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Department Of Pharmacy Practice, Institute Of Pharmacy Lahore College For Women University Lahore, Pakistan.


Caffeine, a plant alkaloid and CNS stimulant is generally recognized as safe drug. Caffeine is consumed daily in various forms such as coffee, tea, cola and other beverages. Some studies suggest that caffeine adversely affects the fertility, pregnancy and post natal health. Excessive pre-pregnancy caffeine consumption may delay the conception.

Caffeine intake in certain quantities during pregnancy is associated with low birth weight, growth restriction, preterm delivery and fetal loss. Caffeine also potentiates the pregnancy related complications like anemia, gestational diabetes, pre-eclampsia, hypertension and hyper emesis gravid arum. Postnatal health is also influenced by caffeine because it is responsible for the emergence of postpartum depression symptoms.

Keywords: fertility, conception, anemia, gestational diabetes, pre-eclampsia.


Caffeine, plant alkaloid was discovered before 1000 A.D in Ethiopia by a shepherd who became hyperactive by eating small seeds. Caffeine is present in tea, coffee, chocolates, certain beverages and medicines. Caffeine has stimulatory effect on CNS and CVS.It is therapeutically effective in infant apnea because it causes relaxation of bronchioles.1 It is rapidly absorbed from gastrointestinal tract and crosses the placenta and reach the same level as mother has in plasma.Fertility is human’s ability to produce offspring or power of reproduction. In recent studies, considerable decline in fertility is seen in Asian women.3 Fertility is influenced by marriage, contraceptive use, lactation, and infecundability, induced abortion demographic and economic factors.4

Pregnancy, nine months or so for which a woman carries a developing embryo and fetus in her womb, is for most women a time of great happiness and fulfillment. During pregnancy women and her child may suffer various health risks. It is important that all pregnancies should be strictly monitored by health care providers. Supplementation during pregnancy is necessary, folic acid, vitamin D, vitamin C, iron and calcium are taken as supplements for proper growth of fetus.Post natal health involves basic care of mother and her newborn child. The postnatal complication involves infections, low birth weight and birth trauma etc. Postnatal care should be provided by skilled person for avoiding these complications.

Effect of caffeine on fertility:

Caffeine affects the fertility but there is conflicting research on it. Caffeine decreases fertility, higher caffeine consumption delays conception.7 However, it is also observed that average conception time is same in women who take one cup of coffee per week and women who takes more than two cup of coffee per day.8 In some cases chances of conception become half in women who take more than one cup of coffee per day as compared to women who take less.9 The association between caffeine beverages and fertility depends upon the beverage type. Tea and coffee may increase fertility and soda drinks reduce fertility 10.

Higher level of caffeine may increase the conception time among fertile women.11 There may be an association between the caffeinated soft drinks and ovulatory disorder infertility12 caffeine may  also aggravate dysmenhorrea (painful menstruation). Dysmenorrheal may be primary or secondary primary does not involve any disease and secondary involves diseases like endometriosis, uterine fibroids and infection. So, it is recommended that to cut and limit the caffeine intake for relieving dysmenorrhea.13 There is an increase risk of uterine fibroids if caffeine consumption is more than 7 cups a day 14.Polycystic ovary syndrome is common health issue in women. It is characterized by elevated level of androgens and its sign and symptoms are insulin resistance, obesity, alopecia and irregular menstruations etc.Polycystic ovary syndrome negatively affect the fertility. It is recommended to limit the caffeine consumption in polycystic ovary syndrome because it increases the estrogen level.15

Effect of caffeine on pregnancy:

Since the early 1970’s it has been reported that maternal caffeine consumption is associated with adverse pregnancy outcomes. In 2001 the committee on toxicity of chemical in food UK concluded that the maternal caffeine intake above 300mg/day may affect the fetus. However some chocolates and cocoa products of specific features are beneficial for pregnant women because they serve as source of energy 16.

