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Many pregnant women are over-consuming caffeine

Tommy's PregnancyHub

A poll by Tommy’s has found that 61% of women would reduce the amount of caffeine they consume after being made aware of how much caffeine there is in daily items.

Over-consumption of caffeine (more than 200mg daily) is linked to miscarriage, low birth-weight and fetal growth restriction, but many women are unaware what 200mg represents in real life.  

• Caffeine is ‘hidden’ in many products including chocolate and energy drinks
• Tommy’s caffeine calculator helps women track their consumption

Since 2008 the Food Safety Authority (FSA) has recommended that pregnant women keep their caffeine intake to under 200mg a day, but evidence from Tommy’s, the pregnancy and baby charity, shows that women do not know what 200mg caffeine represents and are over-consuming.

A poll of 4,100 pregnant women conducted by Tommy’s showed that 61% would reduce their caffeine consumption habits after being made aware of how much caffeine there is in daily items.

Babies of pregnant women who consume over 200 mg of caffeine per day are at an increased risk of fetal growth restriction which could result in low birth weight and/or miscarriage.

“There is evidence that excessive caffeine intake  is associated with an increased risk of miscarriage. Interestingly, this evidence seems to apply to not just women during pregnancy, but also to men, pre-conception. Although more research is required, most clinicians would recommend couples to restrict their caffeine intake.”
Professor Arri Coomarasamy, Clinical Director of Tommy’s National Miscarriage Research Centre

Caffeine is found in tea and coffee, cola, other soft beverages such as energy drinks and chocolate. A mug of tea has around 75mg and a bar of plain chocolate has around 25mg.

“Caffeine consumption can add up so quickly! Two cups of coffee and a bar of chocolate would have enough caffeine to be over the recommended limit while pregnant. Try switching to decaffeinated coffee, herbal teas, fruit juice and water. Don’t worry if you have in the past gone over the 200mg limit but using a caffeine calculator now can help you be more aware of your consumption and to cut down if you need to.” 
Sophie King, Tommy’s midwife

"I've never been a big caffeine drinker and I assumed that a couple of mugs of tea or coffee each day wouldn't take me over the caffeine limit in pregnancy. I decided to check on Tommy's caffeine calculator and I was surprised to see I am going over the recommended limit of 200mg. A mug of tea and a filter coffee takes me just over to 215mg - and a chocolate bar (my current craving) pushes it up even more to 240mg. I had no idea! I'm going to make an effort to stick to one tea or coffee now."
Clio, a mum expecting her third baby

NOTES TO EDITORS:

• 4,100 pregnant women responded to the poll conducted between April-December 2017
• Tommy’s caffeine calculator is free to use here
• The campaign hashtag is #caffeinewise
• Further information for risk assessments on caffeine consumption from the European Food Safety Authority https://www.efsa.europa.eu/en/efsajournal/pub/4102

For more information or to request an interview with Professor Arri Coomarasamy or Sophie King please contact the Tommy's press office on 0207 398 3436 or email [email protected] 

Tommy’s is the largest pregnancy and baby charity in the UK. We fund research into pregnancy problems and provide pregnancy health information to parents-to-be. We believe it is unacceptable that one in four women lose a baby during pregnancy and birth. With four research centres across the UK investigating the causes of miscarriage, stillbirth and premature birth, we lead the way in maternal and fetal research in the UK.

Our pregnancy health information is provided through the midwife-led Tommy’s Pregnancy Health Service, which includes our comprehensive pregnancy information website, our Tommy’s Midwives facebook page and our free Midwives helpline, the PregnancyLine. We believe every pregnancy should have a happy ending and that every baby should have the best chance of being born healthy.

www.tommys.org

Charity reg. nos 1060508 and SC039280

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Effects of restricted maternal caffeine intake on pregnancy, fetal and newborn outcomes

Caffeine is a stimulant found in tea, coffee, cola, chocolate and some over-the-counter drugs. Conflicting literature has made it difficult for health professionals to advise pregnant women on whether caffeine intake should be avoided during pregnancy. The clearance of caffeine from the mother's blood (clearance of caffeine from the blood) is slowed down during pregnancy. Some authors of observational studies have concluded that caffeine intake is harmful to the fetus, causing growth restriction, low birth weight, preterm labor, or stillbirth. The newborn may also experience withdrawal symptoms if the mother consumes large amounts of caffeine during pregnancy (more than eight cups of coffee per day).

Two studies met the inclusion criteria, but only one contributed data to the outcomes of interest for the review. The study was conducted in Denmark. Women less than 20 weeks pregnant were randomized to either caffeinated instant coffee (568 women after elimination) or decaffeinated instant coffee (629 women). Three cups of coffee per day in early pregnancy had no effect on birth weight, preterm birth, or growth restriction.

Both included studies were randomized controlled trials. In one study, pregnant women were randomly assigned to caffeinated or non-caffeinated groups. In another clinical trial, it was not clear if the allocation to study groups was blinded [hidden]. The blinding of study staff and participants was satisfactory in both studies, while blinding of investigators evaluating outcomes was not clearly stated. One study also unclearly explained the presence of attrition bias (dropouts, loss of patients from follow-up). Results from one trial that provided data for analysis showed no evidence of an effect of caffeine withdrawal on outcomes such as birth weight, preterm birth, and small-for-gestational age [gestational age].

