Abstract
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. 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: CRD42017078790.
Highlights
It is widely acknowledged that the first 1000 days from pregnancy to a child’s second birthday is “the crucial window of opportunity” for delivery of nutrition to children, potentially impacting on a child’s current and adult health, and the health of subsequent generations ([1] p.1)
No significant effects on 24-hour heart rate, 24-hour sleep time, or frequent night waking of the breastfed child were found
Maternal chocolate and coffee consumption was associated with increased infant colic, and severe to moderate exacerbation of infant atopic dermatitis
Summary
It is widely acknowledged that the first 1000 days from pregnancy to a child’s second birthday is “the crucial window of opportunity” for delivery of nutrition to children, potentially impacting on a child’s current and adult health, and the health of subsequent generations ([1] p.1). The European Food Safety Authority suggests that “habitual caffeine consumption at doses of 200 mg per day consumed by lactating women in the general population do not give rise to safety concerns for the breastfed infant” ([3] p.5); the UK National Health Service (NHS) has recently updated its recommendations for breastfeeding women to restrict “intake to less than 200 mg a day” (previously 300 mg/day) as caffeine “can make your baby restless” and “may keep them awake” ([4] sec.). The evidence behind the advice is unclear Both a major recent systematic review of the safety of caffeine consumption [5] and a recent umbrella review of clinical trials and observational studies of coffee intake and outcomes [6] did not consider the demographic of breastfeeding mothers and their infants. A further recent systematic review on caffeine and sleep [7] highlighted studies that found no significant effects on frequency of infant night waking between infants of 177 mothers who were heavy caffeine consumers (≥300 mg/day) versus infants of moth-
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