Coffee - for some the word alone conjures up memories of jitters, anxiety, palpitations and insomnia. For others, it can be described as the elixir of life itself, the first thought that pops into your head in the morning, the most comforting and reliable of all drinks.
During pregnancy the caffeine conversation can become heated. Some recommend to abstain entirely, some say 1 cup a day is ok, some may recommend switching to decaf, some say up to 4 cups is ok. It can be challenging to figure out where to draw your own line. Like all things when it comes to health, individual interpretation of the data and choices are key - not all pregnancies and not all pregnant people are created the same. If you had trouble tolerating caffeine before pregnancy, don't start now just because you're pregnant! If you fall into the category of people who tolerate caffeine well and feel like giving it up during pregnancy would be tantamount to torture, then read on.
Perceived or reported issues with caffeine during pregnancy fall into two risk categories
First trimester risk - Miscarriage
Second/Third trimester risk - Fetal development and Preterm delivery.
What do the studies show? In general, pregnant people are a difficult group to study, mostly because they do not generally consent to being tested on. Does that mean it is not safe? Or simply that we don't know? In cases like this researchers often rely on retrospective data - asking people what their habits were during pregnancy and extrapolating safety data accordingly. One confounding factor to these studies - both retrospective and controlled - is the nausea factor. This concept is explored in depth in the excellent resource "Expecting Better" by Emily Oster - a great read if you are looking for facts and explanations in order to make empowered, informed choices during pregnancy. In short, nausea during the first trimester is directly related to better pregnancy outcomes - less incidence of miscarriage. Additionally, when you are nauseous you are less likely to want to drink coffee - the smell alone can be enough to trigger intense nausea. So if people who are nauseous are drinking less coffee and having less miscarriages - this is not because of the coffee, it's because of the nausea. Make sense?
Mice and rats (although morally questionable) are much easier to study. In order to induce problems of either miscarriage, fetal development or preterm labour in pregnant rats, researchers have found the rats need to consume the equivalent of 60 cups of coffee per day. Can you imagine how much you would have to pee??? Clearly, not probable or possible.
Caffeine content varies significantly based on brand and type of beverage.
8 oz cup of Coffee - Brewed or a Espresso based beverage 100-160mg
8 oz Black tea - 20-60mg
8 oz Green tea 20-40mg
12 oz Cola 35 mg
8 oz Hot chocolate 2-8mg
Bottom line: There is very little evidence that consuming up to 300mg (2-3 cups) of coffee daily can negatively affect pregnancy.
Study after study shows that there is NO link between drinking 200mg caffeine daily during all trimesters of pregnancy and any decrease in fetal weight, length or head circumference and no influence on when labour spontaneously occurs.
So, what is a pregnant person to do? Moderation is where it's at.
From an optimal health perspective it is very important to stay well hydrated during pregnancy. Low level dehydration can be responsible for many unpleasant pregnancy complaints such as constipation, headaches, dizziness and fatigue, not to mention low amniotic fluid and preterm labour. Coffee is still a diuretic, meaning it counts against your total hydration status. This is an important factor in deciding what level of caffeine consumption is right for you. If you do develop any palpitations, anxiety, headaches, jitters or insomnia during pregnancy - caffeine can be a culprit. Keep this in mind.
When it comes to safety however, all evidence supports the safety of up to 2 cups of coffee daily. More than that? Switch to water or herbal tea. Try one of Dr Dori's Pregnan-Teas. It doesn't taste like coffee, but it is nourishing, uplifting and totally safe.
As always, please don't hesitate to reach out if you have any questions or clarifications. I'm here to help.