Overview

Staying hydrated is crucial for your overall health, and water is always the best beverage. In reality, some of your daily fluids will come from other liquids. The obvious drinks to be cautious about during pregnancy and while breastfeeding are coffee and alcohol. There are also other beverages that come with risks, like tea, soft drinks, juice, and kombucha. This article examines the concerns over why you should be cautious with particular beverages so you can understand the risks and can make informed choices.

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The Importance of Staying Hydrated

Staying hydrated is crucial for your overall health. Water makes up around 60% of your total body weight, and every cell needs water to function. Staying hydrated helps you regulate body temperature, digest food, transport nutrients, and oxygen to cells, absorb nutrients, and eliminate waste. You also lose more water during pregnancy through urination and increased respiration. Plus, you eliminate more water through sweat from changes to your adrenal and thyroid functions, increased metabolism, and additional blood circulation.

If you do not drink enough water, you can exacerbate many common pregnancy symptoms. Staying hydrated can help with constipation, Braxton hicks contractions, swelling, migraines, and headaches. One of the simplest and best things you can do for your and your baby’s health is to drink plenty of water.

Signs of Dehydration

Our bodies give us many clues that tell us whether we drink enough fluids. These may seem obvious, but these are signs that you are not drinking enough water. The first is that your mouth is dry or you are thirsty. This is your body’s way of telling you that you need fluids. Urinating less frequently, headaches, fatigue, and dizziness can show you need more water. 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 You Should Drink

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.

You have increased requirements for how much fluids you should consume during pregnancy. The American College of Obstetricians and Gynecologists recommends drinking 64-96 ounces (1.9-2.8 liters) of water every day. The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, creates the Dietary Reference Intakes (DRI). The DRI states adequate intake for water in pregnancy is 101 ounces (3.0 liters) per day of total water. This includes approximately 78 ounces (2.3 liters) as total beverages, including drinking water. For breastfeeding mothers, the adequate intake is increased to 128 ounces (3.8 liters) per day of total water. This includes approximately 101 ounces (3.1 liters) as total beverages, including water.

There is an entire episode dedicated to staying hydrated during pregnancy. Check out this episode for in-depth information on the safety and benefits of different water sources, electrolytes, plastic water bottles, and even staying hydrated during labor.

Beverages Other Than Water

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

Caffeinated Drinks

Caffeine is a central nervous system stimulant often found in coffee, tea, sodas, and energy drinks. It is the most widely consumed drug in the world. The most well-known source of caffeine is the coffee bean. An 8-ounce (237 milliliters) cup of coffee has between 95-200 milligrams of caffeine. The amount can differ depending on the bean type, the coffee’s strength, and the brewing method. Cold brew coffee tends to have less caffeine than regular coffee. Be careful because cold brew is often sold as a concentrate. You should check the caffeine content on the label and whether it recommends diluting it. Tea leaves naturally contain caffeine. Some beverages containing caffeine, like sodas or energy drinks, add plant-extracted caffeine. Caffeine is also in cocoa beans, which are used to make chocolate. Generally, the darker the chocolate, the more caffeine it has.

How Caffeine Works

Caffeine works by blocking adenosine receptors in your brain. Adenosine aids sleep onset and passes through receptors in your brain throughout the day. When receptors pick up enough adenosine, it signals your body that you need to sleep. Blocking adenosine makes two 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

An essential element of how you process caffeine is the half-life. The half-life of a drug is the amount of time it takes your body to remove half of the substance from your system. The time it takes your body to eliminate caffeine from your system will be different for everyone. The half-life of caffeine for adults ranges from 5-7 hours. On the short end of the spectrum, after 5 hours, your body processes 50% of the caffeine and 50% remains. After another 5 hours, you process an additional 50%, leaving 25%. This means that after 10 hours, roughly 25% of the caffeine you consume is still in your system. This time is even longer for someone who does not metabolize caffeine quickly.

Caffeine During Pregnancy

The way your body processes some drugs is altered when you are pregnant. Pregnancy increases the half-life of caffeine, so it remains in your system for a more extended period. As your pregnancy progresses, your body takes longer to process caffeine. It takes you longer to process caffeine in the second trimester than in the first and even longer in the third trimester. As your pregnancy progresses and your body takes longer to metabolize caffeine, you pass more of it to your baby. See this article to read more about the pharmacology of caffeine. 

During pregnancy, caffeine in your bloodstream crosses your placenta. Your baby can’t process caffeine as well as you can. Studies have examined caffeine intake in relation to fetal growth restriction, miscarriage, and low birth weight. In animal models, there is evidence that high caffeine consumption can disrupt implantation, fetal growth and development, pregnancy loss, low birth weight, and brain development.

Recommendations for Caffeine Consumption

The American College of Obstetricians and Gynecologists states moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship between 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 European Food Safety Authority states that pregnant or lactating women’s habitual caffeine consumption of up to 200 mg per day does not give rise to safety concerns for the fetus or breastfed infants. Canada sets the maximum daily intake at 300mg of caffeine per day for women trying to become pregnant or are pregnant or breastfeeding.

