Alternatives to Coffee During Pregnancy

Every year, over 200 million women in the world ask themselves the same question: “What can I drink now that I’m pregnant?” Let’s explore the possible options for expectant mothers and also identify unsuspected sources of caffeine in beverages.

Risks associated with coffee consumption during pregnancy

During pregnancy, the health of both the mother and the fetus is of primary importance. Concerning caffeine intake during this phase and during breastfeeding, various studies have highlighted potential risks associated with its consumption. Caffeine can cross the placenta and reach the fetus, and excessive amounts of this substance may be linked to an increased risk of miscarriage and premature birth [1]. Moreover, some studies suggest that high caffeine intake could be associated with an increased risk of fetal developmental delays and low birth weight [2]. Current guidelines recommend limiting caffeine intake during pregnancy to approximately 200-300 mg per day [3].

If you want to know more about drinking coffee during pregnancy, read: The Impact of Caffeine Consumption on Pregnancy and Breastfeeding

World Health Organization’s Recommendations

The World Health Organization (WHO) provides clear guidelines regarding caffeine consumption during pregnancy, recognizing its presence in various sources such as tea, coffee, non-alcoholic beverages, chocolate, and some over-the-counter medications. In particular, coffee stands out as one of the most common sources of high caffeine intake. The WHO’s intervention, updated on August 9, 2023, emphasizes the significant slowdown in caffeine clearance from the mother’s bloodstream during pregnancy [4]. In pharmacology, clearance indicates the organs’ ability to eliminate a drug from the body, specifically referring to the volume of plasma (or blood) that the kidneys can purify of a substance in a given time unit, degrading it to urea, which is then eliminated through urine. During pregnancy, the mother’s ability to clear caffeine decreases, potentially leading to associations between excessive caffeine consumption and adverse outcomes, such as decreased fetal growth, reduced birth weight, premature birth, or fetal death.

In light of these results, the WHO specifically addresses pregnant women with a high daily caffeine consumption, i.e., exceeding 300 mg. The organization recommends reducing daily caffeine intake during pregnancy. Therefore, adhering to these WHO guidelines represents a preventive measure for expectant mothers against adverse pregnancy outcomes associated with excessive caffeine consumption.

The information mentioned above is available in the document “WHO recommendations on antenatal care for a positive pregnancy experience.” This document provides comprehensive guidelines on prenatal care, including specific recommendations for caffeine consumption during pregnancy. You can consult the official WHO document on “WHO recommendations on antenatal care for a positive pregnancy experience” here.

European Food Safety Authority Guidelines

The Scientific Opinion on the safety of caffeine from the European Food Safety Authority (EFSA) provides a thorough assessment of caffeine consumption safety. Following a request from the European Commission, the EFSA’s expert group on Dietary Products, Nutrition, and Allergies was tasked with providing a scientific opinion on the subject, offering advice on caffeine amounts from all food sources that do not raise concerns for the general health of the population and its subgroups.

According to the EFSA’s scientific opinion, habitual caffeine consumption up to 200 mg per day in pregnant women and up to 200 mg per day in breastfeeding women poses no safety concerns for the fetus or newborn.

The Italian Ministry of Health relies on these EFSA indications to formulate guidelines on the safety of caffeine consumption in the population [5].

Main Alternatives to Coffee During Pregnancy

The possible alternatives to coffee during pregnancy are numerous; we’ll list just a few, such as Rooibos, Green Tea, and Decaffeinated Tea.

Rooibos, originating from South Africa, stands out for its caffeine-free nature and richness in antioxidants. Its well-known anti-inflammatory and relaxing properties can provide a flavourful experience without the associated risks of caffeine [6]. Scientific studies suggest Rooibos might even have health benefits, contributing to blood pressure control and immune system improvement [7].

Green Tea is renowned for its antioxidant properties and potential heart health benefits. With a lower caffeine content than coffee, it can be a balanced choice for pregnant women. However, it’s essential to monitor overall caffeine intake, considering other potential sources from the daily diet [6].

Decaffeinated Tea remains a popular choice for those who want to enjoy the warmth and comfort of a teacup without the stimulating effects of caffeine. The decaffeination process significantly reduces caffeine content, making this beverage a safe option for pregnant women. Choosing reliable brands is crucial to ensure proper decaffeination [6].

Beverages Not Considered Coffee Alternatives

Now, let’s delve into the unsuspected ones – beverages that may seem innocuous but are not considered entirely safe. Here are some examples:

Not all drinks commonly associated with coffee alternatives are recommended during pregnancy. Some infusions, such as Hibiscus, Nettle Tea, and Black Tea, may pose risks and should be avoided in certain circumstances.

Hibiscus, known for its vibrant color and tangy taste, carries the risk of lowering blood pressure and interacting with certain medications. During pregnancy, where blood pressure monitoring is crucial, consuming this beverage should be limited or avoided [8].

Nettle Tea, often linked to health benefits, may have a potential uterine-stimulating effect during pregnancy, leading to contractions. Some experts advise against nettle tea consumption during the first trimester to reduce the risk of uterine contractions. The American Pregnancy Association considers it “likely unsafe,” although the Natural Medicines Database rates nettle as probably unsafe. This discrepancy might relate to which part of the nettle plant is used – the root or the leaves – and how much is consumed. Some sources encourage nettle use during pregnancy for its health benefits.

Black Tea, while containing less caffeine than coffee, still holds a significant amount. Excessive caffeine consumption is associated with pregnancy risks, so carefully monitoring total caffeine intake is essential [9].

In conclusion, it is crucial to be aware of beverages that, despite their popularity, might not be safe during pregnancy. Consulting with a healthcare professional to assess the suitability of such drinks based on individual conditions is always recommended. According to the American Pregnancy Association, these are some ingredients you might find in herbal teas, with some having a doubtful safety rating. Safety ratings provided here come from the Natural Medicines Database.