Effect of caffeine on birth weight:

There is increase risk of low birth weight if caffeine consumption is more than 300mg/day. Significant association is seen between caffeine consumption and lower birth weight in women who take 500mg/day.17In another study it is showed that the consumption of two or more cup of coffee per day may associated with lower birth weight of infant.18Each 100mg increase in caffeine intake may increases the risk of  lower birth weight of infant. In some cases a significantly low birth weight is seen with the moderate to high caffeine consumption.19

Effect of caffeine on growth restriction and preterm delivery:

Caffeine consumption affects the fetal growth. There is strong association between caffeine and fetal growth restriction in women with faster caffeine clearance. Risk of stillbirth and fetal loss increases with the increase in caffeine consumption.20 Women, who drink 7-8 cups of coffee a day, risk of fetal loss increases 100 folds. In 1st and 3rd trimester caffeine intake up to 150 mg per day may increase the risk of preterm delivery.

21However, in another study no strong association is found between caffeine intake and preterm delivery.22 Caffeine intake up to 151mg or more per day is associated with spontaneous abortion. The chances of spontaneous abortion increases in women who aborted in their last pregnancy even with the mild to moderate use of caffeine(1-150mg daily)23 In some cases there is no significant association seen between caffeine consumption and preterm delivery.24

Effect of caffeine on pregnancy induced Hypertension and pre-eclampsia:

Caffeine may cause hypertension because it has pressure effect. But the excessive use of caffeine increases the risk for developing hypertension.25Caffeine is also associated with pregnancy induced hypertension and pre-eclampsia. Caffeine increases the systolic blood pressure in 1st and 3rd trimester. Caffeine increases the catecholamine’s level which causes vasoconstriction.

Caffeine intake higher than 6 units (1 unit is equal to 70 mg) causes cardiovascular complications. It is suggested to limit the caffeine consumption up to 2-3 units per day during pregnancy to promote fertility and limit the oxidative stress which may lead to pre-eclampsia.26 In another study there is no positive association between caffeine intake and pre-eclampsia.27However, excessive tea intake during pregnancy may results pre-eclampsia.28

Effect of caffeine on gestational diabetes:

Moderate caffeine consumption up to 200mg in the form of caffeinated beverages, tea and coffee decreases the risk of type 2 diabetes among the young and middle aged women.29Caffeine may impairs insulin sensitivity in women with gestational diabetes mellitus.30 Risk of gestational diabetes become higher in a woman who takes 8 cups of coffee per day. However, 2or 3cups of coffee per day have protective effect in 1st trimester.31 Night eating snacks and black coffee may also increase the risk of gestational diabetes.32Higher caffeine consumption during pregnancy may causes insulin resistance in mid-gestation period33.

Effect of caffeine on Hyperemesis Gravidarum:

Caffeine stimulates the nausea and vomiting during pregnancy. In pregnant women symptoms of nausea and vomiting become worse after taking caffeine during pregnancy and risk of spontaneous abortion increases.34 Caffeine may increases the incidence of Hyperemesis Gravidarum (nausea and vomiting during pregnancy).More than half of women decreases their caffeine consumption during pregnancy to control the nausea and vomiting. Caffeinated beverages are more frequently taken in non pregnant women as compared to pregnant women because it may stimulate nausea and vomiting.35 It is recommended to take decaffeinated carbonated beverages and lemonade for managing the nausea and vomiting during pregnancy36.

Effect of caffeine on supplementation and its interaction with anemia:

Caffeine also interferes with the supplementation taken during pregnancy. Tea causes iron depletion by reducing its absorption. Tea may potentiate anemia by causing iron depletion. So, it is recommended that tea should be taken between meals not during meal.37 Tea also interferes with iron supplementation during pregnancy. Tea effects the utilization of supplemental iron.38 Caffeine has capacity to form chalet with iron and reduced its absorption from intestine.39 Tea and coffee inhibit the iron absorption in concentration dependent manners. So, the pregnant women who has anemia may undergo further iron depletion.40

Effect of caffeine on postnatal health:

Increased caffeine consumption may decrease the risk of depression among women.41Excessive caffeine intake during pregnancy may result emergence of postpartum depression symptoms.42 Caffeine causes hypo activity in mothers and developing rats. There are no conclusive studies available on the effect of caffeine on postnatal depression among the women.43However; excessive consumption of caffeine during pregnancy may causes behavioral changes and postpartum depression.44 Nursing mothers are discouraged for high caffeine consumption because it is transferred to breast milk. Caffeine lower’s the bone mineral density and increase the risk of osteoporosis. Caffeine interrupts sleep and causes hot flashes in some female .So, it is recommended to limit the caffeine consumption to maintain the postnatal health.45


