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The effects of caffeine on reproductive outcomes in women

Vicki Nisenblat, MD
Robert J Norman, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


Caffeine is the most popular pharmacologically active substance consumed and one of the most heavily researched commodities in the world. It is a stimulant, and is often used to enhance mental alertness.

Although there is no high quality evidence that a modest level of caffeine consumption has adverse effects on fertility or pregnancy outcome, putative beliefs about a relationship between caffeine intake and adverse reproductive outcomes are common, and caffeine consumption is often perceived to be an unhealthy habit. The consumption of caffeinated beverages has been implicated in fertility problems, while consumption during pregnancy has been associated with an increased risk of miscarriage, congenital malformations, fetal growth restriction, stillbirth, and long-term behavioral effects in offspring. The biologic rationale for these associations is caffeine's ability to accumulate in fetal tissues and produce diverse pharmacologic effects that could interfere with fetal growth and development [1,2].

This topic will review the relationship between caffeine intake and reproductive issues in women. The physiological effects of caffeine and caffeinated beverages and the effects of caffeine on specific disease processes, including insulin resistance, cancer, cardiovascular disease, and mortality are discussed separately. (See "Cardiovascular effects of caffeine and caffeinated beverages" and "Benefits and risks of caffeine and caffeinated beverages".)


Caffeine originates in more than 60 plants, occurs naturally in various food products and beverages (including coffee, tea, chocolate, cocoa products, colas), and is added to some soft drinks and most "energy" drinks. Caffeine is also present in some prescription and over-the-counter medications, such as cold and flu remedies, allergy and headache treatments, diet pills, diuretics, and stimulants. Increasingly, caffeine is now present as an additive in snack foods, sports performance supplements, and dietary supplements. Examples of the caffeine content of various products can be found online (eg, http://www.cspinet.org/new/cafchart.htm) and in the table (table 1).

Coffee, tea, cocoa and carbonated soft drinks are the main sources of caffeine intake. Consumption varies throughout the world, and is influenced by culture, individual preferences, availability, and advertising. Coffee contains 50 to 70 percent more caffeine than tea and other products, accounting for the main source of caffeine in many populations.


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Literature review current through: Sep 2016. | This topic last updated: Aug 24, 2016.
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  1. Grosso LM, Bracken MB. Caffeine metabolism, genetics, and perinatal outcomes: a review of exposure assessment considerations during pregnancy. Ann Epidemiol 2005; 15:460.
  2. Doepker C, Lieberman HR, Smith AP, et al. Caffeine: Friend or Foe? Annu Rev Food Sci Technol 2016; 7:117.
  3. Frary CD, Johnson RK, Wang MQ. Food sources and intakes of caffeine in the diets of persons in the United States. J Am Diet Assoc 2005; 105:110.
  4. Derbyshire E, Abdula S. Habitual caffeine intake in women of childbearing age. J Hum Nutr Diet 2008; 21:159.
  5. Yamada M, Sasaki S, Murakami K, et al. Estimation of caffeine intake in Japanese adults using 16 d weighed diet records based on a food composition database newly developed for Japanese populations. Public Health Nutr 2010; 13:663.
  6. Knight CA, Knight I, Mitchell DC, Zepp JE. Beverage caffeine intake in US consumers and subpopulations of interest: estimates from the Share of Intake Panel survey. Food Chem Toxicol 2004; 42:1923.
  7. Boylan SM, Cade JE, Kirk SF, et al. Assessing caffeine exposure in pregnant women. Br J Nutr 2008; 100:875.
  8. Harland BF. Caffeine and nutrition. Nutrition 2000; 16:522.
  9. de Leon J, Diaz FJ, Rogers T, et al. A pilot study of plasma caffeine concentrations in a US sample of smoker and nonsmoker volunteers. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:165.
  10. Szucs, G, Myers, VA, Miwa, LJ. Caffeine consumption during pregnancy. Drug Intell Clin Pharm 1988; 22:614.
  11. Berger A. Effects of caffeine consumption on pregnancy outcome. A review. J Reprod Med 1988; 33:945.
  12. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. NHMRC 1999.
  13. Jahanfar S, Jaafar SH. Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes. Cochrane Database Syst Rev 2015; :CD006965.