Tea and Herbal Infusions: The Main Differences

Herbal infusions often provide an additional source of nutrients such as calcium, magnesium, and iron. However, due to the lack of studies on many herbs, the Food and Drug Administration (FDA), a United States government agency tasked with protecting and promoting public health through the regulation and supervision of food products, recommends caution when consuming herbal infusions.

There are true teas and herbal teas, or more accurately, herbal infusions.

True teas are derived from the tea plant’s leaves and come in only three types: black, green, and oolong. They all contain caffeine but in varying percentages, along with different quantities of antioxidants.

The greater the leaf’s oxidation (fermentation), the higher the caffeine level. Infusion time, leaf size, and leaf type can also influence the tea’s caffeine content. Decaffeinated teas still contain some caffeine.

Herbal Infusions during Pregnancy: Considerations and Conclusions

Herbal infusions are made from the roots, berries, flowers, seeds, and leaves of plants other than the tea plant. Herbal infusions do not contain caffeine. These infusions can also be used as medicinal remedies, either related to or possessing medicinal properties.

Since herbal infusions are naturally caffeine-free, they do not pose specific concerns from this perspective. However, as mentioned earlier, not all herbal infusions are harmless during pregnancy.

Concerns about consuming herbal infusions during pregnancy stem from the lack of available data on various herbs and their effects on a developing fetus. There are conflicting opinions on the safety of herbal infusions, both for pregnant and non-pregnant women.

Most commercially produced brands of herbal infusions are considered safe for anyone consuming them in reasonable quantities. Herbal infusions deemed unsafe include those not made commercially, those made with excessive amounts of herbs (quantities exceeding those found in common foods or beverages), and those made with herbs known to be toxic.

In conclusion, exploring alternatives to coffee during pregnancy requires a balanced approach in light of available scientific evidence. The discussed alternatives, such as Rooibos, Green Tea, and Decaffeinated Tea, are supported by research emphasizing their safety during pregnancy.

However, it is crucial to note that some beverages commonly perceived as alternatives, such as Hibiscus, Nettle Tea, and Black Tea, may present risks and require increased caution.

The recommendations of the World Health Organization and the Ministry of Health provide a general framework. The health of both the mother and the child should always remain at the forefront of dietary choices. Awareness and understanding of the specifics of each beverage can contribute to a more peaceful and risk-free pregnancy.

References

1. Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016 May;19(7):1233-44. doi: 10.1017/S1368980015002463. Epub 2015 Sep 2. PMID: 26329421; PMCID: PMC10271029. https://pubmed.ncbi.nlm.nih.gov/26329421/
2. CARE Study Group. Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study. BMJ. 2008 Nov 3;337:a2332. doi: 10.1136/bmj.a2332. Erratum in: BMJ. 2010;340. doi: 10.1136/bmj.c2331. PMID: 18981029; PMCID: PMC2577203. https://pubmed.ncbi.nlm.nih.gov/18981029/
3. American College of Obstetricians and Gynecologists. (2020). ACOG Committee Opinion No. 462: Moderate caffeine consumption during pregnancy. Obstet Gynecol. 2010 Aug;116(2 Pt 1):467-468. doi: 10.1097/AOG.0b013e3181eeb2a1. PMID: 20664420. https://pubmed.ncbi.nlm.nih.gov/20664420/
4. WHO recommendations on antenatal care for a positive pregnancy experience: https://www.who.int/publications/i/item/9789241549912
5. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2015. Scientific Opinion on the safety of caffeine. EFSA Journal 2015; 13(5):4102, 120 pp. doi: 2903/j.efsa.2015.4102 ; https://www.efsa.europa.eu/en/efsajournal/pub/4102
6. Von Gadow, E. Joubert, C.F. Hansmann, Comparison of the antioxidant activity of rooibos tea (Aspalathus linearis) with green, oolong and black tea, Food Chemistry, Volume 60, Issue 1, 1997, Pages 73-77, ISSN 0308-8146, https://doi.org/10.1016/S0308-8146(96)00312-3. (https://www.sciencedirect.com/science/article/pii/S0308814696003123)
7. Afrifa D, Engelbrecht L, Eijnde BO, Terblanche E. The health benefits of rooibos tea in humans (aspalathus linearis)-a scoping review. J Public Health Afr. 2023 Dec 1;14(12):2784. doi: 10.4081/jphia.2023.2784. PMID: 38204815; PMCID: PMC10774856.; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774856/
8. Diane L. McKay, C-Y. Oliver Chen, Edward Saltzman, Jeffrey B. Blumberg,Hibiscus Sabdariffa L. Tea (Tisane) Lowers Blood Pressure in Prehypertensive and Mildly Hypertensive Adults,The Journal of Nutrition,Volume 140, Issue 2, 2010, Pages 298-303, ISSN 0022-3166, https://doi.org/10.3945/jn.109.115097; https://www.sciencedirect.com/science/article/pii/S0022316622069632;
9. “Caffeine content for coffee, tea, soda and more,” https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/caffeine/faq-20058459

Disclaimer

The information contained herein is not and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise or treatment, always consult your doctor or a qualified health professional.

The guidance provided may not be appropriate for your specific situation. Never make any decisions about your health based solely on the information provided in this article.

The author and creator of this article are not responsible for any damage or loss resulting from the improper use of the information presented here. Remember that each person is unique and therefore needs a personalized approach to health.

If you have any concerns about your health, please consult a qualified medical professional.

Caffeine: Is there really a right dose?

Introduction

With its 177 million bags sold worldwide, coffee remains one of the most consumed and appreciated beverages globally in 2024 [1]. Coffee consumption is a widespread phenomenon with deep cultural roots intertwined with the daily habits of millions [2]. While coffee offers benefits, it also exposes consumers to risks associated with caffeine, a mild stimulant that has become a part of everyday life [3]. But what is caffeine, and what are its main effects?

