchamp GK, Riskey DR. Engelman K. Taste perception in three individuals on a low sodium diet. Appetite 198 l2:67-73.

418 28. Stinebaugh Bi, Vasquez

BROWN

AND 37. 38.

TOMA
Lindheimer MD, Katz Al. Sodium and diuretics N EngI J Med 1973288:891-4. metabolism. Clin Obstet in Gy-

MI, Schloeder

FX.

Taste

thresholds for salt in fasting patients. Am J Clin Nutr

1975;28:8 14-7.

pregnancy.

29.

Hytten

FE,

Leitch

I. The

physiology

of human

nancy. Oxford:Blackwell Scientific Publishers, 418-20. 30. Remington RD. Schork MA. Statistics with applications to the biological and health sciences. Englewood

preg1971:

Robertson ER. Water necol 1975;2:431-40. 39. Chesley LC. Disorders trolytes. In: Assali N, tional disorders, V 1. 1972:355-477.

of the kidney, fluids and eleced. Pathophysiology of gestaNew York: Academic Press, Al. Renal changes during

Cliffs, NJ: Prentice-Hall, 1970:161-4, 229-44. 31. Schmidt H. Transient loss of the sense of smell and taste during pregnancy. Klin Wochenschr l925;4:

40. Lindheimer

MD,

Katz

1967-8.
32. Hansen R, Langer W. Uber geschmacksver#{228}nderungen in derschwangerschaft. Klin Wochenschr l935;14: 1173-7. 33. Contreras Ri, Frank M. Sodium deprivation alters neural responses to gustatory stimuli. J Gen Physiol

41.

42.

EK. The influence of dietary sodium uptake on water, electrolyte and nitrogen balance in pregnancy toxaemia. A metabolic study. Am J Obstet Gynecol l956;72:562-88. 35. Palomaki JF, Lindheimer MD. Sodium depletion simulating deterioration in a toxemic pregnancy. N Engi J Med l970282:88-9. 36. Robinson M. Salt in pregnancy. Lancet l958;l:17881.

l979;73:569-94. 34. de Alvarez R, Smith

43.

44.

45.

pregnancy. Their relevance to volume homeostosis. Gin Obstet Cynecol l975;2:345-64. Pike RL, Smiciklas HA. A reappraisal of sodium restriction during pregnancy. Int J Gynaec Obstet l972;10: 1-8. Nolten WE, Ehrlich EN. Sodium and mineralocorticoids in normal pregnancy. Kid Int l980;I8:16272. Grinker J, Hirsch J, Smith D. Taste sensitivity and susceptibility to external influences in obese and normal weight subjects. J Personality and Social Psychol l972;22:320-5. Beauchaznp GK. The development of tastein infancy. In: Bond JT, Filer U, Leveille GA, Thompson A, Weil WB, eds. Infant and early childhood feeding. New York: Academic Press, 198 1:413-26. Dippel RL, Elias JW. Preferences for sweet in relationship to use of oral contraceptives and pregnancy.

Downloaded from ajcn.nutrition.org by guest on November 27, 2013

Hormones

and Behavior

l980;l4:l-6.