200 mg is also the threshold most studies use to define moderate caffeine consumption. 200 mg is one to two cups of coffee or four cups of caffeinated tea. 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.

Tea

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

Some properties of tea warrant caution during pregnancy. A study that looked at heavy metals in teas tested 30 teas 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 at levels below acceptable standards.

Something to remember when discussing these types of contaminants is the toxic load over time. The half-life of some of these is long, and it takes your body a while to get it out of your system. Over time, if you consume high amounts of these heavy metals, they will continue accumulating faster than your body can get rid of them. If you drink large quantities of tea, you may want to consider cutting it down.

Green Tea

One of the antioxidants in green tea inhibits part of the process (dihydrofolate reductase) your body goes through to convert folic acid into a usable form of folate. There are studies showing that high consumption of green tea has an inverse relationship with circulating folate levels. Folate is a critical nutrient for your baby, and folate or folic acid is a primary ingredient in all prenatal vitamins. I could not find evidence on whether green tea would have the same effect of lower circulating folate levels if you take a prenatal with the active form of folate (methyltetrahydrofolate) rather than folic acid. Perhaps one more reason to ensure your prenatal has that active form of folate rather than folic acid. 

Herbal Tea

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

See this episode for in-depth information on drinking tea during pregnancy and a breakdown of teas to avoid, teas that are safe are teas that may provide specific benefits during pregnancy.

Soft Drinks

Soft drinks have two main ingredients to be cautious about, caffeine and sweeteners. A Coca-Cola has 39 milligrams of caffeine. If you aim to keep your caffeine consumption under 200 mg daily, you could technically drink four. The problem is that a 12-ounce Coca-Cola also contains 44 grams of sugar.

Sugar

When you eat sugars, your body breaks them down into glucose and fructose. Your body uses glucose for energy. When you consume glucose, it is absorbed in your gastrointestinal tract and enters your bloodstream. This makes your pancreas produce a hormone called insulin, which helps muscles, fat, and other cells absorb glucose for fuel. Any time you eat, your body has an insulin response to regulate sugar in your blood. Excess glucose is stored as glycogen in your muscles or as lipid in fat tissue. Fructose is processed differently. It has to be processed by your liver and converted into either glucose that your body can use for fuel or fat that your body has to store.

Sugar During Pregnancy

When you are pregnant, your body naturally becomes more resistant to insulin, which means that more glucose remains in your blood. Since less glucose is absorbed, more of it reaches your baby. You can imagine that a growing baby needs a lot of energy. This process makes sense because your baby uses the additional glucose for fuel.

For most expecting moms, this works just like it is supposed to. Even though your body is more resistant to insulin and higher glucose levels are in your blood, your pancreas reacts by producing more insulin. Overall this still keeps your blood sugar levels in check. The problem occurs when your pancreas can’t keep up with the high demand for additional insulin, and more glucose builds up in your blood. This is known as hyperglycemia. Insulin doesn’t cross the placenta, but glucose does. The result is too much glucose that isn’t absorbed and used as energy and instead goes to your baby. See this episode for more information on sugar during pregnancy.

Limiting Your Sugar Consumption

The American College of Obstetricians and Gynecologists recommends avoiding sugary drinks. There is no daily recommended limit on sugar, although the FDA has a daily value of 50 grams of added sugars based on a 2,000-calorie daily diet. The idea is that consuming too much sugar can make it challenging to meet nutrient needs while staying within calorie limits. You nearly reach 50 grams of sugar with one 12-ounce Coca-Cola.

Natural and Artificial Sweeteners

Many soft drinks contain other natural and artificial sweeteners. High-fructose corn syrup is made from hydrolyzed corn starch with enzymes added to convert part of the glucose into fructose. The result is a sweetener with 55% fructose and 45% glucose. It is not much different from table sugar, which is 50% glucose and 50% fructose. High fructose corn syrup is commonly used because it is cheaper than sugar.

Non-nutritive sweeteners include artificial sweeteners and a few derived from plants, like stevia and monk fruit extract, that do not contain any calories. From a purely caloric standpoint, these may be preferred over sugar because they do not add to your total calorie count. These sweeteners can be more challenging to identify on an ingredient list because some go by names you may not recognize. Because they do not contain sugar, they are not included in the total or added sugars on the nutrition facts label.

Overall we do not see detrimental effects from non-nutritive sweeteners. Some red flags show concerns about gut microbiome health and the impact of non-nutritive or artificial sweeteners on future preferences for sweet foods. See this episode for a full breakdown of natural and artificial sweeteners.

GMO Ingredients

If you want to avoid genetically modified foods, you want to look for a soft drink labeled organic or not containing genetically modified ingredients. 88% of corn is genetically modified. In addition to corn syrup, sweeteners like dextrose and maltodextrin are derived from corn. If the label does not specifically state cane sugar, it is likely from sugar beets, 95% of which are GMO. There is more information on GMOs, especially about pesticide use, in this episode.

If you 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 miss having carbonated beverages, you could always enjoy sparkling water or a caffeine-free alternative with a natural or artificial sweetener.

