Vol. 148 No. 3940 (2018)
Effects of maternal caffeine consumption on the breastfed child: a systematic review
- Aimee McCreedy
- Sumedha Bird
- Lucy J. Brown
- James Shaw-Stewart
- Yen-Fu Chen
Nutrition in the first 1000 days between pregnancy and 24 months of life is critical for child health, and exclusive breastfeeding is promoted as the infant’s best source of nutrition in the first 6 months. Caffeine is a central nervous system stimulant occurring naturally in some foods and used to treat primary apnoea in premature babies. However high caffeine intake can be harmful, and caffeine is transmitted into breastmilk.
To systematically review the evidence on the effects of maternal caffeine consumption during breastfeeding on the breastfed child.
METHOD: A systematic search was conducted to October 2017 in MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library. The British Library catalogue, which covers doctoral theses, was searched and PRISMA guidelines followed. Two reviewers screened for experimental, cohort, or case-control studies and performed independent quality assessment using the Newcastle-Ottawa scale. The main reviewer performed data extraction, checked by the second reviewer.
Two cohort, two crossover studies, and one N-of-1 trial were included for narrative synthesis. One crossover and two cohort studies of small sample sizes directly investigated maternal caffeine consumption. No significant effects on 24-hour heart rate, 24-hour sleep time, or frequent night waking of the breastfed child were found. One study found a decreased rate of full breastfeeding at 6 months postpartum. Two studies indirectly investigated caffeine exposure. Maternal chocolate and coffee consumption was associated with increased infant colic, and severe to moderate exacerbation of infant atopic dermatitis. However, whether caffeine was the causal ingredient is questionable. The insufficient and inconsistent evidence available had quality issues impeding conclusions on the effects of maternal caffeine consumption on the breastfed child.
Evidence for recommendations on caffeine intake for breastfeeding women is scant, of limited quality and inconclusive. Birth cohort studies investigating the potential positive and negative effects of various levels of maternal caffeine consumption on the breastfed child and breastfeeding mother could improve the knowledge base and allow evidence-based advice for breastfeeding mothers.
Systematic review registration number
- Bryce J Coitinho D Darnton-Hill I Pelletier D Pinstrup-Andersen P Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: effective action at national level. Lancet. 2008;371(9611):510–26. doi:.https://doi.org/10.1016/S0140-6736(07)61694-8
- World Health Organization. WHO Breastfeeding [Internet]. 2018. Available from: http://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/
- EFSA NDA Panel. (EFSA Panel on Dietetic Products, Nutrition and Allergies). Scientific Opinion on the safety of caffeine. EFSA J. 2015;13(5):4102. doi:. [Internet].https://doi.org/10.2903/j.efsa.2015.4102
- Choices NHS. Breastfeeding and diet. 2016; Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-diet/
- Wikoff D Welsh BT Henderson R Brorby GP Britt J Myers E Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. Food Chem Toxicol. 2017;109(Pt 1):585–648. doi:.https://doi.org/10.1016/j.fct.2017.04.002
- Poole R Kennedy OJ Roderick P Fallowfield JA Hayes PC Parkes J. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ. 2017;359:j5024. doi:.. Corrected in: BMJ. 2018;360:k194. doi: https://doi.org/10.1136/bmj.j5024
- Clark I Landolt HP. Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials. Sleep Med Rev. 2017;31:70–8. doi:.https://doi.org/10.1016/j.smrv.2016.01.006
- Santos IS Matijasevich A Domingues MR. Maternal caffeine consumption and infant nighttime waking: prospective cohort study. Pediatrics. 2012;129(5):860–8. doi:.https://doi.org/10.1542/peds.2011-1773
- Ryu JE. Effect of maternal caffeine consumption on heart rate and sleep time of breast-fed infants. Dev Pharmacol Ther. 1985;8(6):355–63. doi:.https://doi.org/10.1159/000457060
- Fredholm BB Bättig K Holmén J Nehlig A Zvartau EE. Actions of caffeine in the brain with special reference to factors that contribute to its widespread use. Pharmacol Rev. 1999;51(1):83–133. Available at: http://pharmrev.aspetjournals.org/content/51/1/83. [Internet].
- Chen L-W Wu Y Neelakantan N Chong MF-F Pan A van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016;19(7):1233–44. doi:.https://doi.org/10.1017/S1368980015002463
- Chen L-W Wu Y Neelakantan N Chong MF-F Pan A van Dam RM. 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(1):174. doi:.https://doi.org/10.1186/s12916-014-0174-6
- Le Guennec J-C Billon B. Delay in caffeine elimination in breast-fed infants. Pediatrics. 1987;79(2):264–8. Available at: http://pediatrics.aappublications.org/content/79/2/264.short. [Internet].
- Schmidt B Roberts RS Davis P Doyle LW Barrington KJ Ohlsson A Caffeine for Apnea of Prematurity Trial Group. Caffeine therapy for apnea of prematurity. N Engl J Med. 2006;354(20):2112–21. doi:.https://doi.org/10.1056/NEJMoa054065
- Henderson-Smart DJ De Paoli AG. Methylxanthine treatment for apnoea in preterm infants. Cochrane Database Syst Rev. 2010;(12):CD000140. doi:.https://doi.org/10.1002/14651858.CD000140.pub2
- Henderson-Smart DJ Steer PA. Caffeine versus theophylline for apnea in preterm infants. Cochrane Database Syst Rev. 2010;(1):CD000273. doi:.https://doi.org/10.1002/14651858.CD000273.pub2
- Marcus CL Meltzer LJ Roberts RS Traylor J Dix J D’ilario J Caffeine for Apnea of Prematurity–Sleep Study. Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age. Am J Respir Crit Care Med. 2014;190(7):791–9. doi:.https://doi.org/10.1164/rccm.201406-1092OC
- Schmidt B Roberts RS Anderson PJ Asztalos EV Costantini L Davis PG Caffeine for Apnea of Prematurity (CAP) Trial Group. Academic Performance, Motor Function, and Behavior 11 Years After Neonatal Caffeine Citrate Therapy for Apnea of Prematurity: An 11-Year Follow-up of the CAP Randomized Clinical Trial. JAMA Pediatr. 2017;171(6):564–72. doi:.https://doi.org/10.1001/jamapediatrics.2017.0238
- Shrestha B Jawa G. Caffeine citrate - Is it a silver bullet in neonatology? Pediatr Neonatol. 2017;58(5):391–7. doi:.https://doi.org/10.1016/j.pedneo.2016.10.003
- Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. 2018. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
- Clifford TJ Campbell MK Speechley KN Gorodzinsky F. Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum. J Hum Lact. 2006;22(3):292–304. doi:.https://doi.org/10.1177/0890334406290043
- Evans RW Allardyce RA Fergusson DM Taylor B. Maternal diet and infantile colic in breast-fed infants. Lancet. 1981;317(8234):1340–2. doi:.https://doi.org/10.1016/S0140-6736(81)92519-8
- Uenishi T Sugiura H Tanaka T Uehara M. Aggravation of atopic dermatitis in breast-fed infants by tree nut-related foods and fermented foods in breast milk. J Dermatol. 2011;38(2):140–5. doi:.https://doi.org/10.1111/j.1346-8138.2010.00968.x
- Mulder EJH Tegaldo L Bruschettini P Visser GHA. Foetal response to maternal coffee intake: role of habitual versus non-habitual caffeine consumption. J Psychopharmacol. 2010;24(11):1641–8. doi:.https://doi.org/10.1177/0269881109106310