Caffeine affects overall fertile health of women. After reviewing various studies, it can be concluded that caffeine has negative effect on fertility, pregnancy and post-natal health. Excessive use results in fetal loss, low birth weight and preterm delivery. It also potentiate pregnancy induced hypertension, gestational diabetes, pre-eclampsia, hyper emesis gravid arum and anemia. It may also worsen the postnatal depression symptoms. A descriptive study is being conducted at IOP LCWU to get recent insight in caffeine usage by local female population. Since, caffeine is constituent of many products, it is recommended to limit the caffeine consumption up to 200mg per day to maintain the fertile health.


  • Neelam potdar. Maternal caffeine consumption and its adverse pregnancy outcomes.2009 Research gate.
  • Krzysztof M.Kuczkowski .Caffeine in pregnanacy.Arch gynecol obstet.2009;280:695-698.
  • Zeba sathar , Nigel Crook ,Christine callum, Shahnaz Kazi .Women’s status and fertility change in Pakistan. Population and development review 1988;14(3).
  • Azra aziz proximate determinants of fertility in Pakistan . Pakistan development review 1994;33(4) :727-742.
  • World Health Organization: pregnancy definition. The WHO reproductive health library 2016.
  • World Health Organization: Postnatal care. The WHO reproductive health library 2016.
  • R joesoef, V .Beral, R.D Rolfs, S.O. Aral, P.W. Cramer.Are caffeinated beverages delay conception? THE LANCET 1990;335(8682) :136-137.
  • Tina Kold Jensen , Tine Brink Henriksen, Niels Henrik I Hjollund, Thomas Scheike, Henrik Kolstad, Aleksander Giwercman, Erik Ernst, Jens Peter Bonde, Niels E Skakkebaek, Jorn Olsen. Caffeine Intake and Fecundability. Reproductive Toxicology 1998; 12(3): 289-295.
  • Allen Wilcox ,clarice Weinberg ,Donna Baird . Caffeinated beverages and decreased fertility.THE LANCET 1988; 332(8626-8627):1453-1456.
  • Elizabeth E. Hatch, Lauren A. Wise, Ellen M. Mikkelsen, Tina Christensen, Anders H. Riis, Henrik Toft Sorensen and Kenneth J. Rothman. Caffeinated Beverage and Soda Consumption and Time to pregnancy. Epidemiology , 2012; 23(3): 393–401.
  • Eleonora Brillo and Gian Carlo Di Renzo . Chocolate and Other Cocoa Products: Effects on Human Reproduction and Pregnancy.jounal of agriculture and food chemistry 2015; 63(45):9927-9935.
  • Jorge E. Chavarro, Janet W. Rich-Edwards, Bernard A. Rosner and Walter C. Willett. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology. 2009;20(3): 374–381
  • Kashani L, Mohammadi M , Heidari M , Akhondzadeh S. Herbal Medicine in the Treatment of Primary Dysmenorrhea .Journal of Medicinal Plants 2015;14:53.
  • 1 Department of Nutrition, Harvard School of Public Health. Boston, MA
  • 2 Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
  • 3 Division of Women’s Health and Connors Center for Women’s Health and Gender Biology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
  • 4 Department of Epidemiology, Harvard School of Public Health, Boston, MA
  • 5 Department of Biostatistics, Harvard School of Public Health. Boston, MA
  • Address for correspondence: Jorge E. Chavarro, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, Phone: 617-432-4584, Fax: 617-432-2435, Email: dravrah.hpsh@rravahcj
  • Kerry Bone. Phytotherapy for Uterine Fibroids.Medi herb a phtotherapist’s perspectives 2006.
  • Hethir Rodriguez. How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs. Natural fertility info 2007.
