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Overview

You know that your drink of choice during pregnancy should be water. Learn the importance of staying hydrated during your pregnancy, and how much water you should drink every day. In reality, you get the fluids you need from your diet and all the beverages you consume throughout the day. This article dives deeper than merely telling you to avoid coffee and alcohol. Learn about the risks and safety of popular beverages, including soda, juice, tea, and kombucha.

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The importance of Staying Hydrated

Water makes up around 60% of your total body weight, and every cell in your body needs water to function. Staying hydrated helps you regulate body temperature. Staying hydrated can aids in digestion and eliminating waste, which helps with constipation and can help prevent urinary tract infections. Your body relies on water for the absorption of nutrients, and to transport nutrients and oxygen to cells. Staying hydrated can even help prevent preterm labor. There is no question that one of the simplest and best things you can do for your health and your baby’s health is to stay hydrated.

Signs You are Dehydrated

Our bodies give us a lot of clues that can tell us whether we are drinking enough fluids. These may seem obvious, but these are some signs that you are not drinking enough water. The first is that you are thirsty. This is your body’s way of telling you that you need fluids. If you are getting headaches, that is another sign that you could be dehydrated. When you go to the bathroom, your urine should be pale or near clear in color. If it is a darker yellow, that is a good sign that you need more fluids.

How Much Water Should You Drink

The best beverage to drink will always be water. That is true, regardless of whether or not you are pregnant. In reality, we get fluids from more than just water. Your diet may provide up to 20%-30% of your daily fluid needs. This largely depends on what you are eating and will be higher in diets high in fruits and vegetables. Lettuce and cucumber are 96% water. Fluids in food can also come from sources like eggs, which are 75% water. Even a chocolate chip cookie is about 7% water.

During pregnancy, you have increased requirements for how much fluids you should be consuming. The general recommendation is that you should drink ten 8-ounce cups (2.4 liters) of fluids daily. When you are breastfeeding, that increases to 13 8-ounce cups (3.1 liters) per day. If you are exercising or are in hot weather, you may need to increase your consumption of fluids to stay adequately hydrated.

Tips to Drink More Water

If you do not already have a practice of drinking plenty of water throughout the day, here are some tips to make it a habit. Fill up your water bottles at the start of your day. Better yet, fill them up the night before. If you have two forty-ounce water bottles at the beginning of the day, you know exactly how much you should be drinking before you go to bed. To prevent chugging a large amount of water just before you are going to sleep, you should be pacing yourself throughout the day. To keep things interesting, you can enjoy sparkling water or add a squeeze of lemon or lime. You can also put berries or cucumber slices in a glass of water to add some flavor.

Beverages Other Than Water

In the real world, it is unlikely you only drink water, and some of your daily fluids will come from other beverages. Let’s unpack why there are concerns raised over these drinks during pregnancy and while breastfeeding. I have done deep dives into some of the beverages we will talk about, and there are additional links throughout this article.

Caffeine

Caffeine is the most widely consumed drug in the world. It is a central nervous system stimulant often found in coffee, tea, sodas, and energy drinks. Throughout the day adenosine, which aids in the onset of sleep, is passing through receptors in your brain. When enough adenosine is picked up by receptors it signals your body that you need to sleep. Caffeine works by blocking adenosine on receptors in your brain. When adenosine is blocked this makes two additional things happen. First, your adrenal glands begin secreting adrenaline. Adrenaline causes an increase in your heart rate, body temperature, blood pressure, and blood sugar levels. Second, blocked adenosine leads to increased dopamine levels. Dopamine is associated with an elevation in mood. You can likely identify with this if you enjoy a coffee first thing in the morning. 

The Half-Life of Caffeine

The time it takes an adult to fully eliminate caffeine from their system ranges anywhere from 3-7 hours. This time is even longer for someone who does not metabolize caffeine quickly. A huge factor that increases the half-life of caffeine is pregnancy. During pregnancy, your body processes some drugs, like caffeine, differently. As your pregnancy progresses your body takes even longer to metabolize caffeine. In addition, the half-life of caffeine in a newborn has been estimated at as high as 80 hours.

Even after birth, you will want to be mindful of your caffeine consumption when you are breastfeeding because it can also pass to your little one through breastmilk. If you want to go deep and read more about the pharmacology of caffeine click here to read an article that is a good resource.

Recommendations for Caffeine Consumption

The official opinion of the American College of Obstetricians and Gynecologists is that moderate caffeine consumption, which they define as less than 200 mg per day, does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a correlation between high caffeine intake and miscarriage.