Guess what the caffeine molecule looks like

From a chemical standpoint, caffeine is a xanthine with three methyl groups attached to nitrogen at positions 1, 3, and 7, earning it the name 1, 3, 7 trimethylxanthine. Its unique structure allows it to occupy the space of a crucial neurotransmitter in the bodies of those who consume it. Let’s explore further [4].

The molecular structure of caffeine is similar to adenosine. Caffeine can substitute for adenosine by binding to its receptors in brain cells [4]. However, the two molecules have completely different effects. Adenosine promotes relaxation and depresses the central nervous system, slowing down nerve cell activity. Conversely, caffeine does the opposite, reducing fatigue, creating alertness, and increasing nerve cell activity. The result is a temporary feeling of increased wakefulness and energy [5].

What happens to caffeine in the human body?

Caffeine is typically consumed orally and rapidly spreads through all tissues, crossing the blood-brain barrier and the placenta of pregnant women. To learn more about risks related to caffeine intake during pregnancy, read: The Impact of Caffeine Consumption on Pregnancy and Breastfeeding.

Once in circulation, caffeine reaches its peak plasma concentration within two hours and has a variable half-life ranging from a minimum of 2.5 to a maximum of 4.5 hours [6]. Factors like pregnancy, alcohol consumption, or the use of medications such as contraceptives, cimetidine, disulfiram, and allopurinol further influence the molecule’s half-life [7]. Ingesting 100 mg of caffeine produces plasma concentrations between 1.5 and 1.8 mg/ml [7].

The liver predominantly eliminates caffeine, breaking it down into 1-methyluric acid, 1-methylxanthine, and 7-methylxanthine [8, 9, 10]. About 10% remains unchanged and is excreted through urine. The cytochrome P450 enzyme is directly involved in caffeine metabolism in the liver [11, 12].

According to James Lane, an emeritus professor of psychiatry at the Duke University School of Medicine in Durham, North Carolina, not all caffeine disappears after 8 hours. It might take up to 12 hours to completely eliminate caffeine from a morning cup of coffee. As a result, the drug’s effect often fades when a person is almost ready for bed, making it easier for people to develop caffeine dependence as they desire to continue drinking it the next day [13].

Which plants produce caffeine and why?

Plants that produce caffeine include coffee (Coffea spp.), tea (Camellia sinensis), cocoa (Theobroma cacao), yerba mate (Ilex paraguariensis), and certain guarana plants (Paullinia spp.) [14]. Even mate, often called tea, is a beverage containing caffeine.

Caffeine’s role in plants is intriguing. This alkaloid acts as a natural insecticide, toxic to many insects [15]. Present in varying quantities in fruits, leaves, and other parts of the plant, caffeine interferes with the nervous system of insects, causing their death or discouraging them from attacking the plant again [16]. Besides insects, herbivores are also deterred from feeding on plant parts [17]. Additionally, caffeine serves as an antimicrobial agent, protecting the plant from pathogenic microorganisms [15]. Thus, caffeine is a part of the plant’s natural defense strategy against microorganisms, insects, and other predators [15].

While caffeine is naturally found in the mentioned plants, it can also be present in unexpected places, being added to a wide range of products. Therefore, it is crucial to know the sometimes unsuspected sources of caffeine.

Unexpected Sources of Caffeine

Today, it’s possible to purchase bottled water with added caffeine, caffeinated gummy candies, mints, peanut butter, and chewing gum [18]. There are even caffeinated bath soaps designed to help people wake up in the morning. Caffeine has also been added to hair care products such as shampoos and other beauty items like eye creams, scrub lotions, and shaving creams [22].

Although caffeine can be absorbed through the skin, the primary mode of caffeine intake remains oral. Therefore, supplements and medications containing caffeine are the elements to consider if one wishes to monitor their daily caffeine intake [18, 20, 21, 22]. Caffeine can be present in migraine medications, as well as pain relievers and those targeting menstrual pain. It is also sold in the form of caffeine pills, each containing 200 milligrams per tablet [19, 20]. Furthermore, caffeine is found in some weight loss products and dietary supplements [18, 20, 21, 22]. It may be labeled as guaraná, cola nut, yerba mate, green tea extract, or green coffee bean extract, according to the National Institutes of Health [20].

Considering that, according to the European Food Safety Authority (EFSA), single doses of caffeine up to 200 mg (approximately 3 mg/kg of body weight for a 70 kg adult) pose no safety concerns [23], it is prudent to check for the presence of caffeine in medications and supplements to avoid excessive intake.

A healthy daily dose of caffeine can vary significantly from person to person. When doctors talk about moderate caffeine consumption, they refer to an amount ranging between 2 and 300 milligrams. Most coffee consumers tend to fall within this range. Beyond this, 300 milligrams might be perfect for one person but excessive for another. Variability is considerable and depends on factors such as body size, smoking habits, and genetic predisposition to metabolize caffeine slowly [25]. It would be unwise to assert that a specific amount is perfect or excessive.

Women taking contraceptives metabolize caffeine twice as slowly, meaning they get twice the stimulation from the same cup of coffee [24]. Conversely, smokers metabolize it twice as quickly [25]. Some individuals have a genetic predisposition to metabolize caffeine slowly, and they are the ones who will be particularly sensitive to caffeine [25].

Inconsistency in Caffeine Content: A Challenge in Determining the Right Dose

There is no standardized amount of caffeine in each cup of coffee, not even within the same brand.

In a study led by researcher Bruce Goldberger, published in the Journal of Analytical Toxicology [26], it was found that coffees marketed as decaffeinated had caffeine concentrations below 17.7 mg per serving. The caffeine content in caffeinated coffees varied from 58 to 259 mg per serving. The average caffeine content in specialty brewed coffees was 188 mg per 16-ounce cup, just over 470 mL—a substantial amount by European standards but a typical serving size in American-style coffee shops like Starbucks.

Another noteworthy discovery was the wide range of caffeine concentrations (259-564 mg/serving) in the same coffee beverage obtained from the same outlet over six consecutive days. Goldberger found that caffeine levels more than doubled for the same blend within as short a time frame as a week. This implies that we cannot rely on the typical cup of coffee to determine our caffeine intake, as it may vary from day to day, even doubling.