  • Eleonora Brillo and Gian Carlo Di Renzo Chocolate and Other Cocoa Products: Effects on Human Reproduction and Pregnancy.journal of agriculture and food chemistry 2015; 63 (45): 9927–9935.
  • Bette J. Caan and Marilyn K. Gold haber. Caffeinated Beverages and Low Birth weight. American journal of public health  1989;79(9): 1299-1300.
  • Opens overlaySteven A. Narod, MD a, Opens overlay Silvia de Sanjosé, MD, PhD a, †, Opens overlay Cesar Victora, MD, PhD Steven .A Narod, Silvia de Sanjose, Cesar Victora .Coffee during pregnancy: A reproductive hazard? American Journal of obstetrics and gynecology 1991;164(6):1109-1114.
  • Ling-Wei Chen,Yi Wu, Nithya Neelakantan, Mary Foong-Fong Chong, An Pan and Rob M van Dam. Maternal caffeine intake during pregnancy is associated with risk of low birth weight: a systematic review and dose-response meta-analysis.BioMed central medicine 2014 .
  • Justin C Konje, Janet E Cade. Maternal caffeine intake during pregnancy and risk of fetal growth restriction. British medical journal 2008; 337:2332 .
  • Kirsten Wisborg, Ulrik Kesmodel, Bodil Hammer Bech, Morten Hedegaard,Tine Brink Henriksen  . Maternal consumption of coffee during pregnancy and stillbirth. British medical journal 2003;366:420.
  • Lisa M. Pastore and David A. Savitz . Case-Control Study of Caffeinated Beverages and Preterm Delivery. American Journal of Epidemiology 1995;141(1):61-69.
  • Wichit srisuphan,Michael b bracken.Caffeine consumption during pregnanacy and association with spontaneous abortion.American journal of obstetrics and gynecology 1986;154(1):14-20Caffeine consumption during pregnancy and association with late spontaneous abortion Opens overlay Wichit Srisuphan, Dr.P.H. a, b, Opens overlay Michael B. Bracken, Ph.DOpens overlay Wichit Srisuphan, Dr.P.H. a, b, Opens overlay Michael B. Bracken, Ph.DOpens overlay Wichit Srisuphan, Dr.P.H. a, b, Opens overlay Michael B. Bracken, Ph.DOpens overlay Wichit Srisuphan, Dr.P.H. a, b, Opens overlay Michael B. Bracken, Ph.DOpens overlay Wichit Srisuphan, Dr.P.H. a, b, Opens overlay Michael B. Bracken, Ph.D
  • Ekaterina Maslova, Sayanti Bhattacharya, Shih-Wen Lin, and Karin B Michels. Caffeine consumption during pregnancy and risk of preterm birth: a meta-analysis.American journal of clinical nutrition 2010;92(5):1120-1132
  • M-L Nurminen, L Niittynen, R Korpela and H Vapaatalo .Coffee, caffeine and blood pressure: a critical review. European Journal of Clinical Nutrition 1999; 53:( 831-839)
  • Rachel Bakker, Eric A.P. Steegers, Hein Raat, Albert Hofman and Vincent W.V. Jaddoel. Maternal Caffeine Intake, Blood Pressure, and the Risk of Hypertensive Complications During Pregnancy. The Generation R Study, American journal of hypertension. 2010; 10(1038):242.
  • Coffee during pregnancy: A reproductive hazard?Opens overlay Steven A. Narod, MD a, Opens overlay Silvia de Sanjosé, MD, PhD a, †, Opens overlay Cesar Victora, MD, PhD Opens overlay Steven A. Narod, MD a, Opens overlay Silvia de Sanjosé, MD, PhD a, †, Opens overlay Cesar Victora, MD, PhDSharbaf, Fatemeh Rahimi; Dehghanpour, Padideh; Shariat, Mamak; Dalili, Hosein . Caffeine Consumption and Incidence of Hypertension in Pregnancy. Journal of Family and Reproductive Health 2013;7(3):127-130.
  • Shu-Qinweia , Hairong , xu-xiong , Zhong-cheng luo ,Francois Audibert, William D,fraser . Tea consumption during pregnancy and the risk of pre-eclampsia .  International Journal of Gynecology & Obstetrics  2009;105(2) :123–126.
