Is it Safe to Drink Energy Drinks During Pregnancy?

Energy drinks are consumed by people all over the world due to the purported benefits promoted by aggressive marketing strategies. Health benefits associated with energy drinks vary and include claims such as-increasing exercise performance, sharpening mental focus, and alertness. But should you ingest them if you are pregnant? The answer is, no. In fact, most energy drink companies voluntarily post advisory statements on their labels, which discourage pregnant and nursing women from consuming energy drinks.

When you are pregnant, a placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. The nutrients in the food you eat get passed on to your baby, including ingredients in energy drinks. Researchers do not know the effects of all the ingredients in energy drinks and because different types of energy drinks contain different cocktails of ingredients, energy drinks can be hard to test.

Some animal studies have found a negative association when consuming energy drinks regularly. In studies where pregnant mice were given a small amount of energy drink daily during the duration of their pregnancy, found that when exposed to energy drinks daily, the newborn mice had oxidative stress, tissue injury, and behavioral alterations (including anxiety). The researchers concluded that "the consumption of energy drinks (EDs) during pregnancy and lactation has a negative impact on the newborns and should be treated as a significant health problem that warrants attention."

Emily Mitchell, MS, RD, CSSD, CDE, CLT, dietitian at the Center for Fetal Medicine says, "Energy drinks are not recommended during pregnancy as they may contain high levels of caffeine, and other ingredients not recommended for pregnant women. Energy drinks are also not regulated by the FDA as they fall into the category of food supplements. Supplements are not regulated and may contain ingredients that are not listed in the label."

To prove this statement further, it is the position of The American Academy of Nutrition of Dietetics that, "An energy drink is any beverage that contains some form of legal stimulant and/or vitamins added to provide a short-term boost in energy. These drinks may contain substantial and varying amounts of sugar and caffeine, as well as taurine, carnitine, inositol, ginkgo, and milk thistle. Many of these have not been studied for safety during pregnancy. Ginseng, another common ingredient, is not recommended for use during pregnancy. The avoidance of energy drinks during pregnancy is advised."

Numerous studies have tested the differing acute cardiovascular responses in people who drink sugar-sweetened energy drinks. Results of these studies seem to vary, depending on the type of energy drink being studied and the type of measurement tools being used. Some research studies have documented an increase in systolic blood pressure as well as increased heartbeat post energy drink consumption. Although none of the studies were conducted on pregnant women, if these effects are potential post consumption symptoms, then it is wise to avoid consumption when pregnant.

The ingredients in energy drinks will vary depending on the manufacturer. Many energy drinks contain a concoction of ingredients that create an energy blend. The problem with these concoctions is that it is very hard to figure out which ingredients can cause adverse symptoms. One of the main concerns in energy drinks for pregnant women is the amount of caffeine, which may not always be easily determined. According to the National Beverage Association, "Leading energy drinks voluntarily disclose the total quantity of caffeine – from all sources – on a per can/bottle basis, but they are not required to." Because monitoring your caffeine intake during pregnancy is important, this could be problematic if you are unable to track it.

Caffeine is one of the main ingredients in energy drinks and is known to activate the sympathetic nervous system. Caffeine overdose can cause seizures, psychosis, and cardiac arrythmias. Mitchell says, "Too much caffeine can raise blood pressure and heart rate. It affects the nervous system and can cause irritability, nervousness, and sleeplessness. The evidence of caffeine use in pregnancy is not conclusive so it’s best to limit." Pregnant women are advised to limit their caffeine during pregnancy to "200 mg or less, which is the amount in one 12-ounce cup of coffee," she says.

Some energy drinks contain non-nutritive sweeteners. Nonnutritive sweeteners are zero- or low-calorie alternatives to nutritive sweeteners, such as table sugar. They help to add sweetness without adding calories and sugar. Because they are much sweeter than sugar, small amounts need to be added to create sweetness. The Food and Drug Administration has approved the use of the following nonnutritive sweeteners: acesulfame-K, aspartame, neotame, saccharin, sucralose and stevia. The problem with these is that there is limited research that addresses the safety of non-nutritive sweeteners on healthy pregnancy and therefore, most of the time, these types of sweeteners should be avoided.

If energy drinks do not have non-nutritive sweeteners to add sweetness, they use sugar. Too much sugar can add unhealthy excess calories, which can result in excessive weight gain. In addition, for women who have gestational diabetes, this can be very problematic because they need to monitor their carbohydrate intake and limit simple sugars to prevent large swings in blood sugar.

Some energy drinks contain taurine, a conditionally essential sulfur-containing amino acid, naturally found in animal foods, that supports neurological development, and regulates the amounts of water and minerals in the blood. Because the brain and the retina of human infants are not fully developed at birth and may be vulnerable to the effects of taurine deprivation, infant formulas are supplemented with taurine. Little is known about the effects of taurine during pregnancy, when combined with energy drinks. And therefore, it is recommended to avoid it during pregnancy.