Goldberger is not the only one making such findings. In a study, researchers from the School of Public Health at Griffith University in Australia [27] analyzed ninety-seven samples of espresso. The average caffeine amount was 106 (±38) mg per serving with a concentration of 2473 (± 1092) mg/L. There was a considerable variation in caffeine content, with a per-serving range of 25-214 mg and a concentration range of 580-7000 mg/L. Twenty-four samples (24.7%) contained 120 mg of caffeine or more, and 12 samples (12.3%) exceeded 167 mg per serving.

Therefore, not only American-style coffees but also more European espressos exhibit extremely variable caffeine content.

Conclusions

Caffeine is the protagonist of the mornings for millions worldwide, possessing extraordinary properties. However, determining the right dose for each individual remains challenging. Caffeine may have a much better or worse effect on each of us than clinical studies suggest. In this case, the saying “the dose makes the poison” holds true.

What is the “right” dose?

We all wonder, and there is no one-size-fits-all answer. It depends on our age, body composition, physical activity, existing health conditions, pregnancy status, and the medications we are taking. There is no universal dose for each of us, as every body is different. The EFSA guidelines recommend 200 mg per day, but even this amount could be excessive for caffeine-sensitive individuals or those in specific physical conditions.

Therefore, the crucial thing to know about caffeine is that the right dose needs to be calibrated individually.

References

1. International Coffee Organization (ICO): https://icocoffee.org/documents/cy2023-24/Coffee_Report_and_Outlook_December_2023_ICO.pdf
2. Barrea L, Pugliese G, Frias-Toral E, El Ghoch M, Castellucci B, Chapela SP, Carignano MLA, Laudisio D, Savastano S, Colao A, Muscogiuri G. Coffee consumption, health benefits and side effects: a narrative review and update for dietitians and nutritionists. Crit Rev Food Sci Nutr. 2023;63(9):1238-1261. doi: 10.1080/10408398.2021.1963207. Epub 2021 Aug 28. PMID: 34455881. https://pubmed.ncbi.nlm.nih.gov/34455881/

3. Butt MS, Sultan MT. Coffee and its consumption: benefits and risks. Crit Rev Food Sci Nutr. 2011 Apr;51(4):363-73. doi: 10.1080/10408390903586412. PMID: 21432699. https://pubmed.ncbi.nlm.nih.gov/21432699/

4. Ribeiro JA, Sebastião AM. Caffeine and adenosine. J Alzheimers Dis. 2010;20 Suppl 1:S3-15. doi: 10.3233/JAD-2010-1379. PMID: 20164566. https://pubmed.ncbi.nlm.nih.gov/20164566/

5. Reichert CF, Deboer T, Landolt HP. Adenosine, caffeine, and sleep-wake regulation: state of the science and perspectives. J Sleep Res. 2022 Aug;31(4):e13597. doi: 10.1111/jsr.13597. Epub 2022 May 16. PMID: 35575450; PMCID: PMC9541543. https://pubmed.ncbi.nlm.nih.gov/35575450/

6. Vanderlee L, Reid JL, White CM, Acton RB, Kirkpatrick SI, Pao CI, Rybak ME, Hammond D. Evaluation of a 24-Hour Caffeine Intake Assessment Compared with Urinary Biomarkers of Caffeine Intake among Young Adults in Canada. J Acad Nutr Diet. 2018 Dec;118(12):2245-2253.e1. doi: 10.1016/j.jand.2018.07.016. PMID: 30497637; PMCID: PMC10074169. https://pubmed.ncbi.nlm.nih.gov/30497637/

7. Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet. 2000 Aug;39(2):127-53. doi: 10.2165/00003088-200039020-00004. PMID: 10976659. https://pubmed.ncbi.nlm.nih.gov/10976659/

8. Singh D, Kashyap A, Pandey RV, Saini KS. Novel advances in cytochrome P450 research. Drug Discov Today. 2011 Sep;16(17-18):793-9. doi: 10.1016/j.drudis.2011.08.003. Epub 2011 Aug 16. PMID: 21864709. https://pubmed.ncbi.nlm.nih.gov/21864709/

9. Jana S, Paliwal J. Molecular mechanisms of cytochrome p450 induction: potential for drug-drug interactions. Curr Protein Pept Sci. 2007 Dec;8(6):619-28. doi: 10.2174/138920307783018668. PMID: 18220847. https://pubmed.ncbi.nlm.nih.gov/18220847/

10. Zhao M, Ma J, Li M, Zhang Y, Jiang B, Zhao X, Huai C, Shen L, Zhang N, He L, Qin S. Cytochrome P450 Enzymes and Drug Metabolism in Humans. Int J Mol Sci. 2021 Nov 26;22(23):12808. doi: 10.3390/ijms222312808. PMID: 34884615; PMCID: PMC8657965. https://pubmed.ncbi.nlm.nih.gov/34884615/

11. Manikandan P, Nagini S. Cytochrome P450 Structure, Function and Clinical Significance: A Review. Curr Drug Targets. 2018;19(1):38-54. doi: 10.2174/1389450118666170125144557. PMID: 28124606. https://pubmed.ncbi.nlm.nih.gov/28124606

12. Chen L, Bondoc FY, Lee MJ, Hussin AH, Thomas PE, Yang CS. Caffeine induces cytochrome P4501A2: induction of CYP1A2 by tea in rats. Drug Metab Dispos. 1996 May;24(5):529-33. PMID: 8723732. https://pubmed.ncbi.nlm.nih.gov/8723732/

13. Lane JD, Hwang AL, Feinglos MN, Surwit RS. Exaggeration of postprandial hyperglycemia in patients with type 2 diabetes by administration of caffeine in coffee. Endocr Pract. 2007 May-Jun;13(3):239-43. doi: 10.4158/EP.13.3.239. PMID: 17599854. https://pubmed.ncbi.nlm.nih.gov/17599854

