How does life change after achieving a pregnancy? Most mothers-to-be find themselves questioning their daily habits (and expecting to make some lifestyle changes) even within the early weeks of pregnancy. Common, everyday changes might include remembering to drink more water, improving one’s diet (as morning sickness and food aversions allow!), buying a pregnancy pillow when sleep gets uncomfortable, limiting stress, shopping for maternity clothing, and even finding pregnancy-safe alternatives to analgesics and other medications.
Still, some changes loom larger (and more controversial) than others. This is perhaps especially true when it comes to caffeine, alcohol, and tobacco product consumption during pregnancy. Since caffeine is the most widely used stimulant in the world, most people consume it daily without ever thinking twice about it. However, there are common concerns among expectant mothers when it comes to their morning (or afternoon) cup of coffee. For example, is caffeine consumption okay while pregnant–and if so, how much is too much?
The discussion around smoking and drinking alcohol during pregnancy tends to be less nuanced, with near-universal blanket recommendations of abstinence for both. But why, exactly, is that, and what does the data tell us about their effects? The information below is designed to arm you with sources to make an informed decision (with your healthcare provider) about these concerns, so you and your baby can have a happy, healthy pregnancy.
Effects of drinking coffee while pregnant
The effects of coffee and caffeine consumption while pregnant have long been a topic of interest for both researchers and expectant mothers. According to the American Society for Reproductive Medicine (ASRM), moderate caffeine consumption is overall considered safe during pregnancy. That said, expectant mothers should also understand that caffeine is a stimulant that can cross the placenta and reach the developing baby, and it’s not clear how caffeine will affect him or her. So, as the general consensus seems to be, it might be best not to “overdo it.” But what, practically, does that mean for expectant moms?
One concern mothers may have about caffeine consumption–especially in early pregnancy–is a purported connection between miscarriage and caffeine use. However, studies linking caffeine to spontaneous abortions (also known as miscarriages) often have inconclusive results [1]. And, as Brown University Professor Emily Oster, author of Expecting Better points out, women often find coffee well, somewhat less desirable early on in pregnancy, when morning sickness and food aversions are common in a healthy pregnancy that’s proceeding as it should (in fact, as Oster also points out, women who experience nausea in early pregnancy are statistically less likely to miscarry!). Could it simply be, then (as Oster suspects), that pregnant women who continue to drink their regular amount of coffee per day would miscarry due to other causes, anyway?
Still, studies cited by ASRM find that excessive caffeine consumption (defined as more than 500 mg per day) could be associated with an increased risk of delayed conception and decreased fertility, which might clue us into the effects of excessive caffeine consumption on a pregnancy (and, again, leading to the calls for at least moderating caffeine intake during pregnancy) [2],[3]. Which leads us to the next natural question…
How much caffeine is okay during pregnancy?
While you may not need to cut out caffeine cold-turkey during pregnancy, it might be a good idea to at least cut back if you regularly consume multiple cups per day. (For reference, the average 8 oz cup of brewed coffee has between 80 and 100 mg of caffeine, and the average shot of espresso has between 50 and 60 mg of caffeine).
The American College of Obstetricians and Gynecologists (ACOG) agrees, reporting that moderate caffeine consumption (defined as less than 200mg per day) has no apparent adverse effect on fertility or pregnancy outcome [4]. Depending on your caffeine-intake mode of choice, that could look like a few cups of brewed coffee, or a couple of lattes. Not too bad, right? In fact, according to the Harvard School of Public Health, the average adult in the U.S. consumes 135mg of caffeine a day, which means that the average adult consumption of caffeine is already lower than the max recommended for a pregnant woman. (But it’s also important to remember that caffeine can be consumed through various sources such as tea, soda, and even chocolate, so if you’re keeping an eye to moderation, consider other caffeine sources in your diet, too.)
Still, for women who are used to drinking more than a few cups per day, cutting back can be difficult. To make the transition easier, consider the switch from normal coffee to decaf coffee or to pregnancy-safe teas. Both of these options contain lower levels of caffeine and are generally considered safe during pregnancy.
