Don Tracy, Associate Editor
JAMA study investigates whether consuming energy drinks was associated with adverse pregnancy outcomes and whether caffeine consumption affects fetal-growth restriction.
                                                                                           Image Credit: Adobe Stock Images/Viktor
Energy drinks, popular for increasing awareness and energy, have seen a 240% increase in sales since 1987, reaching $9.7 billion in US sales in 2015. Marketing for these products typically targets young adults; however, there are also safety concerns with their consumption, with associations found between energy drinks and health issues, including mental health symptoms and organ damage. There have been very few studies that have explored the link between energy drink intake before and during pregnancy with adverse pregnancy outcomes (APOs). To address this information gap, the authors of a study published by JAMA Network Open aimed to discover any potential links.1
The study analyzed data from two ongoing studies, entitled Nurses’ Health Study 3 (NHS3) and Growing Up Today Study (GUTS), with both studies focusing on women of reproductive age. Authors of the study collected information through validated questionnaires, assessing prepregnancy and during pregnancy consumption. A total number of 7304 pregnancies were analyzed for prepregnancy intake within 4736 participants, and 4559 pregnancies were analyzed in 4559 participants for during pregnancy intake.1
Results indicated that prepregnancy energy drink intake was not associated with APOs in GUTS but showed a higher risk of gestational hypertension in NHS3. A combined analysis discovered an association between energy drink intake and gestational hypertension. However, no significant associations were found for pregnancy loss, preterm birth, gestational diabetes, preeclampsia, or the composite APO.1
However, medical experts suggest that those who are currently pregnant should be mindful of their caffeine intake. Current US guidelines suggest moderate caffeine consumption of less than 200 milligrams per day for anyone pregnant or attempting to become pregnant, with the American College of Obstetricians and Gynecologists suggesting that the level doesn’t appear to be associated with miscarriage or preterm birth, but the relationship between caffeine consumption and fetal-growth restriction remains uncertain.2
“Energy drinks contain varying amounts of caffeine, so check nutrition labels to understand how much caffeine and other ingredients they contain,” said David B. Nelson, MD, associate professor of obstetrics and gynecology, division chief of maternal-fetal medicine, in an interview with UT Southwestern.
Nelson added that it can be difficult to curb intake of caffeine, and doing so can cause withdrawal symptoms including headache, fatigue, and drowsiness, decreased alertness, depressed mood, irritability, and trouble concentrating.2
“Gradual reduction in caffeine intake over several weeks before planning pregnancy, or when you find out you are pregnant, can help prevent caffeine withdrawal,” he continued.
An article from Mom Junction offers seven alternatives to caffeine for women to drink during pregnancy, noting that although energy is needed during this time, energy drinks maintain large amounts of caffeine, sugar, and other supplements. These alternatives include:
• water
• coconut water
• lemonade
• milk and milk-based drinks
• fruit juices
• vegetable juices
• iced tea3
The study also concluded that associations with gestational hypertension were stronger among older participants, suggesting age as a potential modifier. Also, the authors suggest that divergence in findings between the two study populations and low frequency of energy drink consumption call for caution in interpretation.1
While the study included rich data from the cohort studies and allowed a detailed analysis, there were also significant limitations. These include self-reported energy drink intake, potential measurement error, and the study's predominantly white population, limiting its generalizability.1
“Our study found that energy drink intake was associated with higher risk of gestational hypertension,” wrote the study authors. “Given the low prevalence of energy drink intake in the study population, the results should be interpreted with caution. However, our findings suggest that caution regarding energy drink consumption in reproductive-aged individuals should be exercised and that replication in future studies is needed.”