Is coffee consumption safe during pregnancy?

Coffee Consumption During Pregnancy

Pregnant women can consume coffee during pregnancy, but should strictly limit caffeine intake to ≤200 mg per day (approximately 1-2 cups of coffee), as recommended by the European Food Safety Authority and supported by multiple international guidelines. 1

Evidence-Based Caffeine Limits in Pregnancy

• The established safe threshold is ≤200-300 mg/day of caffeine during pregnancy, with most guidelines converging on 200 mg/day as the conservative upper limit. 1
• This recommendation exists because caffeine freely crosses the placenta and is metabolized more slowly during pregnancy, potentially affecting the developing fetus. 1
• For context, coffee contains 50-300 mg per 8 oz (237 mL) serving depending on brewing method, so 200 mg/day typically equals 1-2 cups of regular coffee. 1

Potential Risks of Excessive Caffeine Intake

The evidence regarding adverse outcomes shows concerning associations even at doses below 200 mg/day:

• Pregnancy loss, low birth weight, and small-for-gestational-age infants have been associated with caffeine consumption, with effects often being dose-dependent. 2
• Cardiac and genital anomalies, higher body mass, and neurodevelopmental/neurobehavioral outcomes have been linked to caffeine exposure in some studies. 2
• A 2025 comprehensive review found that adverse effects on fetal development can occur even at doses well below the 200 mg/day threshold, suggesting the current recommendations may not be fully protective. 3
• Miscarriage, stillbirth, and acute leukemia in children have been reported in association with maternal caffeine intake. 3

Reassuring Evidence at Moderate Intake Levels

There is some counterbalancing evidence suggesting moderate intake may be safe:

• In a large cohort study, second trimester caffeine intake of 1-100 mg/day was associated with lower risk of gestational diabetes (relative risk 0.53) and favorable metabolic profiles, with no associations found with preeclampsia or gestational hypertension. 4
• A Polish study found that 73.8% of pregnant women consumed caffeine within the safe range (0-200 mg/day), with mean intake of 114.5 mg/day. 5
• One study of 100 pregnant women with mean caffeine intake of 68 mg/day found no negative effects on neonatal anthropometric measurements. 6

Critical Caveats and Clinical Considerations

• The heterogeneity in study designs makes defining a truly "safe" dose challenging, as reliable assessment of caffeine consumption is difficult and genetic variations in caffeine metabolism may cause differential responses. 2, 3
• Many pregnant women (58.9% in one study) cannot correctly identify the safe amount of caffeine, highlighting the need for clear patient education. 5
• Caffeine sources extend beyond coffee to include tea (15-50 mg per 8 oz), energy drinks, soft drinks, and chocolate—all of which must be counted toward the daily total. 1
• Women with uncontrolled hypertension should avoid caffeine entirely until blood pressure is adequately controlled. 7, 1

Practical Recommendations

• Limit total daily caffeine intake to 200 mg/day maximum, counting all sources including coffee, tea, chocolate, and soft drinks. 1, 5
• Choose water as the primary beverage, with fruit juices as better alternatives to caffeinated drinks when variety is desired. 8
• Track caffeine content carefully: one 8 oz cup of brewed coffee can contain anywhere from 50-300 mg depending on preparation method. 1
• Consider switching to decaffeinated coffee (≤10 mg per 8 oz) or tea (15-50 mg per 8 oz) to stay well below the threshold. 1
• Given emerging evidence of potential harm even below 200 mg/day, the most conservative approach is to minimize caffeine intake as much as possible during pregnancy. 2, 3