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."
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But 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 "maternal 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.
But that 200-milligram mark is a bit arbitrary. "When some pregnancy books put limits on caffeine in pregnancy, they're guessing," Dr. Hakakha reveals. "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 moms-to-be would willingly submit their unborn children to be guinea pigs, most studies on pregnant women 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 a mom-to-be had an adverse outcome like a miscarriage, she always likes to blame it on something," Dr. Elmer says. "So she'll often overestimate her coffee usage." And even moms-to-be who have healthy pregnancies may underreport their usage of "bad-for-you" foods to seem like they are model patients.
With so much conflicting information out there, what's an expectant mom to do? See what your doctor has to say and then use your best judgment. If you want to follow the better-safe-than-sorry route, you should 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.
You can think of your abstinence from supersized coffees as just one in a never-ending string of things moms sacrifice for the good of their kids. 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.
