Is caffeine intake safe during pregnancy?

From the Guidelines

Pregnant women should limit their caffeine intake to no more than 200 mg per day, as recommended by the European Food Safety Authority 1. This amount is roughly equivalent to one 12-ounce cup of coffee. The Dietary Guidelines for Americans (DGA) also advise pregnant women to consume no more than 200 mg of caffeine per day 2. It is essential to consider all sources of caffeine, including coffee, tea, soda, energy drinks, and chocolate, when monitoring daily intake. Exceeding the recommended limit may increase the risk of miscarriage, low birth weight, and preterm birth, although research findings are mixed 1. Caffeine crosses the placenta to the baby, who cannot metabolize it efficiently, leading to higher exposure. If you currently consume more caffeine, consider gradually reducing your intake rather than stopping abruptly to avoid withdrawal symptoms like headaches. Decaffeinated beverages and herbal teas (except certain herbs like black cohosh or licorice root) can be good alternatives. Always check medication labels, as some over-the-counter pain relievers and cold medicines also contain caffeine. Staying well-hydrated with water is particularly important during pregnancy, so try to make water your primary beverage. Key points to consider include:

• The DGA recommends limiting caffeine intake to 400 mg/d for non-pregnant adults, but 200 mg/d for pregnant women 2
• Adolescent and child caffeine consumption should not exceed 2.5 mg · kg body weight –1 · d–1 2
• Decaffeinated coffee and tea can also serve as healthy beverage choices because the phenolic acids and flavonoids associated with health benefits are present in these products, although modestly reduced in amounts 2

From the FDA Drug Label

Pregnancy Category C Concern for the teratogenicity of caffeine is not relevant when administered to infants In studies performed in adult animals, caffeine (as caffeine base) administered to pregnant mice as sustained release pellets at 50 mg/kg (less than the maximum recommended intravenous loading dose for infants on a mg/m2 basis), during the period of organogenesis, caused a low incidence of cleft palate and exencephaly in the fetuses. There are no adequate and well-controlled studies in pregnant women.

Caffeine is categorized as Pregnancy Category C. The drug label indicates that there are no adequate and well-controlled studies in pregnant women. Although animal studies suggest potential teratogenic effects, the label does not provide direct evidence to support or refute the safety of caffeine during pregnancy in humans. Therefore, the use of caffeine during pregnancy should be approached with caution 3.

From the Research

Caffeine Consumption During Pregnancy

• The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women limit their caffeine consumption to less than 200 mg per day 4.
• A study published in the JAMA Network Open found that second-trimester caffeinated beverage intake within current recommendations was associated with lower gestational diabetes risk, but not preeclampsia or gestational hypertension 5.
• However, an integrative review published in Reproductive Toxicology found associations between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes, with effects often being dose-dependent 6.

Safe Dose of Caffeine

• Defining a safe dose for caffeine intake during pregnancy is challenging due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed 6.
• Some studies suggest that even exposures below the recommended level of caffeine intake during pregnancy (200 mg/day) may be associated with adverse outcomes 6.
• A review published in Frontiers in Psychiatry reports that for healthy adults, caffeine consumption is relatively safe, but for some vulnerable populations, including pregnant and lactating women, caffeine consumption could be harmful 7.

Health Benefits and Risks

• Moderate intake of caffeine may have health benefits, such as protective effects on cardiovascular diseases, obesity, diabetes mellitus, and neurodegenerative diseases 8.
• However, long-term or excessive caffeine consumption can lead to side effects such as addiction, insomnia, migraine, and other adverse effects, particularly in children, adolescents, pregnant women, and people sensitive to caffeine 8.