Sometimes, when we are pregnant, it feels as if all we are subjected to is rules. Rules for how to exercise, how to eat, how to care for our bodies, how to feel, what to put on our skin. For the mama choosing to breastfeed or pump, the rules continue postpartum, as our bodies are working hard to make the milk meant to nourish our littles ones.
As I walk through all of these do’s and don’ts for the third time myself, I too understand how annoying the rules can be, how frustrating it might feel to constantly have “right” numbers and values thrown at you. But the nurse side of my brain also appreciates the science behind these numbers, especially evidence-based rules and practices that I do believe are for our good and the good of our little one.
Let’s talk about the prenatal diet for a minute; and in particular, let’s talk about caffeine consumption. Did you know that there are some considerations and rules about how much caffeine the healthcare community believes is best in both pregnancy and when nursing? We live in a culture largely obsessed with caffeine, in its most common form as coffee. However, we (especially those of us who do not drink coffee) must also remember that caffeine sneaks into our diet in a lot of other ways, many of which can also cause you to quickly hit the suggested daily consumption levels.
Caffeine Consumption Recommendations
In Pregnancy: <200 mg/day
Breastfeeding/Pumping: <200 mg/day
· A quick note: The numbers represented here are from the American College of Obstetrics and Gynecology (ACOG). They are one of the larger governing bodies of obstetric care in the United States.
Though the recommendation(s) for caffeine consumption during pregnancy are largely similar, the amount of caffeine that has been deemed appropriate during breastfeeding is not universally agreed upon. While ACOG continues to recommend that women maintain that limit of 200mg when they are postpartum, you will find a multitude of sources that report anywhere from 0-750mg/day.
Why Isn’t There a Clear Consensus?
In pregnancy, it IS known that caffeine can cross the placenta and raise maternal catecholamine levels. Because of this, there has been concern in the obstetric community that there may be a a relationship between caffeine exposure and miscarriage. There have been some studies done on this possible relationship. However, ACOG believes that the studies have been too limited by their sizes and bias; at this time, the relationship between caffeine and miscarriage continues to be undetermined and they have not made any changes to their recommendation.
Though ACOG has landed in this place, other professionals and providers may interpret the existing data and/or evidence differently. Because there is not a clear, evidence-based consensus, it is highly possible that you may have a provider comfortable with intake levels higher or lower (or none) than this 200mg recommendation.
In the postpartum period, a clear consensus also does not exist about how much caffeine is appropriate. This is because caffeine does pass to the baby through breastmilk, but different levels affect infants differently. One text related to the topic, Medications and Mother’s Milk (pg. 139), reports that caffeine is Category L2 (safer) as related to risk to infant. The American Academy of Pediatrics classifies caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.”
At this time, most providers will concur that postpartum caffeine consumption is appropriate in moderation (200-300 mg/day), dependent on baby’s health and age. If the amount of caffeine being consumed appears to be negatively affecting baby (irritability, fussy, wakefulness, etc.), the recommendation would likely be to decrease caffeine consumption for a couple of weeks and see if that causes appropriate changes to baby’s behavior.
Caffeine in Various Food/Drink
*These are estimates pulled from products websites and nutritional information. Actual caffeine content may have some variation.
Lack of clarity in some of these maternal spaces can be really challenging. But knowledge and information is always power, as it provides you with the tools to make the best choices for YOU and YOUR pregnancy and baby. So, take this knowledge, these recommendations, and these numbers and use them to healthily make a decision you can feel good about. There’s no greater goal that a mama can have for herself.
As always, I’m cheering for you,
MSN, RNC-OB, C-EFM