14. Tarka SM, Hurst WJ. Introduction to the chemistry, isolation, and biosynthesis of methylxanthines. InCaffeine 2019 Apr 23 (pp. 1-11). CRC Press. https://doi.org/10.1201/9780429126789

15. Hiroshi Ashihara, Takeo Suzuki. Distribution and biosynthesis of caffeine in plants. Front. Biosci. (Landmark Ed) 2004, 9(2), 1864–1876. https://doi.org/10.2741/1367
16. Tremblay S, Zeng Y, Yue A, Chabot K, Mynahan A, Desrochers S, Bridges S, Ahmad ST. Caffeine Delays Ethanol-Induced Sedation in Drosophila. Biology (Basel). 2022 Dec 30;12(1):63. doi: 10.3390/biology12010063. PMID: 36671755; PMCID: PMC9855986. https://pubmed.ncbi.nlm.nih.gov/36671755/

17. Mustard JA. The buzz on caffeine in invertebrates: effects on behavior and molecular mechanisms. Cell Mol Life Sci. 2014 Apr;71(8):1375-82. doi: 10.1007/s00018-013-1497-8. Epub 2013 Oct 26. PMID: 24162934; PMCID: PMC3961528. https://pubmed.ncbi.nlm.nih.gov/24162934/

18. Fulgoni VL 3rd, Keast DR, Lieberman HR. Trends in intake and sources of caffeine in the diets of US adults: 2001-2010. Am J Clin Nutr. 2015 May;101(5):1081-7. doi: 10.3945/ajcn.113.080077. Epub 2015 Apr 1. PMID: 25832334. https://pubmed.ncbi.nlm.nih.gov/25832334/

19. Drewnowski A, Rehm CD. Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location. Nutrients. 2016 Mar 10;8(3):154. doi: 10.3390/nu8030154. PMID: 26978391; PMCID: PMC4808882. https://pubmed.ncbi.nlm.nih.gov/26978391/

20. Frary CD, Johnson RK, Wang MQ. Food sources and intakes of caffeine in the diets of persons in the United States. J Am Diet Assoc. 2005 Jan;105(1):110-3. doi: 10.1016/j.jada.2004.10.027. Erratum in: J Am Diet Assoc. 2008 Apr;108(4):727. PMID: 15635355. https://pubmed.ncbi.nlm.nih.gov/15635355/
21. Mladenov K, SunariĆ S. Caffeine in Hair Care and Anticellulite Cosmetics: Sample Preparation, Solid-Phase Extraction, and HPLC Determination. J Cosmet Sci. 2020 Sep/Oct;71(5):251-262. PMID: 33022196. https://pubmed.ncbi.nlm.nih.gov/33022196/

22. Otberg N, Teichmann A, Rasuljev U, Sinkgraven R, Sterry W, Lademann J. Follicular penetration of topically applied caffeine via a shampoo formulation. Skin Pharmacol Physiol. 2007;20(4):195-8. doi: 10.1159/000101389. Epub 2007 Mar 29. PMID: 17396054. https://pubmed.ncbi.nlm.nih.gov/17396054/

23. EFSA Panel on Dietetic Products, Nutrition and Allergies https://www.efsa.europa.eu/en/efsajournal/pub/4102
24. Patwardhan RV, Desmond PV, Johnson RF, Schenker S. Impaired elimination of caffeine by oral contraceptive steroids. J Lab Clin Med. 1980 Apr;95(4):603-8. PMID: 7359014. https://pubmed.ncbi.nlm.nih.gov/7359014/

25. Nehlig A. Interindividual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption. Pharmacol Rev. 2018 Apr;70(2):384-411. doi: 10.1124/pr.117.014407. Epub 2018 Mar 7. PMID: 29514871. https://pubmed.ncbi.nlm.nih.gov/29514871/

26. Rachel R. McCusker, Bruce A. Goldberger, Edward J. Cone, Caffeine Content of Specialty Coffees, Journal of Analytical Toxicology, Volume 27, Issue 7, October 2003, Pages 520–522, https://doi.org/10.1093/jat/27.7.520
27. Desbrow B, Hughes R, Leveritt M, Scheelings P. An examination of consumer exposure to caffeine from retail coffee outlets. Food Chem Toxicol. 2007 Sep;45(9):1588-92. doi: 10.1016/j.fct.2007.02.020. Epub 2007 Feb 23. PMID: 17412475. https://pubmed.ncbi.nlm.nih.gov/17412475/

Disclaimer

The information contained here is not intended to replace professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise, or treatment regimen, always consult with your doctor or a qualified healthcare professional.

The provided guidelines may not be suitable for your specific situation. Never make any health-related decisions solely based on the information provided in this article.

The author and creator of this article are not liable for any damages or losses resulting from the improper use of the information presented here. Remember that each person is unique and requires a personalized approach to health.

For any health concerns, consult with a qualified medical professional.

The Impact of Caffeine Consumption on Pregnancy and Breastfeeding

Is it worth to consume caffeine while pregnant or during lactation?

Introduction

A cup of coffee remains the most socially accepted way to get a rush of caffeine, the drug of happiness, in our bodies.

From the very beginning through the Literary Cafés, where, thanks to this new drink, ideas flowed faster and people felt more alive and alert, coffee has gained its reputation as the invigorating drink par excellence both in Europe and in the United States.

The caffeine present in coffee and many other drinks is viewed with suspicion by many pregnant women who are regular coffee consumers.

But not all coffees are the same! American coffee, espresso coffee, and Turkish coffee can vary a lot in their caffeine content [1].

Let’s find out how much caffeine the different types of coffee in the world contain and the amount of coffee that pregnant women around the world can drink with pleasure avoiding risks for themselves and their babies.

What’s caffeine?

Caffeine is a xanthine alkaloid and protects several parts of the coffee plant from being eaten or attacked by insects or animals. Basically, it acts as a natural pesticide.

