孕妇可以喝咖啡吗

孕妇可以喝咖啡吗

国内的姐妹交流怀孕心得的时候,少不了听到会抱怨几句,什么都不让吃!

咖啡,茶,巧克力,在国内很多婆婆都明令禁止孕妇享受的食品……

那天和小p聊天,她大吐苦水。于是我们一起查询了一下。用科学的角度看这个话题:孕妇可以喝咖啡吗?

英国:Midwife (助产士问我)问我,喝咖啡吗? 我说喝,控制一杯以内。 她笑着说,二杯以内都是可以接受的。

其实大多天然的食品对身体伤害都是比较小的。咖啡是个例外其实是有两个原因。

  1. 咖啡因

可是如同所有的事情一样,量的控制最重要。

就现有的资料来看,在通常饮用量(每天1、2杯)下,没发现咖啡对胎儿发育有实质危害。

FDA的建议只是“减少”而非“禁绝”咖啡因的摄取。减少到多少比较合适呢?这显然是一个难以准确回答的问题。对于未孕女性,大致的建议是每天摄入的咖啡因不要超过200毫克,即每天喝咖啡不超过3杯(速溶小包装咖啡)。不同种类的咖啡之咖啡因含量差异较大,咖啡店一杯普通中杯(250~280毫升)装即磨咖啡,含有150至200毫克咖啡因。

 

对于已经怀孕或可能怀孕的女性,每天不要超过1杯(速溶小包装咖啡)。当发现胎儿出现兴奋反应(胎动明显增加)时,要停止喝咖啡。即使胎儿没有表现出明显的兴奋,也要注意监测胎儿的发育速度,如果发现胎儿发育较慢(小于孕周),亦应停止喝咖啡。

这些建议都是根据咖啡因对胎儿的影响做出的,所以那些低咖啡因的咖啡(1杯咖啡只含3毫克咖啡因,大致相当于普通咖啡的二十分之一)不在此限制范围之内。也就是说,低咖啡因咖啡可以喝数杯。在咖啡豆送进烘焙机之前,先经过处理,分离出大部分咖啡因,使得咖啡中的咖啡因仅“残留”5%左右,这就是低咖啡因咖啡。不过,不论咖啡因含量高低,喝咖啡都会带来其他一些值得重视的健康问题。

2.反式脂肪酸

除咖啡因外,咖啡伴侣或速溶咖啡中的植脂末也可能会带来不利影响。植脂末(咖啡伴侣)的成分比较复杂,主要有葡萄糖浆、氢化植物油和各种食品添加剂,如乳化剂、水分保持剂、拮抗剂等。各种复杂多样的食品添加剂暂且不论,氢化植物油含有的“反式脂肪酸”对胎儿有潜在的危害。

“反式”是相对“顺式”而言的。所谓反式脂肪酸是指按分子空间结构,氢(H)在双键的两侧的脂肪酸。与之相对的则是“顺式脂肪酸”,即氢(H)在双键的同侧的脂肪酸。在天然食物中,绝大部分脂肪酸都是顺式脂肪酸,反式脂肪酸少之又少。反式脂肪酸主要来源一大类特殊的加工的油脂——氢化植物油。

所谓氢化,是指一种特殊的油脂加工工艺。氢化植物油,简单地说,就是把棕榈油、菜籽油等植物油中的不饱和脂肪酸,通过加上氢变成饱和脂肪酸,从而获得很多非常好的性能,比如口感润滑、不易氧化等,这对改善咖啡的口感非常重要。但与此同时,氢化植物油也常常含有一定量的副产品——反式脂肪酸。

反式脂肪酸已经被证实对健康有害。目前已经非常明确的害处是造成血脂异常,增加冠心病的危险性。还有研究发现,反式脂肪酸能通过胎盘以及母乳转运给胎儿和婴儿,并影响其生长发育。世界卫生组织(WHO)建议限制反式脂肪酸摄入,每日不超过 1%总能量(大约2克)。我国婴儿配方食品国家标准(GB10765、GB10767、GB10770)也禁止使用氢化植物油。

不过,咖啡伴侣或植脂末并不是反式脂肪酸的唯一来源。面包、饼干、方便面、蛋黄派、糕点、油条、薯条、薯片、各种酥类、膨化零食、沙拉酱、奶茶、等都普遍使用氢化植物油并含有反式脂肪酸。而且,与这些加工食品相比,植脂末中的反式脂肪酸含量反倒要少一些。因此,就反式脂肪酸而言,孕妇仅仅控制咖啡饮用量还不够,甚至不是关键。

孕妇喝咖啡时要少放咖啡伴侣,少选用含有植脂末的速溶咖啡,可以在咖啡中直接加入热的全脂牛奶,这样不仅口味同样香浓,而且营养价值更高。

 

