Your days of tequila shots and tuna sashimi are over -- at least for the next nine months or so. But will that venti extra-caf do something bad to your baby? The short answer: No one is completely sure.
"It's difficult to get good and accurate studies on pregnant women," says David Elmer, M.D., an ob-gyn at Nantucket Cottage Hospital in Nantucket, Massachusetts. "It isn't ethical to give 1,000 pregnant women an unknown drug and see how many have complications -- so most of the evidence comes from retrospective studies, where we look at people who happen to encounter a particular drug or substance to see if they're having more problems than those who don't." In most retrospective studies, the evidence suggests that caffeine isn't a big issue. "The overwhelming evidence is that it really isn't as bad as we think," he says.
In fact, Dr. Elmer describes one highly caffeinated mom-to-be who drank no fewer than six cups of coffee per day, sometimes up to 24 in a single day. "She carried the pregnancy uneventfully, with no birth defects or changes in growth, but she did end up going into premature labor," Dr. Elmer says. "It's hard to know for sure if caffeine caused it. You have to look at the entire lifestyle of someone who would drink 24 cups of coffee in a day -- perhaps she was smoking, she was working in a high-stress environment, or she used other products excessively." Still, some concerns still remain because animal studies say otherwise. Although "there are no conclusive studies in humans, studies in animals do show decreased fertility, increases in birth defects and miscarriage rates, and low-birthweight babies," says Michele Hakakha, M.D., a board-certified ob-gyn in Beverly Hills, California and author of Expecting 411.
But what about decaffeinated coffee? Decaf may seem like a great alternative, but it contains trace amounts of caffeine. According to the Mayo Clinic, a single cup of decaf has between 2 and 12 milligrams of caffeine. So if you like the taste and can do without that caffeine buzz, you can have (lots) more decaf coffee before you hit the 200-milligram limit. "It's ok to drink decaf coffee and tea during pregnancy, but to not overdo it," says Elisa Zied, M.S., R.D., C.D.N., a dietitian in New York City and author of Feed Your Family Right. Even small amounts of caffeine in so-called decaf products can add up if you're having multiple servings.
So should you try to stop your Starbucks habit cold turkey the second that pregnancy test turns blue? "People get rebound headaches when they cut back on caffeine, so cutting back slowly is better than going cold turkey, especially when there's no good evidence of it being a big problem. Somebody who's a six- or eight-cup of coffee person could cut down to five or fewer, and aim for just two to three cups a day," Dr. Elmer says. Just take it slow and gradually reduce your coffee intake. Try "having a smaller cup, switching to decaf, diluting your coffee with milk or cream, or start drinking tea, which has some caffeine but much less than coffee," Dr. Hakakha suggests. Although the most conservative ob-gyn probably wouldn't deny you that daily cup of joe, the American College of Obstetricians and Gynecologists does recommend calling it quits at 200 milligrams per day -- which is about the amount in one eight-ounce cup of regular coffee. (Keep in mind, though, that the super-caffeinated coffee at Starbucks is over the 200-milligram limit, even at the smallest "tall" size.) "My advice to patients is: no more than one, and on occasion, two caffeinated drinks a day," Dr. Hakahka says. "Always avoid something that might be potentially dangerous to your developing fetus." But even if you do have to cut back on the coffee now, don't worry -- you'll be drinking plenty of it in a few months when your baby keeps you up all night!
For more information on caffeine amounts in different types of beverages, visit the Center for Science in the Public Interest (cspinet.org/new/cafchart.htm).
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