Two outcomes were assessed and assigned a quality rating using the GRADE methodology. The quality of the evidence for these two outcomes, namely birth weight and preterm birth rate, was rated as low, with downward decisions due in part to the relatively small sample sizes and wide confidence intervals of the single included trial that contributed data to this review.

There is insufficient evidence to confirm or refute the effectiveness of avoiding caffeine intake on birth weight and other pregnancy outcomes.

Translation notes:

Translation: Yudina Ekaterina Viktorovna. Editing: Ziganshina Lilia Evgenievna. Russian translation project coordination: Kazan Federal University - an affiliated center in Tatarstan of the Northern Cochrane Center. For questions related to this translation, please contact us at: [email protected]

Coffee during pregnancy: a complete guide to all the do's and don'ts

When a woman sees "two lines" on her test, her life begins to change that same day. In this life, there are more good habits (timely sleep, proper nutrition, moderate exercise) and less bad habits (alcohol, smoking, sedentary lifestyle, unhealthy food). Coffee as a potentially dangerous product, around which there is a lot of controversy, often falls under the barrier of prohibitions.

Even without any pregnancy, coffee often raises a number of questions and concerns in people, so the debate around this drink is quite understandable and justified. But our task is to separate myth from reality and figure out when restrictions make sense and when they are a pointless obstacle to a fulfilling joyful lifestyle.

How does coffee affect the body of a pregnant woman?

Before talking about some special effect of coffee on a pregnant woman, let's refresh our memory of what actually happens to us when we drink coffee:

• After caffeine enters the blood, dopamine is released, which, as we remember, is responsible for a good mood. This hormone of joy very willingly “jumps out” in response to a shot of espresso or cappuccino and makes us feel good.
• Under the influence of dopamine, it is easier for us to play sports, we become more enduring and notice less pain in the muscles. It also improves overall performance.
• If there is too much caffeine (read - dopamine), the suppression of serotonin production begins. This leads to increased anxiety and can provoke depression.
• In parallel, under the influence of caffeine, adrenaline is released, another hormone that is responsible for our good mood and cheerfulness.
• Increased concentration.
• In most cases, coffee stimulates our heart to beat faster. The rhythm of the heartbeat accelerates and at the same time the pressure rises.
• The theophylline contained in coffee acts on the intercostal muscles and muscles of the diaphragm, as a result of which our breathing becomes more relaxed and easy.
• The excretory systems (diuretic and intestines) are stimulated – under the influence of caffeine, we feel the desire to visit the restroom faster.
• Caffeine also stimulates the nervous system. The peak of this action occurs in the first hour or two after drinking coffee, then for an average of 3-4 hours the breakdown of caffeine in the blood occurs, at which time many people have difficulty falling asleep.

What changes when a pregnant woman drinks coffee? In addition to the above phenomena, the following important parameters should be additionally indicated:

• slows down the process of removing caffeine from a woman's body;
• increased fetal heart rate;
• increased fetal activity;
• Excessive use creates possible risks for the child.

It is the last item on this list that is cause for concern and doubt about the admissibility of coffee in the diet of a pregnant woman. Below we describe in detail what these risks are and in what cases concerns can be justified.

Can pregnant women drink coffee?

Let's start with a high-profile peer-reviewed study published in the BMJ Evidence-Based Medicine. Professor Jack James from Reykjavik University in Iceland conducted a series of studies in 2020 and concluded that there is no safe level of caffeine intake for pregnant women: even the smallest amount can negatively affect the development of the fetus. However, Mr. James' colleagues from other countries categorically disagree with him. The National Health Service, the European Food Safety Authority, and the American and British Colleges of Obstetricians and Gynecologists recommend limit but not eliminate caffeine intake during pregnancy . The research paper was deemed "too panicky" and inconsistent with the accepted evidence.

“There are so many do's and don'ts associated with pregnancy, and the last thing we want to do is cause unnecessary worry. After all, women need to be sure that caffeine can be consumed in moderation during pregnancy,” says Dr. Luc Grzeskowiak, a pharmacist at the University of Adelaide in Australia.

Most doctors around the world agree that drinking up to 200 mg of caffeine per day (1-2 cups of coffee) is a perfectly acceptable limit that will not harm either mother or child.

When thinking about the amount of caffeine consumed per day, it is very important to remember that it is added not only from your cups of cappuccino, but also from other products (energy drinks, tea, cola, chocolate, cocoa).

The World Health Organization confirms that excess caffeine consumption may be associated with problems (fetal growth restriction, low birth weight, preterm birth or stillbirth).

Is coffee allowed in early pregnancy (first trimester)?

