Moderate caffeine consumption during pregnancy may reduce gestational diabetes risk, according to researchers in the Perelman School of Medicine at the University of Pennsylvania and the National Institutes of Health, in a prospective study of 2,529 pregnant women.
“While we were not able to study the association of consumption above the recommended limit, we now know that low-to-moderate caffeine is not associated with an increased risk of gestational diabetes, pre-eclampsia, or hypertension for expecting mothers,” said the study’s lead author Stefanie Hinkle, PhD, an assistant professor of epidemiology at Penn. The findings were published in JAMA Network Open.
The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women limit their caffeine consumption to less than 200mg (about two cups) per day. The recommendations are based on studies that suggest potential associations with pregnancy loss and foetal growth at higher caffeine levels.
However, there remains limited data on the link between caffeine and maternal health outcomes.
To better understand this association, researchers studied prospective data from 2,529 pregnant participants who were enrolled in the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singleton Cohort at 12 US clinical centres between 2009 and 2013.
At enrolment and at each office visit thereafter, women reported their weekly intake of caffeinated coffee, caffeinated tea, soda, and energy drinks. Concentrations of caffeine were also measured in the participants’ plasma at 10 to 13 weeks into their pregnancies. The researchers then matched their caffeine consumption with primary outcomes: clinical diagnoses of gestational diabetes, gestational hypertension, and pre-eclampsia.
The research team found that caffeinated beverage intake at 10 to 13 weeks gestation was not related to gestational diabetes risk. During the second trimester, drinking up to 100mg of caffeine per day was associated with a 47% reduction in diabetes risk. There were no statistically significant differences in blood pressure, pre-eclampsia, or hypertension between those who did and did not drink caffeine during pregnancy.
The researchers note that the findings are consistent with studies that have found caffeine has been associated with improved energy balance and decreased fat mass. They also say that they cannot rule out that these findings are due to other constituents of coffee and tea, such as phytochemicals, which may impact inflammation and insulin resistance, leading to a lower risk for gestational diabetes.
However, past studies from the same group have shown that caffeine consumption during pregnancy, even in amounts less than the recommended 200mg per day, was associated with smaller neonatal anthropometric measurements, according to Hinkle.
“It would not be advised for women who are non-drinkers to initiate caffeinated beverage consumption for the purpose of lowering gestational diabetes risk,” she said. “But our findings may provide some reassurance to women who already are consuming low to moderate levels of caffeine that such consumption probably won’t increase their maternal health risks.”
Study details
Assessment of Caffeine Consumption and Maternal Cardiometabolic Pregnancy Complications
Stefanie N. Hinkle, Jessica L. Gleason, Samrawit F. Yisahak, Sifang Kathy Zhao, Sunni L. Mumford, Rajeshwari Sundaram, Jagteshwar Grewal, Katherine L. Grantz, Cuilin Zhang.
Published in JAMA Network Open on 8 November 2021
Key Points
Question Is caffeine intake associated with major cardiometabolic complications during pregnancy (ie, gestational diabetes [GDM], pre-eclampsia, gestational hypertension)?
Findings In this cohort study of 2802 pregnant women, low and moderate caffeinated beverage intake early in second trimester within current guidelines of less than 200mg per day were associated with a lower risk for GDM, lower glucose levels at GDM screening, and more favourable cardiometabolic profile compared with no consumption. Caffeine was not associated with gestational hypertension or pre-eclampsia.
Meaning The findings of this study may be reassuring for pregnant women with moderate caffeine intake and should be considered in the context of published data on associations with offspring health.
Abstract
Importance
Women are recommended to limit caffeine consumption to less than 200mg per day based on risks to foetal health. Impacts of caffeine on maternal health remain unclear.
Objective
To determine whether caffeinated-beverage intake and plasma caffeine and paraxanthine are associated with cardiometabolic complications in pregnancy (ie, gestational diabetes [GDM], pre-eclampsia, and gestational hypertension [GH]).
Design, Setting, and Participants
This cohort study used data from a longitudinal pregnancy cohort study from the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons (2009-2013). This post-hoc secondary analysis of 2,802 pregnant women without major chronic conditions enrolled at 12 US clinical sites was completed in 2021. The final sample for caffeinated beverage analyses included 2,583 women. After excluding women who did not consent to have their biospecimens stored for future research (n = 54), plasma caffeine analyses included 2,529 women. Analyses of caffeine consumption and fasting cardiometabolic profiles included 319 women.
Exposures
Daily total caffeine intake was estimated at 10 to 13 gestational weeks and 16 to 22 gestational weeks based on self-reported past week intake of caffeinated coffee, tea, soda, and energy drinks. Plasma caffeine and paraxanthine were measured in specimens collected at 10 to 13 weeks.
Main Outcomes and Measures
Clinical diagnoses of GDM, pre-eclampsia, GH, glucose concentrations from GDM screening, and blood pressure were extracted from medical records.
Results
Participants had a mean (SD) age of 28.1 (5.5) years and 422 participants (16.3%) were Asian/Pacific Islander women, 741 (28.9%) were Hispanic women, 717 (27.8%) were non-Hispanic black women, and 703 (27.2%) were non-Hispanic white women. At 10 to 13 weeks, 1,073 women (41.5%) reported consuming no caffeinated beverages, 1,317 (51.0%) reported consuming 1 mg/d to 100 mg/d, 173 (6.7%) reported consuming 101 mg/d to 200 mg/d, and 20 (0.8%) reported consuming more than 200 mg/d. At 16 to 22 weeks, 599 women (23.6%) reported consuming no caffeinated beverages, 1,734 (68.3%) reported consuming 1 mg/d to 100 mg/d, 186 (7.3%) reported consuming 101 mg/d to 200 mg/d, and 20 (0.8%) reported consuming more than 200 mg/d caffeinated beverages. Intake at 16 to 22 weeks was associated with lower GDM risk and lower glucose concentrations (1 mg/d to 100 mg/d vs none: relative risk, 0.53 [95% CI, 0.35 to 0.80]; β, –2.7 mg/dL [95% CI, –5.4 mg/dL to 0 mg/dL]) and lower C-reactive protein and C-peptide concentrations and favourable lipid profiles. Total plasma caffeine and paraxanthine at 10 to 13 weeks was inversely associated with glucose (quartile 4 vs quartile 1: β = –3.8 mg/dL [95% CI, –7.0 mg/dL to –0.5 mg/dL]; trend of P = .01). No associations were observed with pre-eclampsia or GH.
Conclusions and relevance
In this cohort study, second trimester caffeinated beverage intake within current recommendations was associated with lower GDM risk, but not pre-eclampsia or GH. These findings may be reassuring for women with moderate caffeine intake.
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