Over the course of their evolution and in order not to be eaten, plants controlled the behaviour of animals—and, indirectly, us by producing caffeine [2].

As regards the human body, the stimulant effects of caffeine are primarily due to its ability to resemble adenosine, a neurotransmitter that promotes sleep and relaxation. Caffeine is structurally similar to adenosine and can occupy the same receptors. By blocking adenosine receptors, caffeine prevents the calming effects associated with adenosine binding [3].

This leads to increased neuronal activity and the release of neurotransmitters like dopamine and norepinephrine. Dopamine is associated with pleasure and reward, while norepinephrine is involved in the body’s “fight or flight” response. The level of alertness increases and the perception of fatigue is temporarily reduced [4].

That’s why caffeine is so beloved.

Variables affecting the percentage of caffeine in coffee

The quantity of caffeine present in a coffee depends on various factors ranging from the variety of coffee to the type of extraction [1]. Among these, the type of extraction is the element that most influences the final caffeine content, as the latter is soluble in water.

The longer the water is in contact with the coffee, the higher the caffeine content of the resulting drink will be. But let’s go into more detail and see how the various ways of preparing coffee influence the final caffeine content of the product.

The habits of coffee drinking vary across cultures, for example, Italy is known for its expresso while Nord European countries prefer long coffee such as Filter Kaffee in Germany or lightly roasted coffee in Finland. The American coffee is once again different from the styles mentioned above, as well as the Turkish coffee.

Additionally, variations in extraction methods, such as French press versus pour-over, contribute to the diversity of caffeine levels in the final cup. Finally, the brewing method significantly impacts caffeine content.

The landscape of coffee consumption is complicated and even more so during pregnancy.

Accordingly, it becomes essential to consider not only the cultural differences in coffee preferences but also the inherent variations in caffeine content. Understanding that a shot of espresso may differ significantly from a standard brewed cup is crucial when adhering to recommended guidelines for safe caffeine intake during this particular moment of a woman’s life.

Table 1: Factors influencing caffeine content in coffee brews [1]

Which aspects have a major influence on the amount of caffeine?

The temperature of water used for brewing and the brewing techniques significantly impact the caffeine content in coffee.

Using hotter water in the brewing process extracts more caffeine from the coffee grinds. Brewing methods that fully submerge the coffee grinds result in coffee with increased caffeine levels compared to pour-over methods.

There are several brewing methods according to the different world cultures and traditions in coffee consumption, this makes it even worse to evaluate the amount of coffee a pregnant woman can drink per day respecting the indications of the World Health Organization.

Let’s consider the most common types of brewing methods and their caffeine content.

Infographic 1: Extraction methods of coffee around the world

In the study conducted by Crema Coffee Garage and the University of Newcastle the caffeine content of the espresso, stovetop espresso, pour-over (filter brew), cold brew, and French press (plunger) was measured not only according to the aspects influencing the brewing method but it was also reported to the serving size [21].

The results were pretty interesting, when compared milliliter to milliliter (mL) with other brew methods, espresso contains the biggest amount of caffeine, as shown in the table below.

Table 2: Coffee Types and Caffeine Content (mg/L) [21]

However, the amount of caffeine per serve depends on serving size, which is not equal for all methods as each brew is served differently.

The open question about caffeine is the correspondence between the amount suggested by the World Health Organization, that is 300 mg for pregnant women, and the serving size according to the differences existing all over the world.

According to the measurements of the mentioned study, a pregnant woman can drink 60 mL or 2-oz of Espresso, 100 mL of Stovetop Espresso, 90 mL of Cold Brew, 300 mL of French Press, 250 mL or 8-oz of Filter Coffee (Filter Kaffee in Germany).

Table 3: Caffeine content according to Mug Size [21]

According to the study, a pregnant woman can drink a cup of expresso (60 mL) per day, or 300 mL of French Press Coffee and the amount of caffeine will remain pretty similar but the amount of liquid is 5 times more.

So, the brewing method makes a great difference in the amount of coffee and the serving size that we can drink.

For the ones who like to drink coffee even when pregnant, a solution could be to make a change from expresso to French Press or Pour-over.

Let’s analyze some alternatives like decaffeinated, instant, and moka coffees.

Decaffeinated brewed

Even if during decaffeination, about 97% of caffeine is removed, a typical cup of decaf coffee still has about 2 mg of caffeine. It is not a lot, compared to a typical cup of regular coffee, but it is not completely absent [22].

Instant coffee

Instant coffee usually contains less caffeine than freshly brewed coffee. A typical 8-oz cup of regular instant coffee contains about 62 mg of caffeine [23].

Moka Pot

A study conducted by the College of Newcastle outlines that a Moka pot-brewed 100 ml (around 3.4 ounces) of coffee contains generally 219 mg of caffeine, implying a considerable caffeine substance. In comparison, the French press yields almost 74 mg of caffeine in a comparable volume of brew, making it around three times less caffeinated [24].

Be that as it may, there’s a caveat to this comparison. French presses by and large create a bigger volume of coffee per serving. The commonplace service cup of French press coffee is around 100 ml (3.4 oz), whereas a service cup of Moka pot coffee is approximately 30 ml (1 oz). Thus, when considering a single serving of coffee for each strategy, the caffeine substance per cup remains moderately reliable.

Mechanisms of action: how it overcomes the fetal barrier, which substances can increase caffeine absorption.

Do you know what passive diffusion is?

Passive diffusion is the classic mechanism through which molecules pass from a solution of higher concentration to a solution of lower concentration. In this case, the solution with the highest concentration is the maternal blood while the placenta is the part with the lowest concentration.

Thanks to this mechanism, the baby receives oxygen and nutrients but unfortunately also medicines, drugs, or potentially toxic substances taken by the mother during pregnancy [7].

Caffeine is a water-soluble and rather small molecule. It is, therefore, able to pass from the maternal bloodstream to the placenta without any difficulty. Caffeine is then metabolized in the liver [11].