Drinking alcohol during pregnancy
Drinking any amount of alcohol is almost universally advised against during pregnancy and while trying to conceive. The CDC reports that alcohol consumption during pregnancy can expose the baby to alcohol through the mother’s blood as it passes through the umbilical cord. This can lead to Fetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorder (ARND), and Alcohol-Related Birth Defects (ARBD) [5].
While binge-drinking and excessive drinking are undoubtedly associated with risks for babies (as well as for moms!), it is less clear whether the occasional alcoholic drink or light drinking (often defined as up to one drink per day) has the same detrimental effects. As reported in The Guardian, a 2017 study published in BMJ Open and performed by researchers at the University of Bristol in the U.K., found:
“‘Despite the distinction between light drinking and abstinence being the point of most tension and confusion for health professionals and pregnant women and contributing to inconsistent guidance and advice now and in the past, our extensive review shows that this specific question is not being researched thoroughly enough, if at all.’”
“Without the evidence, it is impossible to say whether drinking small amounts is safe or not, [researchers] say. ‘Formulating guidance on the basis of the current evidence is challenging,’ they say. They agree that drinking no alcohol in pregnancy is the safest option, but women should be told that little research has been done on light drinking, although they should also be informed that ‘absence of evidence is not evidence of absence,’ they write.”
Because a randomized-control trial to study the effects of alcoholic intake on unborn babies is unlikely to be performed for ethical reasons, most major medical societies hold the line that “no amount of alcohol is proven to be safe during pregnancy,” and simply advise total abstention. Yet some researchers, Professor Emily Oster included, maintain that there is little data to support concerns surrounding the occasional alcoholic drink during pregnancy.
So, while binge-drinking, heavy drinking, and likely moderate drinking are ill-advised during pregnancy (with good data to support their detrimental effects), the data is less conclusive when it comes to the occasional single celebratory drink or small glass of wine with dinner. Like other benefit-vs-risk decisions to be made in pregnancy, it is best to decide for yourself, with the help of your doctor, and with the best data available.
Effects of smoking during pregnancy
Smoking, in particular, is well-documented to have detrimental effects on developing babies and can expose them to harmful chemicals such as nicotine and carbon monoxide. These chemicals are known to reduce the amount of oxygen that reaches the baby which can lead to slower development of the child before birth, damage to the lungs, and damage to the brain. Not only is smoking detrimental during pregnancy, but studies have also shown that women who smoke are more likely to be infertile than non-smoking women [6].
Smoking during pregnancy is also associated with an increased risk of miscarriage in both natural pregnancies and those achieved using Assisted Reproductive Technology (ART) [7], [8]. It can likewise lead to complications such as low birth weight, premature birth, and developmental issues [9], [10], [11].
There are also recent studies that present a possible mechanism for how smoking increases a woman’s risk of experiencing an ectopic pregnancy [12]. The study postulates that smoking and nicotine alter the natural tubal epithelial cell turnover by preventing a cellular process called apoptosis or controlled, planned cell death in the fallopian tubes. This lack of turnover may ultimately affect tubal motility, possibly promoting an environment favorable for ectopic egg implantation, and increasing the risk for ectopic pregnancy.
Quitting smoking during pregnancy
Quitting smoking as soon as possible during pregnancy will have tremendous health benefits for both the mother and the baby. Although it can be challenging, there are many resources and support systems available and ready to assist expectant mothers in their endeavor to become smoke-free. Smoking cessation also reduces the risks associated with smoking for moms, such as lung cancer, cardiac disease, stroke, and chronic obstructive pulmonary disease (COPD) [13].
Quitting smoking can even have effects after the baby is born by affecting the quantity and quality of breast milk produced by the mother [14]. Breastmilk produced by smoking mothers can even affect the amount of sleep the baby gets since nicotine will still be present in the milk produced [15].