Ginseng, often referred to by its Latin name, Panax ginseng, is an Asian herbal supplement that has been used for more than 2,000 years. According to the National Institute of Health, "questions have been raised about its long-term safety, and some experts recommend against its use by infants, children, and women who are pregnant or breastfeeding." In fact, the American Academy of Nutrition and Dietetics discourages use in pregnancy. This is probably because there are few quality studies that examine the long-term effects.

In addition, the most common side effects of ginseng are headaches, sleep problems, such as insomnia, and digestive symptoms. Lastly, it could affect blood sugar and blood pressure, so if you have gestational diabetes or high blood pressure you should avoid ginseng.

Gluconolactone is a naturally occurring polyhydroxy acid (PHA) with metal chelating, moisturizing, and antioxidant activity. Glucuronolactone is often said to increase energy because of its supposed impact on energy metabolism, but it is questionable as to whether it influences energy levels. Because it is not well studied in pregnancy it should be avoided.

Guarana is another source of caffeine that comes naturally from a plant. It is often added to energy drinks for its potential to increase athletic performance and concentration. Because women who are pregnant need to monitor their caffeine intake, energy drinks with caffeine and guarana should be avoided.

This herb comes from the leaves of the gingko tree and has been used in China for Centuries. It is believed that it can improve memory. However, because it has not been studied in pregnancy and ingestion may cause gastrointestinal upset, headache, dizziness, palpitations, constipation, and allergic skin reactions, it is prudent to avoid this product.

L-carnitine is derived from lysine and methionine. It is often added to energy drinks to improve athletic performance based on the theory that it can help to spare muscle glycogen. However, according to the Linus Pauling Institute, most studies have shown no effect on physical performance. It is found naturally in animal products and doesn't appear to have any adverse effects unless consumption is more than 5 gram per day, in which diarrhea and "fish odor syndrome" can occur.

Commonly used in weight loss products, Yohimbe has been associated with sleeplessness, mood disorder, nervousness, and anxiety. It has not been studied in pregnancy and should be avoided.

B vitamins are involved in the metabolism of carbohydrate, fat, and protein and are believed to help increase energy by converting energy from the macronutrients into adenosine triphosphate (ATP), a form of energy our body uses. The problem with B vitamins in energy drinks is twofold; 1) Levels of vitamins and other additives in energy drinks often exceed recommended daily intakes, 2) Most of the research has not supported supplementation with enhanced performance.

B vitamins are water soluble, and if taken in excess, are usually not problematic because much gets excreted in the urine, however, adverse effects of high doses of B vitamins have been noted:

• B3 Niacin - can cause flushing (burning, itching, redness on the face, arms, and chest) and increased heartbeat
• B6 Pyridoxine - long term supplementation with very high doses may result in sensory neuropathy and may increase the risk of hip fractures in older adults

All energies drinks are not created equal and do not contain the same ingredients. This can make understanding the effects of energy drinks more difficult. For example, one can of regular Redbull contains: caffeine, taurine, sugar, and B vitamins, while Monster contains: ginseng, carnitine, glucose, caffeine, guarana, inositol, glucuronolactone, and maltodextrin.

Many women who are nursing, especially in the early stages of infancy, experience disrupted sleep schedules, which can make one feel lethargic. Although it might seem reasonable to consume an energy drink, to increase energy and alertness, the caffeine in energy drinks can cross into a mother's milk supply. Some infants can be sensitive to caffeine and display increased irritability and sleep disturbances when exposed to caffeine from breastmilk. While some caffeine intake, is considered safe and acceptable, too much is not recommended.

In addition, breastfeeding women who consume energy drinks may be ingesting herbal ingredients that have not undergone scientific evaluation. It's important to discuss consumption and review labels with your healthcare provider because if you are taking prenatal vitamins you are more susceptible to vitamin toxicity.

Oftentimes energy drinks are found displayed next to sports drinks in grocery and convenience stores. It is important not to confuse energy drinks with sports drinks. Sports drinks, which are made to support hydration and electrolyte balance, do not contain caffeine. Energy drinks contain caffeine and too much caffeine can lead to an increase in urine output, which may increase the risk or make dehydration worse. It's always important to be label savvy and read labels of all beverages before consuming.

Energy shots are condensed forms of energy drinks that are sold in small containers, holding 2 to 2½ oz. Caffeine is a major ingredient and ranges, from about 113 to 200 mg in an energy shot. As stated earlier, too much caffeine in pregnancy is not recommended.

Energy drinks are consumed all over the world for various reasons, but if you are pregnant you should avoid them. The ingredient blends vary, and the concoctions aren't well studied in women who are expecting or those that are nursing. Because we cannot determine the effects energy drinks will have on mother or expectant baby, it is best to avoid them altogether. Whenever you are doubtful about a product, consult with your physician.