The majority of the studies are looking at 200 mg per day as the cut off as low or moderate consumption. This is in line with most recommendations by national health agencies around the world. Canada recommends that women of reproductive age consume no more than 300mg of caffeine per day. The Food Standards Agency in the U.K. states that pregnant and breastfeeding women are advised not to have more than 200mg of caffeine over the course of a day.

Sources of Caffeine

The most well-known source of caffeine is the coffee bean. An 8 ounce, or 237 milliliters, a cup of coffee has somewhere between 95-200 milligrams of caffeine. There is a range because this can differ depending on the type of the bean, the strength of the coffee, and the method of brewing it. Cold brew coffee usually has less caffeine than regular coffee. Beware of buying concentrated cold brew. You want to check the caffeine content on the label and whether it recommends diluting it. The leaves that are used to make tea also naturally contain caffeine.

Some beverages containing caffeine, like sodas or energy drinks use caffeine that has been extracted by a plant and added in. Caffeine is also found in cocoa beans. This means chocolate has some caffeine.  Generally the darker the chocolate the more caffeine it has. Overall the most conservative approach would be to cut out caffeine, after that, would be to limit your consumption to the equivalent of one cup of coffee per day. For a deep dive into caffeine and an examination of the current research check out this article on Caffeine During Pregnancy. 

Tea

Tea, made from tea leaves, has beneficial ingredients like polyphenols or flavonoids, which are antioxidants. They can also contain theobromine and theophylline which are stimulants related to caffeine, but in very small amounts in tea. These stimulants relax smooth muscles so it can make breathing easier, stimulate heart, and improve blood flow.

There are also some properties of tea that you may want to be cautious of. In a study that looked at heavy metals in teas, 30 teas available from a store were tested for heavy metals. 83% of teas had lead levels above acceptable limits for reproductive health limit when consuming 4 cups of tea daily. All teas had significant levels of aluminum. Teas contained arsenic and cadmium, although in levels below acceptable standards.

Something to keep in mind when we are talking about these types of contaminants is the toxic load over time. Consuming high amounts of heavy metals over time means you may accumulate them faster than your body can get rid of them. It is doubtful that you are consuming this much tea during your pregnancy. According to this evidence, if you are drinking large quantities of tea you may want to consider cutting down.

Green Tea

One of the antioxidants in green tea has been found to inhibit part of the process your body goes through to convert folic acid into a usable form of folate. There are studies showing that a high consumption of green tea has an inverse relationship with circulating folate levels.

If you are taking a prenatal with methyltetrahydrofolate, I don’t’ know if green tea would have the same effect, as far as lower levels of circulating folate. With folic acid, green tea is affecting the process before it is converted to methyltetrahydrofolate. Perhaps one more reason to make sure your prenatal has that active form of folate, rather than folic acid.

Herbal Teas

Herbal teas are naturally caffeine-free because they are made from herbs, berries, fruit, flowers, seeds, not tea leaves. Rooibos tea, sometimes known as red tea is also caffeine-free, comes from the rooibos plant, and not tea leaves.

There are long lists of teas to avoid and for more information on what teas to avoid during pregnancy and which are safe, check out this episode on Drinking Tea During Pregnancy.

Fruit Juice

If you want the benefits of vitamin C you are better off eating an orange than drinking a glass of orange juice. With that being said there are some things to keep in mind if you do enjoy juices. The first is that juices can be loaded with sugar. This is especially important to pay attention to if you have gestational diabetes. Reading labels of the juices you buy is important. You would think buying something labeled as juice contains only that. Unfortunately, labels can be deceptive. If it doesn’t say 100% juice it may contain other ingredients like other types of juices, and added sugars. You may want to consider organic juice if you are concerned about pesticides.

Freshly squeezed juices are delicious, but they have not been pasteurized. Pasteurization is a process that heats foods to eliminate bacteria and pathogens for safety. This process also extends the shelf life. One risk of unpasteurized juices is listeria, which is short for listeriosis. This is the foodborne illness caused by the bacterium listeria monocytogenes. According to the CDC, An estimated 1,600 people get listeriosis each year, and about 260 die. The infection is most likely to sicken pregnant women and their newborns, adults aged 65 or older, and people with weakened immune systems. Unpasteurized juices always carry a risk that they could be contaminated with listeria. Although this is rare, listeria is a bacteria that can be really harmful to your baby and it is something you would not want to encounter while pregnant. If you want to avoid this risk altogether you can look for juices that are pasteurized.