  14. Brent RL, Christian MS, Diener RM. Evaluation of the reproductive and developmental risks of caffeine. Birth Defects Res B Dev Reprod Toxicol 2011; 92:152.
  15. Peck JD, Leviton A, Cowan LD. A review of the epidemiologic evidence concerning the reproductive health effects of caffeine consumption: a 2000-2009 update. Food Chem Toxicol 2010; 48:2549.
  16. Stein Z, Susser M. Miscarriage, caffeine, and the epiphenomena of pregnancy: the causal model. Epidemiology 1991; 2:163.
  17. McCusker RR, Goldberger BA, Cone EJ. Caffeine content of specialty coffees. J Anal Toxicol 2003; 27:520.
  18. Crozier TW, Stalmach A, Lean ME, Crozier A. Espresso coffees, caffeine and chlorogenic acid intake: potential health implications. Food Funct 2012; 3:30.
  19. Weng X, Odouli R, Li DK. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol 2008; 198:279.e1.
  20. CARE Study Group. Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study. BMJ 2008; 337:a2332.
  21. Grosso LM, Triche E, Benowitz NL, Bracken MB. Prenatal caffeine assessment: fetal and maternal biomarkers or self-reported intake? Ann Epidemiol 2008; 18:172.
  22. Savitz DA, Chan RL, Herring AH, et al. Caffeine and miscarriage risk. Epidemiology 2008; 19:55.
  23. Signorello LB, Nordmark A, Granath F, et al. Caffeine metabolism and the risk of spontaneous abortion of normal karyotype fetuses. Obstet Gynecol 2001; 98:1059.
  24. Sata F, Yamada H, Suzuki K, et al. Caffeine intake, CYP1A2 polymorphism and the risk of recurrent pregnancy loss. Mol Hum Reprod 2005; 11:357.
  25. Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage--results from a UK-population-based case-control study. BJOG 2007; 114:170.
  26. Furneaux EC, Langley-Evans AJ, Langley-Evans SC. Nausea and vomiting of pregnancy: endocrine basis and contribution to pregnancy outcome. Obstet Gynecol Surv 2001; 56:775.
  27. US Department of Agriculture Agricultural Research Service. USDA National Nutrient Database for Standard Reference, release 21. http://www.ars.usda.gov/nutrientdata. (Accessed on July 06, 2009).
  28. Nehlig A, Debry G. Potential teratogenic and neurodevelopmental consequences of coffee and caffeine exposure: a review on human and animal data. Neurotoxicol Teratol 1994; 16:531.
  29. NISHIMURA H, NAKAI K. Congenital malformations in offspring of mice treated with caffeine. Proc Soc Exp Biol Med 1960; 104:140.
  30. Scott WJ Jr. Caffeine-induced limb malformations: description of malformations and quantitation of placental transfer. Teratology 1983; 28:427.
  31. Moriguchi M, Scott WJ Jr. Prevention of caffeine-induced limb malformations by maternal adrenalectomy. Teratology 1986; 33:319.
  32. Li XD, He RR, Qin Y, et al. Caffeine interferes embryonic development through over-stimulating serotonergic system in chicken embryo. Food Chem Toxicol 2012; 50:1848.
  33. Ma ZL, Qin Y, Wang G, et al. Exploring the caffeine-induced teratogenicity on neurodevelopment using early chick embryo. PLoS One 2012; 7:e34278.
  34. Marret S, Gressens P, Van-Maele-Fabry G, et al. Caffeine-induced disturbances of early neurogenesis in whole mouse embryo cultures. Brain Res 1997; 773:213.
  35. Wilkinson JM, Pollard I. In utero exposure to caffeine causes delayed neural tube closure in rat embryos. Teratog Carcinog Mutagen 1994; 14:205.
  36. Gross C, Zhuang X, Stark K, et al. Serotonin1A receptor acts during development to establish normal anxiety-like behaviour in the adult. Nature 2002; 416:396.
  37. Herlenius E, Lagercrantz H. Development of neurotransmitter systems during critical periods. Exp Neurol 2004; 190 Suppl 1:S8.
  38. Weinstock M. Does prenatal stress impair coping and regulation of hypothalamic-pituitary-adrenal axis? Neurosci Biobehav Rev 1997; 21:1.
  39. Huang J, Zhou S, Ping J, et al. Role of p53-dependent placental apoptosis in the reproductive and developmental toxicities of caffeine in rodents. Clin Exp Pharmacol Physiol 2012; 39:357.
