Caffeine Consumption During Pregnancy and Lactation

In the United States, the American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women limit their caffeine intake to less than 200 milligrams per day (3). This amount is roughly equivalent to one 12-ounce cup of coffee.

The World Health Organization (WHO) recommends that pregnant women limit their caffeine intake, but their suggested limit is up to 300 milligrams per day (4). This guideline takes into account caffeine consumption from all sources, including coffee, tea, chocolate, and medication. While this limit is slightly higher than the ACOG recommendation, both organizations aim to minimize potential risks associated with caffeine intake during pregnancy while acknowledging that moderate consumption is generally considered safe.

Understanding the risks associated with caffeine consumption during pregnancy allows parents to make informed decisions. Drinking caffeine during pregnancy is considered quite normal in our society, and the below information is not meant to instill guilt in any parents who drank caffeine during pregnancy. Remember that the research is constantly being updated, and we can only do the best we can with the information that we have at the present time. Staying within the established guidelines or avoiding caffeine altogether is going to be the best bet. Risks are purely risks; they are not guaranteed and many factors go into determining our health and that of our babies.

A somewhat controversial meta-analysis was conducted by Jack James, PhD — a professor of psychology at Reykjavik University in Iceland (5) — where 48 studies were reviewed, all focusing on maternal caffeine consumption over the past two decades. His findings indicated a risk of pregnancy loss associated with any amount of caffeine intake and he concluded that “no amount of caffeine intake during pregnancy is safe.” This information made headlines some time ago, and prompted the ACOG to put out a response sharing that they stand by their assessment that limited caffeine is safe during pregnancy (6). The research by Jack James, PhD has received criticism for having several flaws, including that his research involved asking mothers to recall from memory their caffeine intake during pregnancy rather than accurately tracking real time caffeine intake.

Other studies, such as one conducted at the University of Leeds in the UK, show that while there is a definite link between caffeine intake during pregnancy and miscarriage, the risk is dose dependent and moderate consumption is safe (7).

The key takeaway is that there is an increased risk of miscarriage associated with caffeine intake during pregnancy, but the exact amount of caffeine intake required in order to fall into this “higher risk zone" is still being discussed in the scientific community. Most doctors and government authorities stand by the assessment that a moderate amount of caffeine intake is okay. 

A recent study identified a positive association between maternal caffeine intake in rats and autism spectrum disorder-related behaviors in their offspring (8). Another study found that maternal caffeine consumption in humans, as well as higher maternal BMI, may influence the risk of ASD in children born to parents who already had a genetic predisposition to autism spectrum disorder (9). More research is needed in this area but it is worth paying attention to as it highlights the potential for maternal caffeine intake to impact their child’s behavior long term.

An analysis published by The National Institutes of Health found that children of mothers who consumed higher amounts of caffeine during pregnancy were slightly shorter in height than children of mothers with lower caffeine intake (10). This analysis points towards the hypothesis that caffeine may interfere with fetal growth and development and can potentially lead to long-term effects on a child's physical stature.

Caffeine crosses the placental barrier (11), meaning that caffeine consumption during pregnancy exposes the fetus to its effects. Research has shown that higher caffeine consumption, particularly in the third trimester, correlates with higher caffeine levels in newborns (12), indicating cumulative fetal caffeine exposure. It is important to note that during pregnancy, a woman’s metabolism changes, causing caffeine clearance to slow significantly. By the third trimester, caffeine's half-life increases from about five hours to approximately 18 hours (12), meaning that the fetus is exposed to caffeine for a significantly longer time.

Newborns exposed to caffeine in utero may experience caffeine withdrawal symptoms similar to adults, including disturbed sleep, irritability, increased frequency of irregular heartbeat, respiration issues, and more vomiting (13). These symptoms resolve on their own once caffeine clears the body, but they highlight the importance of managing caffeine intake during pregnancy.

Caffeine consumption also has implications for breastfeeding mothers. Caffeine can pass into breast milk and be passed on to the nursing infant, who metabolizes caffeine much more slowly than adults (14). This can lead to increased irritability, sleep disturbances, and fussiness in the infant (15). Moderate caffeine intake is generally considered safe while breastfeeding: The Centers for Disease Control and Prevention (CDC) advises that moderate caffeine consumption of no more than 200-300 milligrams per day while breastfeeding is generally safe for most infants. However, it is important to be aware that as with adults, some babies may be more sensitive to caffeine than others. It is important for breastfeeding mothers to observe their babies for signs of caffeine sensitivity, such as increased wakefulness or irritability. If such signs are present, further reducing caffeine intake may be necessary.

For expecting and new mothers looking to reduce their caffeine intake, several natural alternatives can help maintain energy levels without the associated risks of caffeine.

For those choosing to reduce or eliminate their caffeine intake, withdrawal symptoms like headaches can occur. Managing these symptoms can be challenging, but they should resolve within a few days. Staying hydrated is crucial, as drinking plenty of fluids can help flush caffeine from the system. Opting for nutrient-dense snacks can also help maintain energy levels and reduce the urge for caffeinated beverages. Herbal support like Mother’s Nature Profen™ can be helpful for managing occasional aches.

Understanding the risks associated with caffeine consumption during pregnancy and while breastfeeding is important for making informed decisions. While moderate caffeine intake is generally considered safe by organizations like the ACOG and WHO, there are potential risks, including miscarriage, that are associated with caffeine intake. It is important for parents to be aware that caffeine crosses the placental barrier and is metabolized more slowly during pregnancy, exposing the fetus for longer periods.

For breastfeeding mothers, the same guidelines of moderation apply, with the added recommendation to observe infants for signs of caffeine sensitivity, such as increased wakefulness and fussiness. Fortunately, there are many natural alternatives to maintain energy levels, such as herbal preparations, nutrient-dense foods and supplements, outdoor time, and proper hydration. 

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