ABSTRACT

Caffeine, a habit-forming substance of no nutritional value, is consumed daily by most pregnant women. This focused narrative review examines evidence of association between maternal caffeine consumption and negative pregnancy outcomes, and assesses whether current advice guidelines are consistent with the available evidence. The majority finding from original empirical studies, systematic reviews, and meta-analyses is that maternal consumption of caffeine is reliably associated with serious negative pregnancy outcomes and negative outcomes in offspring. Evidence of harm is strong for miscarriage, stillbirth, and low birth weight and/or small for gestational age, while being less strong for childhood acute leukemia, childhood overweight and obesity, and childhood behavioural and neurocognitive development. In contrast, preterm birth appears not to be at increased risk. Many studies report significant dose-response associations indicative of causation and the absence of a threshold of consumption below which associations are absent. In general, findings are robust to threats from potential confounding and misclassification. Notwithstanding compelling grounds to the contrary, national and international authorities continue to suggest that "moderate" caffeine consumption during pregnancy is safe. Rather, pregnant women and women contemplating pregnancy should be advised not to consume coffee, tea, sodas, or energy drinks that contain caffeine.

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