  40. Sharmin S, Guan H, Williams AS, Yang K. Caffeine reduces 11β-hydroxysteroid dehydrogenase type 2 expression in human trophoblast cells through the adenosine A(2B) receptor. PLoS One 2012; 7:e38082.
  41. Shams M, Kilby MD, Somerset DA, et al. 11Beta-hydroxysteroid dehydrogenase type 2 in human pregnancy and reduced expression in intrauterine growth restriction. Hum Reprod 1998; 13:799.
  42. Grant I, Cartwright JE, Lumicisi B, et al. Caffeine inhibits EGF-stimulated trophoblast cell motility through the inhibition of mTORC2 and Akt. Endocrinology 2012; 153:4502.
  43. Khanna NN, Somani SM. Maternal coffee drinking and unusually high concentrations of caffeine in the newborn. J Toxicol Clin Toxicol 1984; 22:473.
  44. Mulder EJ, Tegaldo L, Bruschettini P, Visser GH. Foetal response to maternal coffee intake: role of habitual versus non-habitual caffeine consumption. J Psychopharmacol 2010; 24:1641.
  45. Devoe LD, Murray C, Youssif A, Arnaud M. Maternal caffeine consumption and fetal behavior in normal third-trimester pregnancy. Am J Obstet Gynecol 1993; 168:1105.
  46. McGowan J, Devoe LD, Searle N, Altman R. The effects of long- and short-term maternal caffeine ingestion on human fetal breathing and body movements in term gestations. Am J Obstet Gynecol 1987; 157:726.
  47. Salvador HS, Koos BJ. Effects of regular and decaffeinated coffee on fetal breathing and heart rate. Am J Obstet Gynecol 1989; 160:1043.
  48. Buscicchio G, Piemontese M, Gentilucci L, et al. The effects of maternal caffeine and chocolate intake on fetal heart rate. J Matern Fetal Neonatal Med 2012; 25:528.
  49. Kirkinen P, Jouppila P, Koivula A, et al. The effect of caffeine on placental and fetal blood flow in human pregnancy. Am J Obstet Gynecol 1983; 147:939.
  50. Soyka LF. Effects of methylxanthines on the fetus. Clin Perinatol 1979; 6:37.
  51. Tsubouchi H, Shimoya K, Hayashi S, et al. Effect of coffee intake on blood flow and maternal stress during the third trimester of pregnancy. Int J Gynaecol Obstet 2006; 92:19.
  52. Mills JL, McPartlin JM, Kirke PN, et al. Homocysteine metabolism in pregnancies complicated by neural-tube defects. Lancet 1995; 345:149.
  53. Wenstrom KD, Johanning GL, Johnston KE, DuBard M. Association of the C677T methylenetetrahydrofolate reductase mutation and elevated homocysteine levels with congenital cardiac malformations. Am J Obstet Gynecol 2001; 184:806.
  54. Verhoef P, Pasman WJ, Van Vliet T, et al. Contribution of caffeine to the homocysteine-raising effect of coffee: a randomized controlled trial in humans. Am J Clin Nutr 2002; 76:1244.
  55. Liu YA, Ostlund E, Fried G. Endothelin-induced contractions in human placental blood vessels are enhanced in intrauterine growth retardation, and modulated by agents that regulate levels of intracellular calcium. Acta Physiol Scand 1995; 155:405.
  56. Manderson JG, Mullan B, Patterson CC, et al. Cardiovascular and metabolic abnormalities in the offspring of diabetic pregnancy. Diabetologia 2002; 45:991.
  57. Sowers MR, Crawford S, McConnell DS, et al. Selected diet and lifestyle factors are associated with estrogen metabolites in a multiracial/ethnic population of women. J Nutr 2006; 136:1588.
  58. Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update 2007; 13:209.
  59. Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril 2013; 100:631.
  60. Wilcox A, Weinberg C, Baird D. Caffeinated beverages and decreased fertility. Lancet 1988; 2:1453.
  61. Bolúmar F, Olsen J, Rebagliato M, Bisanti L. Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity. European Study Group on Infertility Subfecundity. Am J Epidemiol 1997; 145:324.
  62. Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 2004; 81:384.
  63. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology 2009; 20:374.
