How Much Caffeine Can You Safely Drink During Pregnancy?
Whether your beverage of choice is coffee, an energy drink, tea, or diet cola, odds are you need a cup (or five) of something caffeinated to keep you energized throughout the day. But now that you're eating and drinking for two, the decision to ingest stimulants such as caffeine can be a bit trickier.
"Caffeine in pregnancy can be an issue if large amounts are consumed," says Michele Hakakha, M.D., a board certified OB-GYN in Beverly Hills, California, and author of Expecting 411. "We know from many of our studies that caffeine crosses the placenta, and a baby's developing metabolism can't quite handle the caffeine jolt."
- RELATED: Can You Drink Coffee While Pregnant?
So how much caffeine is safe during pregnancy? From the amount you can safely ingest to how it will affect baby, here's everything you need to know about consuming this stimulant.
How Much Caffeine is Safe During Pregnancy?
Although experts agree that caffeine should be limited, they can't come to a consensus on exactly how much. An August 2020 review published in the journal BMJ concluded that no amount of caffeine is safe. The observational study found "caffeine consumption to be associated with increased risk for the four outcome categories of miscarriage, stillbirth, low birth weight and/or small for gestational age, and childhood acute leukaemia."
However, most experts, including the American College of Obstetricians and Gynecologists (ACOG) and the United Kingdom's Royal College of Obstetricians and Gynaecologists, disagree with the review's results. "Moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth," says the ACOG in a statement, which they reaffirmed in August 2020. They recommend keeping your daily caffeine consumption under 200 milligrams to be safe. That's slightly more than the amount of caffeine in one standard cup of coffee—though even an 8-ounce tall cup of super-charged Starbucks brew will take you over that amount.
That said, it's important to note the 200-milligram mark is a bit arbitrary. "When some pregnancy books put limits on caffeine in pregnancy, they're guessing," reveals Dr. Hakakha. "There is no data that says that 200 milligrams is safe, but 300 milligrams is dangerous." That figure is based on animal studies that show decreased fertility and increased risk of miscarriage and birth defects after the animals consumed large doses of caffeine (over 300 milligrams). But human studies don't seem to come to the same conclusion about the dangers of caffeine.
"There's been a shift in paradigm, where we don't go on conventional wisdom and practice evidence-based medicine," says David Elmer, M.D., an OB-GYN at Nantucket Cottage Hospital in Nantucket, Massachusetts. "And the overwhelming evidence does not support much, if any, damage in having caffeine." Because few expectant parents would willingly submit their unborn children to be guinea pigs, most studies on the affects of caffeine during pregnancy are retrospective studies, which observe people who were exposed to a particular chemical or medication to see if they experienced any negative side effects.
"If an expectant parent had an adverse outcome, like a miscarriage, they always blame it on something," Dr. Elmer says. "This leads to skewed data because, in these cases, many overestimate their coffee usage." Those who have healthy pregnancies tend to do the same thing, i.e. they may underreport their usage of "bad-for-you" foods to seem like they are model patients.
How Does Caffeine Affect You and Your Baby?
While caffeine affects most people the same—it "wakes" you up, increasing awareness and alertness; it also raises your blood pressure and can cause difficulty sleeping—the effects of caffeine on baby are unclear. "Any amount of caffeine can also cause changes in your baby's sleep pattern or normal movement pattern in the later stages of pregnancy," says an article from the American Pregnancy Association (APA). Some studies have linked caffeine consumption to miscarriage and preterm birth. Others say this is untrue. And still others remain inconclusive.
"Until we know more about how caffeine can affect pregnancy, it's best to limit the amount you get to 200 milligrams each day," explains an article from March of Dimes. "This is about the amount in 1½ 8-ounce cups of coffee or one 12-ounce cup of coffee."
What Food and Drinks Contain Caffeine?
Caffeine is found in dozens of products, including:
- Coffee, and coffee-flavored foods or drinks
- Energy drinks
- Soft drinks
Is Caffeine Safe While Breastfeeding?
According to the American Academy of Pediatrics (AAP) and La Leche League (LLL), it is safe to consume caffeine while breastfeeding. However, since the stimulant can be passed to baby, you'll want to limit your consumption. "It is recommended for nursing parents... [to[ limit their daily consumption to less than three cups of coffee per day (or up to 300 mg of caffeine,)" explains LLL.
The Bottom Line
With so much conflicting information out there, what's an expectant parent to do? See what your doctor has to say and then use your best judgment. If you want to go the better-safe-than-sorry route, keep your daily caffeine intake below the 200-milligram mark—the equivalent of either four diet colas, three cups of green tea, or just one Grande Caffe Mocha at Starbucks per day. Besides, when it comes to your baby, it may be better to err on the side of caution. "My advice to patients: no more than one, and on occasion, two, caffeinated drinks a day," says Dr. Hakakha.