Fruit Juice

Fruit juice can be packed with vitamins and nutrients. There are some things to remember if you enjoy drinking juice. The first is that juices can be loaded with sugar. This is especially important to pay attention to if you have gestational diabetes. If you drink juice for the benefits, consider going directly to the source and eating whole fruit. If you want the benefits of vitamin C, you are better off eating an orange than drinking a glass of orange juice. An 8-ounce glass of orange juice has 21 grams of sugar, the equivalent of three oranges.

Reading the 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 and extends shelf life. One risk of unpasteurized juices is listeria, which is short for listeriosis. 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 juice always carries a risk that it could be contaminated with listeria. Listeria can be harmful to your baby, and it is something you would not want to encounter while pregnant.

Kombucha

Kombucha is a fermented tea that has grown in popularity in recent years. There are many beneficial ingredients in kombucha, like probiotics, polyphenols (antioxidants), B vitamins, amino acids, and active enzymes, that can help with digestion. When it comes to pregnancy and breastfeeding, the most common recommendation is to avoid kombucha because it contains caffeine and alcohol, it is not pasteurized, and it can have a detoxifying effect on your body. Let’s take a closer look at the safety of kombucha.

Kombucha does contain caffeine because it is brewed with black or green tea. Typically, kombucha includes 8-14 mg of caffeine per serving. This is very low compared to the caffeine content of 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 minimize the caffeine.

Another byproduct of the kombucha brew process is alcohol. Generally, if you are home brewing, the alcohol contained will be less than .5%, assuming additional sugar, fruit, or juice is not added, which can increase the fermentation amount. When you add extra sugars in any form, it reactivates the yeast and creates higher alcohol content. Most kombucha you buy in a store will be under 0.5% alcohol. If the alcohol percentage is higher, in the U.S., you would have to be of the legal drinking age of 21 to buy it. Some kombuchas have slightly higher alcohol and even high alcohol kombucha (7%+), which would be more like a beer.

The pasteurization process kills harmful and beneficial bacteria, and kombucha is not pasteurized. You obviously wouldn’t want to detox during pregnancy or breastfeeding because you don’t need those toxins going to your baby either through your placenta or breast milk. 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 for introducing kombucha slowly and increasing the amount you consume over time. This could be for two reasons. First, the detox effect it can have. Secondly, introducing new bacteria into your gut microbiome can have unfavorable effects like gas, bloating, or even diarrhea. Probiotics have similar directions for starting with a smaller dose and increasing it over time. You will likely have different experiences with different types and brands of kombucha. There is a lot more information on kombucha in this episode.

Alcohol

When you drink alcohol, it is absorbed through your stomach and small intestines and enters your bloodstream. Once in your bloodstream, it goes everywhere to your heart, brain, muscles, and other tissues. If you are pregnant, it is also crossing your placenta and going to your baby. This article will examine the evidence from the party night you had before you realized you were pregnant, enjoying a drink or two during pregnancy, and why you may not need to pump and dump if you drink while breastfeeding.

The Official Opinions on Alcohol During Pregnancy

All major medical organizations advise against alcohol in any amount. The Centers for Disease Control and Prevention state that there is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer.

According to the American Academy of Pediatrics, prenatal alcohol exposure 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. It states that there is no safe amount or type of alcohol use during pregnancy. These organizations are adamantly against alcohol consumption during pregnancy because alcohol-related birth defects are entirely preventable.

Finding Solutions that Work for You

The better you are about staying hydrated throughout the day with water, the less you will be thirsty and reach for other beverages. You always have the option to play it as safely as possible and avoid the drinks covered in this article. You can employ a few strategies to enjoy some of these beverages while avoiding or mitigating risks. One tool to evaluate drinks you should be cautious about is to weigh the risks and the benefits. The benefit may outweigh the risk depending on how much you want that kombucha or cup of coffee. You can use alternatives like sparkling water to enjoy a cold fizzy drink without the downsides of caffeine or sugar.

It is easy to go down the rabbit hole of overanalyzing everything you consume. For some of the beverages in this article, the dose matters. There is a big difference in the amount of sugar you consume if you drink soft drinks and juice throughout the day than if you enjoy them in moderation. I know this seems impossible now if you decide to limit or cut out something you love, like your morning coffee. You are only pregnant for nine months. This period of being cautious about everything you consume is short and gets easier over time. 

More In-Depth Information on Beverages During Pregnancy and Breastfeeding

Many episodes of the Pregnancy Podcast examine the evidence of the risks and benefits of specific beverages or ingredients during pregnancy. Check out these episodes for in-depth information on the following topics:

Hydration and Drinking Water

Pregnancy Diet

How Much Caffeine Is Safe?

Is Any Amount of Alcohol Safe During Pregnancy and Breastfeeding?

Drinking Tea During Pregnancy

Kombucha

Eating Organic During Pregnancy

Sugar

Natural and Artificial Sweeteners

IV Fluids and Drinking During Labor

Talking to Your Doctor or Midwife

If you have questions about whether any beverage 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.

Thank you to the amazing companies that have supported this episode.