  64. Taylor KC, Small CM, Dominguez CE, et al. alcohol, smoking, and caffeine in relation to fecundability, with effect modification by NAT2. Ann Epidemiol 2011; 21:864.
  65. Caan B, Quesenberry CP Jr, Coates AO. Differences in fertility associated with caffeinated beverage consumption. Am J Public Health 1998; 88:270.
  66. Florack EI, Zielhuis GA, Rolland R. Cigarette smoking, alcohol consumption, and caffeine intake and fecundability. Prev Med 1994; 23:175.
  67. Jensen TK, Henriksen TB, Hjollund NH, et al. Caffeine intake and fecundability: a follow-up study among 430 Danish couples planning their first pregnancy. Reprod Toxicol 1998; 12:289.
  68. Hatch EE, Wise LA, Mikkelsen EM, et al. Caffeinated beverage and soda consumption and time to pregnancy. Epidemiology 2012; 23:393.
  69. Klonoff-Cohen H, Bleha J, Lam-Kruglick P. A prospective study of the effects of female and male caffeine consumption on the reproductive endpoints of IVF and gamete intra-Fallopian transfer. Hum Reprod 2002; 17:1746.
  70. Al-Saleh I, El-Doush I, Grisellhi B, Coskun S. The effect of caffeine consumption on the success rate of pregnancy as well various performance parameters of in-vitro fertilization treatment. Med Sci Monit 2010; 16:CR598.
  71. Higdon JV, Frei B. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr 2006; 46:101.
  72. www.marchofdimes.com/professionals/14332_1148.asp. (Accessed on August 12, 2009).
  73. Ramlau-Hansen CH, Thulstrup AM, Bonde JP, et al. Semen quality according to prenatal coffee and present caffeine exposure: two decades of follow-up of a pregnancy cohort. Hum Reprod 2008; 23:2799.
  74. Horak S, Polanska J, Widlak P. Bulky DNA adducts in human sperm: relationship with fertility, semen quality, smoking, and environmental factors. Mutat Res 2003; 537:53.
  75. Sobreiro BP, Lucon AM, Pasqualotto FF, et al. Semen analysis in fertile patients undergoing vasectomy: reference values and variations according to age, length of sexual abstinence, seasonality, smoking habits and caffeine intake. Sao Paulo Med J 2005; 123:161.
  76. Schmid TE, Eskenazi B, Baumgartner A, et al. The effects of male age on sperm DNA damage in healthy non-smokers. Hum Reprod 2007; 22:180.
  77. Jensen TK, Swan SH, Skakkebaek NE, et al. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol 2010; 171:883.
  78. Belloc S, Cohen-Bacrie M, Dalleac A, et al. Caffeine intake and sperm parameters. Analysis of a cohort of 4474 consecutive semen samples. Fertil Steril 2014; 100:S212.
  79. Klebanoff MA, Levine RJ, DerSimonian R, et al. Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion. N Engl J Med 1999; 341:1639.
  80. Howards PP, Hertz-Picciotto I, Bech BH, et al. Spontaneous abortion and a diet drug containing caffeine and ephedrine: a study within the Danish national birth cohort. PLoS One 2012; 7:e50372.
  81. Buck Louis GM, Sapra KJ, Schisterman EF, et al. Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study. Fertil Steril 2016; 106:180.
  82. Hahn KA, Wise LA, Rothman KJ, et al. Caffeine and caffeinated beverage consumption and risk of spontaneous abortion. Hum Reprod 2015; 30:1246.
  83. Chen L, Bell EM, Browne ML, et al. Maternal caffeine consumption and risk of congenital limb deficiencies. Birth Defects Res A Clin Mol Teratol 2012; 94:1033.
  84. Schmidt RJ, Romitti PA, Burns TL, et al. Maternal caffeine consumption and risk of neural tube defects. Birth Defects Res A Clin Mol Teratol 2009; 85:879.
  85. Browne ML, Hoyt AT, Feldkamp ML, et al. Maternal caffeine intake and risk of selected birth defects in the National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol 2011; 91:93.
  86. Miller EA, Manning SE, Rasmussen SA, et al. Maternal exposure to tobacco smoke, alcohol and caffeine, and risk of anorectal atresia: National Birth Defects Prevention Study 1997-2003. Paediatr Perinat Epidemiol 2009; 23:9.