Lifestyle changes during pregnancy
Some women may find the lifestyle changes required by pregnancy to be easy, while others may struggle to adopt new habits–or change old ones. But these very same lifestyle changes can benefit moms in some surprising ways, making pregnancy a time of unexpected health benefits. Still, women deserve the benefit of good data when making any decisions during pregnancy, which can be all too hard to find at times. Ultimately, respectful dialogue with their healthcare providers that takes into account their personal values is a key part of making pregnancy, childbirth, and postpartum a happy, healthy experience for moms and babies.
References:
[1] Signorello, L. B., & McLaughlin, J. K. (2004). Maternal caffeine consumption and spontaneous abortion: A review of the epidemiologic evidence – PubMed. Epidemiology (Cambridge, Mass.), 15(2). https://doi.org/10.1097/01.ede.0000112221.24237.0c [2] Bolumar, F., Olsen, J., & Bisanti, L. (1997). Caffeine Intake and Delayed Conception: A European Multicenter Study on Infertility and Subfecundity . American Journal of Epidemiology, 145(4), 324–334. [3] Wilcox, A., Weinberg, C., & Baird, D. (1988). Caffeinated beverages and decreased fertility – PubMed. Lancet (London, England), 2(8626–8627). https://doi.org/10.1016/s0140-6736(88)90933-6 [4] How much coffee can I drink while I’m pregnant? (n.d.). ACOG. Retrieved July 6, 2023, from https://www.acog.org/womens-health/experts-and-stories/ask-acog/how-much-coffee-can-i-drink-while-pregnant [5] CDC. (2022, November 4). Basics about fasds. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/fasd/facts.html [6] Augood, C., Duckitt, K., & Templeton, A. A. (1998). Smoking and female infertility: A systematic review and meta-analysis – PubMed. Human Reproduction (Oxford, England), 13(6). https://doi.org/10.1093/humrep/13.6.1532 [7] Ness, R. B., Grisso, J. A., Hirschinger, N., Markovic, N., Shaw, L. M., Day, N. L., & Kline, J. (1999). Cocaine and tobacco use and the risk of spontaneous abortion – PubMed. The New England Journal of Medicine, 340(5). https://doi.org/10.1056/NEJM199902043400501 [8] Winter, E., Wang, J., Davies, M. J., & Norman, R. (2002). Early pregnancy loss following assisted reproductive technology treatment – PubMed. Human Reproduction (Oxford, England), 17(12). https://doi.org/10.1093/humrep/17.12.3220 [9] CDCTobaccoFree. (2022, April 11). Smoking during pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm [10] Stock, S. J., & Bauld, L. (2020). Maternal smoking and preterm birth: An unresolved health challenge. PLoS Medicine, 17(9). https://doi.org/10.1371/journal.pmed.1003386 [11] Key, A. P. F., Ferguson, M., Molfese, D. L., Peach, K., Lehman, C., & Molfese, V. J. (2007). Smoking during pregnancy affects speech-processing ability in newborn infants. Environmental Health Perspectives, 115(4). https://doi.org/10.1289/ehp.9521 [12] Horne, A. W., Brown, J. K., Nio-Kobayashi, J., Abidin, H. B. Z., Adin, Z. E. H. A., Boswell, L., Burgess, S., Lee, K.-F., & Duncan, W. C. (2014). The Association between Smoking and Ectopic Pregnancy: Why Nicotine Is BAD for Your Fallopian Tube. PLoS ONE, 9(2). https://doi.org/10.1371/journal.pone.0089400 [13] CDCTobaccoFree. (2022a, March 30). Health effects of smoking and tobacco use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm [14] Breastfeeding and alcohol, drugs, and smoking. (n.d.). WIC Breastfeeding Support. Retrieved July 5, 2023, from https://wicbreastfeeding.fns.usda.gov/breastfeeding-and-alcohol-drugs-and-smoking [15] Mennella, J. A., Yourshaw, L. M., & Morgan, L. K. (2007). Breastfeeding and smoking: Short-term effects on infant feeding and sleep. Pediatrics, 120(3). https://doi.org/10.1542/peds.2007-0488Additional Reading:
The surprising health benefits of pregnancy