The first trimester is the time when the foundation of the future life is laid, the most exciting and unpredictable. It is during this period that most miscarriages occur. And if we talk about coffee, then, according to studies, such miscarriages in the early stages are indeed more common in women who drink this drink often and a lot. However no one can say for sure whether high caffeine intake is a threat to the fetus or whether constant coffee consumption is a marker of a failed pregnancy (increased aversion to coffee, along with nausea and vomiting, is a feature of a healthy pregnancy).

Thus, we conclude that for a healthy woman with a healthy pregnancy, moderate coffee consumption is quite acceptable .

Can I drink coffee during the second trimester?

The second trimester is the quietest time for a future mother: by this moment the most dangerous milestones have been passed and there is no need to be afraid for the child's viability. Often it is during this period that all those strange and unexpected taste preferences of pregnant women fall, and coffee often becomes such an object of desire. If you do not have strict medical contraindications, you can continue to drink your favorite drink without any worries. The main thing is not to get carried away (remember about 200 mg of caffeine per day). To be completely calm, dilute coffee with milk. To minimize the risks, doctors recommend drinking your coffee in the morning.

Is coffee allowed in late pregnancy (3rd trimester)?

The last trimester again increases the risk that the baby will leave the mother's body earlier than necessary, so if you are not sure about your health and the health of the fetus, it is better to reduce coffee consumption to a minimum at this time. Many studies indicate that in the third trimester of pregnancy, coffee had a negative effect on the condition of the child (premature birth, miscarriage). On the other hand, scientists tend to assume that mothers who drink a lot of coffee in late pregnancy also allow themselves other questionable products (alcohol, tobacco), and this greatly distorts the picture of research.

Benefits and harms of coffee for pregnant women

As we have already found out, many studies have shown that it is unwise to drink coffee (or in general any caffeinated drink) during pregnancy in large quantities. Unfortunately, the publication of this information at one time gave rise to a lot of rewritten materials in which it was no longer possible to trace the connection with the original and see the important mention of the amount of caffeine. Meanwhile, in the case of coffee and pregnancy, the most important thing is not to overdo it (as, indeed, in many other areas of our lives).

Benefits of coffee during pregnancy

Coffee has many pleasant and beneficial effects that do not disappear when a pregnant woman drinks it. So, for example, coffee for pregnant women with low blood pressure might be a good idea. Thanks to the effect of caffeine, the pressure rises and the well-being of the expectant mother improves.

Coffee with milk will also benefit pregnant women: it is a good source of calcium, which is so necessary for the harmonious development of the child and maintaining the health of the mother. Latte is an ideal coffee drink during pregnancy: milk takes up more cup volume, which simultaneously reduces the effect of caffeine and replenishes calcium stores.

Coffee is an effective remedy against edema characteristic of pregnant women (diuretic effect).

Do not forget that it is useful for pregnant women to be in a good mood, and coffee certainly helps to lift it.

Harm of coffee during pregnancy

As we remember, there is a version that caffeine consumption during pregnancy can increase the likelihood of infertility, birth defects, miscarriage, stillbirth, premature birth and fetal growth retardation. However, this version is not sufficiently proven.

But we know for sure that coffee will be harmful to pregnant women who are prone to hypertension (high blood pressure) and tachycardia (rapid heartbeat), as well as to those who have a lack of calcium, potassium and phosphorus (caffeine does little to flush out these elements). Also, coffee is contraindicated in women with hypertonicity (additional stimulation with caffeine can really cause a miscarriage).

Another unpleasant consequence of taking coffee by pregnant women is additional stimulation of the excretory systems. Not a very pleasant thing, given that a woman in position already wants to go to the toilet more often than usual. However, any drink stimulates our kidneys to work more actively, so this is a controversial argument "against".

Which coffee is safer during pregnancy?

If you are not ready to give up coffee, but want to minimize the possible risks, it is worthwhile to figure out in advance which type of coffee is best for you.

Natural bean coffee

Classic coffee made from beans has the highest caffeine content, especially if the coffee is made in Turkish and the blend includes a high percentage of Robusta (this type of coffee has almost twice as much caffeine as Arabica). It is worth drinking no more than one cup a day, and also pay attention to the content of the blend (the ratio of robusta to arabica).

A standard cup of Americano (70 ml. ), Espresso (30 ml.) or Cappuccino (180 ml.) contains about 50-70 mg of caffeine (they use the same amount of coffee - 1 shot).

Instant coffee

Instant coffee contains less caffeine in most cases than coffee beans. Doctors believe that a pregnant woman can afford up to two servings of such a drink. 1 teaspoon (without a slide) of instant coffee contains 30–50 mg of caffeine.

Decaffeinated coffee

Perhaps the safest option is for those who value aroma and ritual more than the effect produced. In decafe, caffeine is removed by 97-99%, which means that any risks are reduced to almost zero. One serving of decaffeinated coffee contains 3 to 6 mg of caffeine.

Alternative to coffee

If for some reason coffee is contraindicated for you (even decaffeinated), but you want to keep your favorite ritual, you can always try to make a replacement and try drinks made from chicory or barley grain. They do not contain caffeine at all.

To summarize

If a pregnant woman and her unborn child have no health problems, it is permissible to drink 1-2 cups of coffee per day with a total caffeine content of no more than 200 mg*.

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