Pregnant women are bombarded with information from the minute that those two lines show up on the pregnancy test. Eat this, don’t eat that, rest often, but make sure you exercise often…hundred of messages come at you, loud, but definitely not clear!
Caffeine consumption during pregnancy is one such topic that is surrounded by controversy and confusion. How much is too much? Should we just stop consuming all caffeine during pregnancy to be safe? Is three cups of coffee a day ok?
Recently, just to add to this confusion, a narrative review written by an Icelandic researcher named Jack James concluded that cumulative scientific evidence supports ‘pregnant women and women contemplating pregnancy being advised to avoid caffeine.’ (1) To non-coffee drinkers this may not seem like a big deal, but for those who live for their morning long black, this advice may incite a whole range of emotions, from guilt to anxiety.
This recommendation also goes against current guidelines in Australia, which recommend that women who are pregnant should reduce their caffeine intake to 200mg per day, the equivalent of about 2 cups of coffee a day, 2 mugs of tea, 5 cans of cola, 400g chocolate, or 2 energy drinks.
So, does this ‘new’ evidence mean we should be ditching our coffees, teas, and chocolates when planning for a family?
Firstly, it is important to note that there are some risks of over-consuming caffeine during pregnancy.
These include:
· Delayed conception for women consuming 500-1000mg of caffeine per day. (2)
· An association between high coffee consumption with low birth weight, preterm birth in the 1st and 2ndtrimester, and mental retardation in offspring. (2, 3)
· An increase in the risk of spontaneous abortion. (2)
James’ conclusion that pregnant women should be told to completely avoid caffeine, however, has been slammed by medical professionals globally as being ‘alarmist’ and ‘overkill’. (4) There are several concerns with this narrative review that should not be overlooked. To begin with, narrative reviews, by their very nature, are subject to bias because the author may ‘cherry-pick’ the studies examined, as opposed to systematic reviews, which strive to include all relevant studies on the given topic. This particular review includes 37 observational studies, which poses another problem in the author’s conclusion. Observational studies do not allow a cause-and-effect relationship to be established and observed correlations may be confounded by external factors and recall error (or bias). The conclusion that the author delivers is therefore speculative and is not an accurate representation of the available data.
It is therefore unlikely that this recent paper will impact the current advice given to pregnant women in regards to caffeine intake. Although it is important that pregnant women are advised to reduce their caffeine consumption to 200mg/day to reduce the potential adverse health effects of caffeine over-consumption, it is equally important to consider the mental health of pregnant women when making these guidelines. Over-cautious guidelines that are not backed by solid evidence, such as those published by James, only add to the stress and pressure that pregnant women already often feel. Whilst pregnant women and those trying to conceive may need to cut back on the amount of coffees they normally consume to reach the advised 200 mg/day, they should also rest assured that those one or two glorious cups of coffee per day are to be completely and utterly enjoyed, with no guilt and no anxiety.
This article was written by Clare Carrick, as part of her 2020 internship with me.
References
1. James JE. Maternal caffeine consumption and pregnancy outcomes: a narrative review with implications for advice to mothers and mothers-to-be. BMJ Evidence-Based Medicine. 2020 Jul 28.
2. Ahsan F, Bashir S. Coffee consumption: health perspectives and drawbacks. J Nutr Obes. 2019;2(1):1-4.
3. Poole R, Kennedy OJ, Roderick P, Fallowfield JA, Hayes PC, Parkes J. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. bmj. 2017 Nov 22;359.
4. BBC News. Having some caffeine in pregnancy ‘is fine’. BBC News [Internet]. 2020 Aug 25 [cited 2020 Aug 31];Health. Available from: https://www.bbc.com/news/health-53887440