However, a child’s liver is not able to metabolize caffeine in the same way as an adult’s liver. The time it takes for the amount of a drug in the body to decrease by 50% during elimination is called the half-life (T/2) [5].

The half-life of caffeine in the child is longer than in the mother. The caffeine that enters the circulation, therefore, remains much longer in the child’s body than in the mother’s body [5].

The child has a limited ability to metabolize and eliminate substances; therefore, caffeine can accumulate in the tissues of the embryo in higher doses than in the maternal tissues [5,8].

The consequences involve an increased risk of preterm birth and low birth weight. The choice to eliminate or significantly reduce the doses of caffeine by the future mother is, therefore, desirable to minimize the risks due to the accumulation of caffeine in the embryo [9,10].

What are the risks during pregnancy?

Major risks associated with caffeine consumption during pregnancy include stunted baby growth and an elevated risk of miscarriage. As always, it’s essential to consider the dose as the determining factor [7].

Caffeine exerts adverse effects on successful pregnancy development, necessitating limitation of its use. Specifically, heightened caffeine intake during pregnancy can elevate fetal catecholamine levels, leading to increased fetal heart rate, placental vasoconstriction, and compromised fetal oxygenation. Therefore, immediate treatment is imperative for cases of caffeine intoxication in pregnant women [1,11].

Subsequently, we will explore the permissible milligrams of caffeine to avert the aforementioned risks and the corresponding amounts in various types of coffee.

Out of the 1,063 pregnant women interviewed, 172 experienced miscarriages. The investigation revealed an escalated risk of miscarriage with higher caffeine levels, showing an adjusted hazard ratio of 2.23 (95% confidence interval [CI] 1.34–3.69) for an intake of 200 mg per day or more [4, 5].

In addressing coffee during pregnancy, the World Health Organization recommends limiting caffeine intake to 300 mg daily. In Italy, this is reduced to 200 mg based on the Ministry of Health’s guidelines [6].

However, caution is necessary, as caffeine is present not only in coffee but also in other beverages and foods containing nerve-stimulating substances such as tea, chocolate, and energy drinks.

Equally important is vigilance in tea consumption due to the presence of theine and catechins, which can interfere with folic acid absorption. This substance is crucial for preventing fetal malformations, particularly in the case of black tea [2].

Doses allowed during lactation

The elimination time of caffeine during the latter stages of pregnancy is significantly prolonged compared to nonpregnant women [12]. Nevertheless, maternal caffeine half-life normalizes within the initial week after childbirth. Caffeine manifests in breast milk, typically reaching its peak about an hour after maternal consumption [13]. Its presence in breast milk occurs swiftly following ingestion. Unfortunately, there is a lack of sufficient high-quality data to formulate evidence-based recommendations regarding safe maternal caffeine intake.

Infants born to mothers with exceptionally high caffeine consumption, equivalent to around 10 or more cups of coffee daily, have exhibited signs of fussiness, jitteriness, and disrupted sleep patterns [14]. Conversely, studies involving mothers consuming 5 cups of coffee daily showed no discernible stimulation in breastfed infants aged 3 weeks and older [15,16].

Other sources of caffeine, including cola, energy drinks, yerba mate, or guarana, are likely to induce similar dose-dependent effects on breastfed infants [17]. Notably, a daily coffee intake exceeding 450 mL may lead to decreased iron concentrations in breast milk, potentially resulting in mild iron deficiency anaemia in some breastfed infants [18].

The consequences involve an increased risk of preterm birth and low birth weight. The choice to eliminate or significantly reduce the doses of caffeine by the future mother is, therefore, desirable to minimize the risks due to the accumulation of caffeine in the embryo [19,20].

Caffeine intake during breastfeeding, in accordance with the statements from the European Food Safety Authority (EFSA), is considered safe under specific conditions.

According to the EFSA, single doses of caffeine up to 200 mg and habitual caffeine consumption at doses of 200 mg per day by lactating women in the general population do not raise safety concerns for the breastfed infant. At these caffeine doses, the daily caffeine intake for the breastfed infant would not exceed 0.3 mg/kg body weight, which is 10 times below the lowest dose of 3 mg/kg body weight tested in a dose-finding study where no adverse effects were observed in the majority of infants.

However, it is essential to note that there is insufficient data to characterize the risk of single doses of caffeine consumed by lactating women, and information on habitual caffeine consumption in this population subgroup is limited. Therefore, it is advisable for breastfeeding women to adhere to the EFSA recommendations, limiting caffeine intake within the specified limits to ensure the safety of the breastfeeding infant.

Conclusion

Caffeine, a widely consumed stimulant found in various sources, including coffee, exhibits convergent evolution in plants and has an established role in human physiology [2]. Its mechanisms of action involve passive diffusion, allowing it to cross the fetal barrier and potentially impact the developing embryo [3]. Maternal caffeine consumption during pregnancy has been associated with an increased risk of adverse outcomes, including miscarriage and fetal growth restriction [4,5].

The risks extend into lactation, with caffeine passing into breast milk and potentially affecting the breastfed child [6,7]. While the evidence regarding the effects on breastfed infants is nuanced, very high maternal caffeine intakes have been linked to fussiness, jitteriness, and disrupted sleep patterns in infants [5].

Considering the potential risks, it becomes imperative to delineate safe doses during lactation. Various studies have explored the transfer of caffeine into breast milk and the subsequent effects on infants [14,15]. Striking a balance between maternal caffeine intake and minimizing risks to the infant is crucial.

In light of the available evidence, the question arises: Is it worth consuming caffeine while pregnant or during lactation? The answer depends on individual circumstances, but caution is advised. The potential risks associated with caffeine intake during these critical periods suggest that moderation and informed decision-making are key. Pregnant and breastfeeding individuals should at least respect the indications of the WHO of 300 mg daily.