  87. Browne ML, Bell EM, Druschel CM, et al. Maternal caffeine consumption and risk of cardiovascular malformations. Birth Defects Res A Clin Mol Teratol 2007; 79:533.
  88. Collier SA, Browne ML, Rasmussen SA, et al. Maternal caffeine intake during pregnancy and orofacial clefts. Birth Defects Res A Clin Mol Teratol 2009; 85:842.
  89. Slickers JE, Olshan AF, Siega-Riz AM, et al. Maternal body mass index and lifestyle exposures and the risk of bilateral renal agenesis or hypoplasia: the National Birth Defects Prevention Study. Am J Epidemiol 2008; 168:1259.
  90. Nawrot P, Jordan S, Eastwood J, et al. Effects of caffeine on human health. Food Addit Contam 2003; 20:1.
  91. Browne ML. Maternal exposure to caffeine and risk of congenital anomalies: a systematic review. Epidemiology 2006; 17:324.
  92. Martin TR, Bracken MB. The association between low birth weight and caffeine consumption during pregnancy. Am J Epidemiol 1987; 126:813.
  93. Fortier I, Marcoux S, Beaulac-Baillargeon L. Relation of caffeine intake during pregnancy to intrauterine growth retardation and preterm birth. Am J Epidemiol 1993; 137:931.
  94. Fenster L, Eskenazi B, Windham GC, Swan SH. Caffeine consumption during pregnancy and fetal growth. Am J Public Health 1991; 81:458.
  95. Jarosz M, Wierzejska R, Siuba M. Maternal caffeine intake and its effect on pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2012; 160:156.
  96. Clausson B, Granath F, Ekbom A, et al. Effect of caffeine exposure during pregnancy on birth weight and gestational age. Am J Epidemiol 2002; 155:429.
  97. Grosso LM, Rosenberg KD, Belanger K, et al. Maternal caffeine intake and intrauterine growth retardation. Epidemiology 2001; 12:447.
  98. Parazzini F, Chiaffarino F, Chatenoud L, et al. Maternal coffee drinking in pregnancy and risk of small for gestational age birth. Eur J Clin Nutr 2005; 59:299.
  99. Santos IS, Matijasevich A, Valle NC. Mate drinking during pregnancy and risk of preterm and small for gestational age birth. J Nutr 2005; 135:1120.
  100. Chen LW, Wu Y, Neelakantan N, et al. Maternal caffeine intake during pregnancy is associated with risk of low birth weight: a systematic review and dose-response meta-analysis. BMC Med 2014; 12:174.
  101. Rhee J, Kim R, Kim Y, et al. Maternal Caffeine Consumption during Pregnancy and Risk of Low Birth Weight: A Dose-Response Meta-Analysis of Observational Studies. PLoS One 2015; 10:e0132334.
  102. Bech BH, Obel C, Henriksen TB, Olsen J. Effect of reducing caffeine intake on birth weight and length of gestation: randomised controlled trial. BMJ 2007; 334:409.
  103. Maslova E, Bhattacharya S, Lin SW, Michels KB. Caffeine consumption during pregnancy and risk of preterm birth: a meta-analysis. Am J Clin Nutr 2010; 92:1120.
  104. Matijasevich A, Santos IS, Barros FC. Does caffeine consumption during pregnancy increase the risk of fetal mortality? A literature review. Cad Saude Publica 2005; 21:1676.
  105. Adeney KL, Williams MA, Schiff MA, et al. Coffee consumption and the risk of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2007; 86:161.
  106. Hinkle SN, Laughon SK, Catov JM, et al. First trimester coffee and tea intake and risk of gestational diabetes mellitus: a study within a national birth cohort. BJOG 2015; 122:420.
  107. Tunnicliffe JM, Shearer J. Coffee, glucose homeostasis, and insulin resistance: physiological mechanisms and mediators. Appl Physiol Nutr Metab 2008; 33:1290.
  108. Beaudoin MS, Graham TE. Methylxanthines and human health: epidemiological and experimental evidence. Handb Exp Pharmacol 2011; :509.
  109. Robinson LE, Spafford C, Graham TE, Smith GN. Acute caffeine ingestion and glucose tolerance in women with or without gestational diabetes mellitus. J Obstet Gynaecol Can 2009; 31:304.