  • Rob M. van Dam,Walter C. Willett, JoAnn E. Manson and Frank B. Hu .Coffee, Caffeine, and Risk of Type 2 Diabetes. Diabetes Care  2006;29(2): 398-403.
  • Kathryn L. Adeney,Michelle A. Williams, Melissa A. Schiff,Chunfang Qiu and Tanya K. Sorensen. Coffee consumption and the risk of gestational diabetes mellitus.  Acta Obstetricia et Gynecologica Scandinavica  2009;86(2):161-166.
  • 37)  SN Hinkle,SK Laughon,JM Catov,J Olsen,BH Bech . First trimester coffee and tea intake and risk of gestational diabetes mellitus . International journal of Obstetrics and gynecology 2014 122(3):420-8.
  • Hee-jin Park,JinJu Lee, Ji-Myung Kim,Hyun Ah Lee, Sung-Hoon Kim, and Yuri Kim . A Study of Snack Consumption, Night-Eating Habits, and Nutrient Intake in Gestational Diabetes Mellitus. The Korean Society of Clinical Nutrition  2013;2(1):42-5.
  • Katherine Laughon, Robert W. Powers, James M. Roberts, Sarah Parana, and Janet Catov . Caffeine and insulin resistance in pregnancy.American journal of perinatol 2011; 28(7):571-578.
  • Wen Wanqing, Shu, Xiao Ou; Jacobs, David R. Jr Brown, Judith E .The Associations of Maternal Caffeine Consumption and Nausea with Spontaneous Abortion. Journal of Epidemiology 2001;12(1):38-42.
  • Margaretha Haugen, A se Vikanes , Anne Lise Brantsaeter , Helle Margrete Meltzer, Andrej M. Grjibovski and Per Magnus .Diet before pregnancy and the risk of hyperemesis Gravidarum. British Journal of Nutrition 2011;106: 596–602.
  • Bonapace ES, Jr., Fisher RS. Constipation and diarrhea in pregnancy. Gastroenterol Clinic North America . Institute of Medicine. Nutrition during pregnancy and lactation: an implementation guide. Washington. DC: National Academy Press 1998;27(1):197-211.
  • Itske M. Zijp , Onno Korver and Lilian B. M. Tijburg , . Effect of tea and other dietary factors  on iron absorption. Critical review in food science  and  nutrition  2000;40(5).
  • K G Dewey,M E Romero-Abal, J Quan de Serrano, J Bulux, J M Peerson, P Eagle, and   N W Solomons.  Effects of discontinuing coffee intake on iron status . The American Journal of  Clinical Nutrition 1997;66(1):168-176.
  • Sevgi Kolaylı, Miraç Ocak, Murat Kucuk, Rıza Abbasoglu . Does caffeine bind to metal ions? Food chemistry  2004;84(3):383-388.
  • Morris ER. An overview of current information on bioavailability of dietary iron to humans. Federation Proceedings 1983;42(6):1716-1720.
  • Dr Michel Lucas,Dr Fariba Mirzaei, Dr An Pan, Dr Olivia I. Okereke, Dr Walter C Willett, Dr Eilis J O’Reilly, Dr Karestan Koenen, and Dr Alberto Ascherio. Coffee, Caffeine, and Risk of Depression Among Women.  Arch Intern Med. 2012;171(17): 1571–1578.
  • Dagher RK, Shenassa E .Prenatal health behaviors and postpartum depression: Is there any association? Arch Womens Ment Health 2012 15(1):31-7.
  • J T Concannon, J M Braughler and M D Schechter . Pre- and postnatal effects of caffeine on brain biogenic amines, cyclic nucleotides and behavior in developing rats. Journal of Pharmacology and Experimental Therapeutics 1983;226(3):673-679.
  • Milderd S Christian, Robert L brent . Evaluation of the reproductive and developmental risks of caffeine.Journal of Clinical and molecular teratology 2001;64(1):51-78.
  • Reviewed by Meri Rafetto, Theresa Grumet and Gerri French .Effects of Caffeine and Coffee on Women’s Health: Fertility, Menopause, Breast and Uterine Health.Teeccino Caffé, Inc 2004.