Soda

Sodas have two main ingredients you want to be cautious about, those are sugar and caffeine. A Coke has 39 milligrams of caffeine. If you are aiming to keep your caffeine consumption under 200 mg per day you could technically drink four. The problem is a Coke also contains 44 grams of sugar, and four of those would be a total of 176 grams of sugar. There is not a daily recommended limit on sugar and in a perfect world, you avoid it completely. The American College of Obstetricians and Gynecologists recommends avoiding sugary drinks. A lot of sodas contain high fructose corn syrup as a sweetener and this is almost always GMO. If you want a diet soda it may contain artificial sweeteners that have raised a lot of questions. I do plan to dig into the research on artificial sweeteners in an article in the future. If you really want to enjoy a soda it could be a good idea to enjoy one occasionally as a treat, rather than making it a daily staple. If you really miss having carbonated beverages you could always opt to enjoy sparkling water instead.

Kombucha

Kombucha is a fermented tea. Beneficial ingredients in kombucha include probiotics, polyphenols (antioxidants), amino acids and active enzymes that can help with digestion, and B vitamins. When it comes to pregnancy and breastfeeding, the most common recommendation is to avoid kombucha. This is because it contains caffeine and alcohol, it is not pasteurized, and it can have a detoxifying effect on your body.

Because kombucha is brewed with black or green tea it does contain caffeine. Typically, kombucha will contain 8-14 mg of caffeine per serving. This is very low compared to caffeine in coffee (95-200 milligrams), black tea (14-70 mg) or green tea (24-45 mg). It is an option to look for kombucha brewed from green tea, rather than black tea, to limit your caffeine.

Another byproduct in the kombucha brew process is alcohol. Generally, if you are home brewing the alcohol contained will be less than .5%. This assumes no additional sugar, fruit, or juice is added, which can increase the amount of fermentation. When you add additional sugars, in any form, it reactivates the yeast and creates higher alcohol content. The majority of kombucha you buy in a store will also be under 0.5% alcohol. If the alcohol percentage is higher you need to be of legal drinking age to buy it. You can now buy high alcohol kombucha (7%+) which would be more like a beer.

Kombucha is not pasteurized because that would kill the beneficial bacteria. You obviously wouldn’t want to do any kind of detox while pregnant or breastfeeding because you don’t need those toxins going to your baby either through your placenta or through your breastmilk.

There is a difference between someone who consumes kombucha regularly pre-pregnancy and someone who has never had it before. Sometimes you will see recommendations to introduce kombucha slowly and increase the amount you are consuming over time. This could be for two reasons. First, the detox effect kombucha can have. Secondly, because introducing new bacteria your gut microbiome can have some unfavorable effects like gas, bloating, or even diarrhea. Probiotics have similar directions for use to start off with a smaller dose and increase it over time. You will likely have different experiences with different types and brands of kombucha. There is a lot more information on this topic in the episode on kombucha.

Alcohol

Alcohol is absorbed through your stomach and small intestines and enters your bloodstream. Once it is in your bloodstream it goes everywhere. To your heart, brain, muscles, and other tissues.  If you are pregnant, it is also going to your placenta, which it crosses. This means it gets passed to your baby through the umbilical cord. So yes, if you enjoy a beer or a glass of wine, your baby does too. The episode on Alcohol During Pregnancy is an in-depth examination of the research behind alcohol and pregnancy.

The Official Opinions on Alcohol During Pregnancy

Most major organizations advise against any alcohol in any amount. The Centers for Disease Control and Prevention state there is no known safe amount of alcohol to drink while pregnant. According to the American Academy of Pediatrics, prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. The Academy states that during pregnancy no amount of alcohol intake should be considered safe; there is no safe trimester to drink alcohol; all forms of alcohol, such as beer, wine, and liquor, pose a similar risk; and binge drinking poses a dose-related risk to the developing fetus. The American College of Obstetricians and Gynecologists strongly advises against any amount of alcohol during pregnancy and states that there is no safe amount or type of alcohol use during pregnancy.

While all of the official opinions warn against alcohol consumption in any amount, some expecting mothers do enjoy a drink once in a while. You can find more information on the research on alcohol and pregnancy here.

Finding Solutions that Work For You

A good strategy in evaluating drinks that you need to be cautious about is to weigh the risks and the benefits. Depending on how much you really want that kombucha or that cup of coffee, the benefit may outweigh the risk. You can mitigate your risks of drinks by making water your primary drink of choice and limiting your consumption of other drinks. The better you are about staying hydrated throughout the day with water, the less you will be thirsty and reach for other beverages. If you feel like you cannot live without something that we talked about today you should have some good tools to evaluate your risks.

If you do decide that you need to limit or cut out something you love, like that morning cup of coffee. I know this may seem like an impossible task now. You are only pregnant for 9 months and this period of being cautious about everything you are consuming is short, and it gets easier over time.

Talking to Your Doctor or Midwife

If you have any questions about whether a drink is safe please bring it up with your doctor or midwife. Don’t be afraid to ask why something is off-limits. You can also ask what the risks are of consuming it so you can better make an informed choice.

 

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