  110. Biaggioni I, Davis SN. Caffeine: a cause of insulin resistance? Diabetes Care 2002; 25:399.
  111. Laughon SK, Powers RW, Roberts JM, et al. Caffeine and insulin resistance in pregnancy. Am J Perinatol 2011; 28:571.
  112. Bakker R, Steegers EA, Raat H, et al. Maternal caffeine intake, blood pressure, and the risk of hypertensive complications during pregnancy. The Generation R Study. Am J Hypertens 2011; 24:421.
  113. Dagher RK, Shenassa ED. Prenatal health behaviors and postpartum depression: is there an association? Arch Womens Ment Health 2012; 15:31.
  114. McGowan JD, Altman RE, Kanto WP Jr. Neonatal withdrawal symptoms after chronic maternal ingestion of caffeine. South Med J 1988; 81:1092.
  115. Martín I, López-Vílchez MA, Mur A, et al. Neonatal withdrawal syndrome after chronic maternal drinking of mate. Ther Drug Monit 2007; 29:127.
  116. Mongraw-Chaffin ML, Cohn BA, Cohen RD, Christianson RE. Maternal smoking, alcohol consumption, and caffeine consumption during pregnancy in relation to a son's risk of persistent cryptorchidism: a prospective study in the Child Health and Development Studies cohort, 1959-1967. Am J Epidemiol 2008; 167:257.
  117. Mongraw-Chaffin ML, Cohn BA, Anglemyer AT, et al. Maternal smoking, alcohol, and coffee use during pregnancy and son's risk of testicular cancer. Alcohol 2009; 43:241.
  118. Ford RP, Schluter PJ, Mitchell EA, et al. Heavy caffeine intake in pregnancy and sudden infant death syndrome. New Zealand Cot Death Study Group. Arch Dis Child 1998; 78:9.
  119. Cheng J, Su H, Zhu R, et al. Maternal coffee consumption during pregnancy and risk of childhood acute leukemia: a metaanalysis. Am J Obstet Gynecol 2014; 210:151.e1.
  120. Klebanoff MA, Keim SA. Maternal Caffeine Intake During Pregnancy and Child Cognition and Behavior at 4 and 7 Years of Age. Am J Epidemiol 2015; 182:1023.
  121. Barr HM, Streissguth AP. Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicol Teratol 1991; 13:441.
  122. Loomans EM, Hofland L, van der Stelt O, et al. Caffeine intake during pregnancy and risk of problem behavior in 5- to 6-year-old children. Pediatrics 2012; 130:e305.
  123. Linnet KM, Wisborg K, Secher NJ, et al. Coffee consumption during pregnancy and the risk of hyperkinetic disorder and ADHD: a prospective cohort study. Acta Paediatr 2009; 98:173.
  124. Bekkhus M, Skjøthaug T, Nordhagen R, Borge AI. Intrauterine exposure to caffeine and inattention/overactivity in children. Acta Paediatr 2010; 99:925.
  125. Rivera-calimlim L. Drugs in breast milk. Drug Ther (NY) 1977; 7:59.
  126. Caffeine and babies. BMJ 1989; 299:121.
  127. Santos IS, Matijasevich A, Domingues MR. Maternal caffeine consumption and infant nighttime waking: prospective cohort study. Pediatrics 2012; 129:860.
  128. http://www.marchofdimes.com/professionals/25079_1148.asp (Accessed on November 15, 2012).
  129. Health Canada. Caffeine in food. February 16, 2012. http://www.hc-sc.gc.ca/fn-an/securit/addit/caf/food-caf-aliments-eng.php (Accessed on October 15, 2012).
  130. Food Standards Agency new caffeine advice for pregnant women. http://www.food.gov.uk/news/newsarchive/2008/nov/caffeinenov08. (Accessed on July 06, 2009).
  131. American College of Obstetricians and Gynecologists. ACOG CommitteeOpinion No. 462: Moderate caffeine consumption during pregnancy. Obstet Gynecol 2010; 116:467.
  132. Kaiser L, Allen LH, American Dietetic Association. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc 2008; 108:553.
  133. Greenwood DC, Thatcher NJ, Ye J, et al. Caffeine intake during pregnancy and adverse birth outcomes: a systematic review and dose-response meta-analysis. Eur J Epidemiol 2014; 29:725.