Balancing the Brew: Navigating Caffeine Intake During Pregnancy and Breastfeeding

As the warm aroma of freshly brewed coffee fills the air, expectant and nursing mothers find themselves at a crossroads to strike the perfect balance between savoring their favorite beverages and safeguarding their little ones' well-being.
 
 Women have been both advised to avoid caffeine during pregnancy and breastfeeding out of concern it could affect the mother's or the baby's health, as well as given the greenlight to drink it moderately. With more research and data available, navigating caffeine intake during pregnancy and breastfeeding is ever-changing. The costs and benefits are described below.

For individual prenatal nutrition support, make a telehealth appointment with a registered dietitian nutritionist and certified lactation counselor at ZEST Nutrition. Evening and weekend appointments are available.

Caffeine is found naturally in plants like cacao, yerba, tea leaves, coffee beans, and guarana berries. It’s added to foods like sodas, energy drinks, and tablets.

The amount of caffeine found in foods and drinks varies widely. This chart shows the number of milligrams of caffeine found in commonly consumed serving sizes of foods, drinks, and pills:

Despite its categorization as a psychoactive drug, caffeine actually has health benefits for most people, including those who are pregnant and nursing. There are specific levels of caffeine that need to be consumed to produce health benefits and prevent harm to the baby, however. We take a look at the caffeine recommendations below.

Caffeine affects different populations in different ways. For instance, caffeine will stay in the body of pregnant women longer than it will for any other adult. Infants, however, are affected the most, with caffeine hanging around for over three days.

The length of time caffeine stays in a person’s body is also partially determined by their genetics.

The UK NHS, the American College of Obstetricians and Gynecologists, the Dietary Guidelines for Americans, and the European Food Safety Authority set the safe level of caffeine intake during pregnancy at 200mg.

In 2020, an analysis of observational studies published in BMJ Evidence Based Medicine concluded that no amount of caffeine was safe for the fetus. In 14 of 48 studies analyzed, maternal caffeine consumption was associated with increased risk for four adverse outcomes: miscarriage, stillbirth, low birth weight and/or small for gestational age, and childhood acute leukemia.

Observational studies like these can’t establish causation, and the author points out that the results could be impacted by other confounding factors, such as incorrectly remembering amount of caffeine consumption, maternal cigarette smoking, and pregnancy symptoms. Pregnancy symptoms such as nausea and vomiting in early pregnancy are predictive of a healthy pregnancy and women who experience them are likely to reduce their caffeine intake.

But he adds that "the dose-responsive nature of the associations between caffeine and adverse pregnancy outcomes, and the fact some studies found no threshold below which negative outcomes were absent, supports likely causation rather than mere association."

The author concludes that there is “substantial cumulative evidence” of an association between maternal caffeine intake and negative pregnancy outcomes.

On the other side of the coin, a 2021 longitudinal pregnancy cohort study of over 2,800 pregnant women actually showed health benefits related to consuming 200mg or less of caffeine during the second trimester. Drinking up to 2 cups of coffee or 4 cups of black tea per day was associated with a lower risk for:

compared with no caffeine consumption.

Additionally, caffeine was not associated with gestational hypertension or preeclampsia.

If a woman finds she is craving a cup of coffee or tea during her pregnancy, is it safe to have up to 200mg of caffeine per day? The evidence is mixed.

Until there is stronger evidence that caffeine indeed causes negative health outcomes, caffeine in doses less than 200mg/day on an infrequent to moderate basis (1-4 days per week) is likely safe. If a cup or two of a caffeinated beverage can reduce a mother's stress, headaches, glucose and cholesterol levels, or exhaustion, it may be worth it until more randomized clinical trials can determine the actual effects of caffeine on infant health.

What does 200mg of caffeine look like?

A breastfeeding woman who drinks caffeine does not need to be concerned that the caffeine will affect her infant’s sleep. There is no evidence of this occurring based on studies reviewed by the Healthy Children Project.

However, caffeine can be detected in breastmilk. The amount of caffeine found in breastmilk is NOT directly related to the amount of caffeine the mother drinks. There are a number of factors that can influence the amount of caffeine that makes its way into breastmilk, including genetics, amount of food eaten, if the mother is a smoker, and more.

Research reviewed by the Healthy Children Project also shows that coffee drinking does NOT affect the duration of exclusive breastfeeding. There is no correlation between a woman consuming caffeine and how long she and the baby continue to nurse.

It is safe for exhausted mothers to breastfeed and drink caffeine. According to LactMed, a database managed by the National Institutes of Health, “Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. A maternal intake limit of 300 to 500mg daily might be a safe level of intake for most mothers, although European authorities set a likely safe level at 200mg.”

However, caffeine may accumulate in premies and very newborn babies similar to their mothers' caffeine levels, so a lower intake level is recommended when breastfeeding these infants. Although the first weeks are the hardest to stay awake and alert, it’s recommended to wait 3-4 weeks to load up on caffeine if breastfeeding.

(Interestingly, hospitals will use caffeine to treat sleep apnea and pain in premature babies. This is administered by health professionals in a controlled environment and should NOT be done at home.)

One other caution is that coffee intake of more than 15 oz. per day may decrease the amount of beneficial iron a baby gets from breastmilk. This could cause the baby to have mild iron deficiency anemia.

LactMed doesn’t confirm whether this is related to the coffee itself or the caffeine, but breastfeeding mothers who want to err on the side of caution should consider limiting their caffeine intake from all sources to 300mg per day.

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