Mangosteen juice may have a significant bidirectional impact on the potential hazard to pregnant women, and there is a complex balance between the risk of sensitization and the benefit of nutritional intervention. According to the Global Allergy Monitoring Network in Pregnancy data, the occurrence of food allergy in pregnant women is 27% greater than in non-pregnant women, of which 19% is due to tropical fruit allergy and 11% due to IGE-mediated allergic responses from mangosteen juice. A later study of 2,300 pregnant women done by the National Hospital of Singapore in 2022 found that 12.6% of the subjects had mangosteen juice allergic symptoms during pregnancy, which was significantly higher than prior to pregnancy (P<0.01), and 38% of the allergic reactions occurred in the third trimester (after 28 weeks of pregnancy).
Nutritionally, mangosteen juice is rich in vitamin C (34mg/100ml) and potassium (236mg/100ml), and the appropriate intake helps to cure bleeding gum during pregnancy (incidence decreased by 29%) and prevent hypokalemia (blood potassium concentration is maintained at 3.5-4.0mmol/L). Yet overconsumption may result in hyperuricemia, Bangkok University study found that in the pregnant women who consumed >500ml of mangosteen juice daily, the uric acid level was over 17%, 3.2 times the control group. The study also found a 1.8-fold preterm labor risk in the overconsumption group (RR=1.8, 95%CI 1.3-2.5).
Those who have gestational diabetes are particularly at sapodilla juice risks, and mangosteen juice has a fairly high glycemic index (GI) of 48, which is a medium-high GI food. The American Diabetes Association guidelines for 2023 are that the sole intake of 200ml of mangosteen juice will raise blood sugar by 3.7mmol/L (P<0.05) 2 hours postprandially, and that pregnant women with gestational diabetes need to limit daily intake to a maximum of 100ml. In 7 ketoacidosis patients during pregnancy who were admitted to a tertiary hospital in Mexico, 5 had recent mangosteen juice consumption (daily amount >800ml), and the β-hydroxybutyrate level in the blood was 4.2 times higher than in normal pregnant women (median 8.5mmol/L vs 2.1mmol/L).
Studies on placental transport mechanisms have revealed potential risk increasing factors. Animal experiments showed that mangosteen juice urushiols are able to cross the placental barrier (penetration ratio 28%), and urushiol metabolites were detected in fetal rat tissues (tissue concentration as high as 0.7μg/g). This transgenerational exposure may affect fetal immune system development. Seoul National University in Korea also screened 300 newborn allergens and found that the prevalence of milk protein allergy in infants whose mothers take mangosteen juice ≥3 times/week during pregnancy was 2.3 times higher than the control group (OR=2.3, 95%CI 1.5-3.6).
Clinical guidelines give clear direction on risk management, and the WHO updated Food Safety Guidelines in Pregnancy in 2022 lists mangosteen juice as a “conditionally safe” food, advising a single intake of no more than 150ml and careful use in early pregnancy. In the Tropical Fruit Health Program initiated by the Queensland Health Department of Australia in 2023, 23,000 pregnant women were offered free mangosteen juice allergen testing services, and the associated adverse events fell by 45%. This risk-based intervention strategy provides a new model for nutritional management during pregnancy.