References

1. Olechno E, Puścion-Jakubik A, Zujko ME, Socha K. Influence of Various Factors on Caffeine Content in Coffee Brews. Foods. 2021 May 27;10(6):1208. doi: 10.3390/foods10061208. PMID: 34071879; PMCID: PMC8228209. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228209/
2. Huang R, O’Donnell AJ, Barboline JJ, Barkman TJ. Convergent evolution of caffeine in plants by co-option of exapted ancestral enzymes. Proc Natl Acad Sci U S A. 2016 Sep 20;113(38):10613-8. doi: 10.1073/pnas.1602575113. PMID: 27638206; PMCID: PMC5035902. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035902/#:~:text=The%20well%2Dknown%20stimulant%20caffeine,in%20plant%20defense%20and%20pollination
3. Brain, Marshall, Charles Bryant, and Matt Cunningham. “How Caffeine Works.” HowStuffWorks. Accessed March 11, 2014. http://science.howstuffworks.com/caffeine4.htm
4. Oatman, Maddie. “9 Things You Should Know About Your Caffeine Habit.” Mother Jones. Accessed March 11, 2014. http://www.motherjones.com/environment/2014/03/caffeine-murray-carpenter-energy-drink-keurig-cup-coffee
5. McCreedy A, Bird S, Brown LJ, et al. Effects of maternal caffeineconsumption on the breastfed child: A systematic review. Swiss Med Wkly 2018;148:w14665. https://pubmed.ncbi.nlm.nih.gov/30294771/
6. Ryu JE. Effect of maternal caffeineconsumption on heart rate and sleep time of breast-fed infants. Dev Pharmacol Ther 1985;8:355-63. https://pubmed.ncbi.nlm.nih.gov/4075934/
7. EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Scientific opinion on the safety of caffeine. EFSA J 2015;13:4102. doi:10.2903/j.efsa.2015.4102 https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2015.4102
8. McNamara PJ, Abbassi M. Neonatal exposure to drugs in breast milk. Pharm Res 2004;21:555-66. https://pubmed.ncbi.nlm.nih.gov/15139511/
9. Oo CY, Burgio DE, Kuhn RC, et al. Pharmacokinetics of caffeineand its demethylated metabolites in lactation: Predictions of milk to serum concentration ratios. Pharm Res 1995;12:313-6. https://pubmed.ncbi.nlm.nih.gov/7784352/
10. Muñoz LM, Lönnerdal B, Keen CL, Dewey KG. Coffee consumption as a factor in iron deficiency anemia among pregnant women and their infants in Costa Rica. Am J Clin Nutr 1988;48:645-51. https://pubmed.ncbi.nlm.nih.gov/3414579/
11. Knutti R, Rothweiler H, Schlatter CH. Effect of pregnancy on the pharmacokinetics of caffeine. Eur J Clin Pharmacol 1981;21:121-6. https://pubmed.ncbi.nlm.nih.gov/7341280/
12. Berlin CM, Jr, Denson HM, Daniel CH, Ward RM. Disposition of dietary caffeinein milk, saliva, and plasma of lactating women. Pediatrics 1984;73:59-63. https://pubmed.ncbi.nlm.nih.gov/6691042/
13. Findlay JW, DeAngelis RL, Kearney MF, et al. Analgesic drugs in breast milk and plasma. Clin Pharmacol Ther 1981;29:625-33. https://pubmed.ncbi.nlm.nih.gov/7214793/
14. Stavchansky S, Combs A, Sagraves R, et al. Pharmacokinetics of caffeinein breast milk and plasma after single oral administration of caffeine to lactating mothers. Biopharm Drug Dispos 1988;9:285-99. https://pubmed.ncbi.nlm.nih.gov/3395670/
15. Tyrala EE, Dodson WE. Caffeinesecretion into breast milk. Arch Dis Child 1979;54:787-9. https://pubmed.ncbi.nlm.nih.gov/3395670/
16. Bailey DN, Welbert RT, Naylor A. A study of salicylate and caffeineexcretion in the breast milk of two nursing mothers. J Anal Toxicol 1982;6:64-8. https://pubmed.ncbi.nlm.nih.gov/7098450/
17. Ryu JE. Caffeinein human milk and in serum of breast-fed infants. Dev Pharmacol Ther 1985;8:329-37. https://pubmed.ncbi.nlm.nih.gov/4075932/
18. Calvaresi V, Escuder D, Minutillo A, et al. Transfer of nicotine, cotinine and caffeineinto breast milk in a smoker mother consuming caffeinated drinks. J Anal Toxicol 2016;40:473-7. https://pubmed.ncbi.nlm.nih.gov/27129353/
19. Purkiewicz A, Pietrzak-Fiećko R, Sörgel F, Kinzig M. Caffeine, paraxanthine, theophylline, and theobromine content in human milk. Nutrients 2022;14:2196. https://pubmed.ncbi.nlm.nih.gov/35683994/
20. Rivera-Calimlim L. Drugs in breast milk. Drug Ther (NY) 1977;7:59-63. https://pubmed.ncbi.nlm.nih.gov/12336945/
21. https://cremacoffeegarage.com.au/caffeine-study
22. https://www.ncausa.org/Decaffeinated-Coffee
23. https://fdc.nal.usda.gov/fdc-app.html#/food-details/171893/nutrients
24. https://www.newcastle.edu.au/newsroom/featured/study-reveals-which-cup-of-coffee-delivers-the-biggest-caffeine-kick

Disclaimer

The information contained here is not intended to replace professional medical advice, diagnosis, or treatment. Before making any changes to your dietary, exercise, or treatment regimen, always consult your doctor or a qualified healthcare professional.

The provided explanations are based on general knowledge and may not be suitable for your specific situation. Never make any health decisions solely based on information provided in this article.

The author and creator of this article are not liable for any damages or losses resulting from the improper use of the information presented here. Remember that each individual is unique and may require a personalized approach to health.

For any health concerns, we strongly advise consulting with a qualified medical professional.