3.其他

咖啡在肠道内会干扰钙、铁、锌等矿物质的吸收,降低其吸收率。所以喝咖啡的时候,也尽量不要与食物混杂。

咖啡对胃炎、溃疡患者不利。由于咖啡会促进胃液分泌,促进胃酸增加,故胃肠不好的孕妇在喝咖啡时,要多加注意,不要空腹喝咖啡。

咖啡会造成钙质流失。有研究说,咖啡因使尿中排出的钙增多,从而增加患骨质疏松的危险。这对需要大量钙的孕妇显然不是好消息。所以经常喝咖啡的女性应注意补钙。

总而言之,如果综合衡量的话,咖啡对孕妇弊多利少。咖啡几乎没有任何重要营养素,或含量极微。这对需要大量营养素的孕妇来说的确不是好事。因此,孕妇以不喝咖啡为最佳,非喝不可时一定要限量,尽量少喝。当然,这建议并不意味着喝咖啡会对胎儿造成巨大危害。这种客观的态度亦适用于其他含有咖啡因的食品,如茶、可可、巧克力、可乐饮料等。

 

跑题了!言归正传。咖啡在很多国家被认为是无可或缺的饮品,满街都是咖啡馆。我的美国老师每天早中晚举着三大杯咖啡出入,除了咖啡和碳酸饮料基本上不喝其他东西。每天傍晚的学术会更要提供黑咖啡畅饮才有人来。在这样的国家,咖啡因摄入真是躲不开的问题。但如今中国越来越时髦,咖啡也成了中国孕妈妈关注的因素。

 

通常大家担心咖啡,是担心里面的咖啡因。但是含咖啡因的可不光咖啡,巧克力、可可、茶、能量饮料,甚至某些碳酸饮料,比如可乐里都有。不同品牌咖啡浓度不同,一小杯咖啡差不多125毫升,含有85毫克咖啡因(不是星巴克的“杯”哦,星巴克tall大概350毫升,有不少于200毫克咖啡因);而可乐也有35毫克;你可能想象不到,巧克力里咖啡因含量也不少;茶虽然敌不过咖啡,但反复冲泡,也能积少成多。

 

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各种咖啡的咖啡眼含量表格

 

咖啡“有影响”派

 

科研界对咖啡因的影响还有些令人困惑,一些研究认为孕期大量咖啡摄入(比如一天4-7杯,甚至8杯以上,马克杯算2杯)和流产有关,也有的说会导致早产或新生儿体重轻。

 

这方面结果并不太令人意外:咖啡因和代谢产物都是小分子,通过胎盘畅通无阻,因此在胎儿体内能达到和妈妈体内相似的浓度;胎儿体内分解咖啡因的酶却很少,有的研究就曾发现咖啡因代谢物会集中在胎儿的大脑;而到了孕中、后期,连准妈妈自身代谢咖啡因的能力都减弱了,代谢速度只相当于孕前1/3。这也许解释了为什么我后来逐渐不太想喝咖啡了。

 

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咖啡因”无影响”派

 

但实际上科研得出的结果更多支持咖啡无害,考察指标包括是否早产、体重轻、流产,甚至畸形。有一种丹麦减肥药曾受到不少女性的青睐,里面的咖啡因剂量相当于每天服用6杯咖啡,可想而知不少女性孕前(因为不知道自己什么时候怀孕)甚至孕初期都曾吃这种减肥药。若干年后,科学家对他们进行了追踪,结果是她们孕早期到孕五个月的流产率并未增高。注意,尽管这种减肥药里的咖啡因对胎儿没有统计出不良后果,但并不意味着减肥药可以随便吃,说减肥药对身体无害都是扯淡!

 

去年还有一项针对6万妈妈的研究,想再看看咖啡因和出生体重轻、早产是不是有关联。可以看出,哪怕不怎么喝咖啡,只要吃巧克力或者巧克力甜点、喝茶,也躲不开咖啡因。最后的结果也挺令人意外,貌似巧克力、茶、碳酸饮料和咖啡的作用并不一样,只有咖啡和新生儿体重轻有关系,但仔细一算,每天一杯咖啡也只是让体重从平均的7斤2两减少了半两,出生时间延长了8小时……

 

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除了新生儿,科学家也关注了咖啡对宝宝大脑和行为发育的长期效应。比如有人曾怀疑孕期喝咖啡影响大脑发育,宝宝晚上容易醒。科学家回访了近1000个三月大的宝宝,他们的妈妈中只有一个严格自律到令人发指的程度,整个孕期一滴咖啡不沾——我们把她忽略吧……20%的妈妈从怀到生都是咖啡依赖,每天至少保证300毫克咖啡因在血管中游走,差不多1-2杯tall星巴克;还有14.3%在孕早期维持这个量。然而她们的宝宝们醒夜的次数也没有显著增加。

 

我的娃还没出来,据奶爸奶妈朋友反馈,是天使宝宝还是恶魔宝宝、夜里是不是总醒来大哭,很大程度上也要看怎么带,而不是怀孕的时候吃了什么。

 

还有人担心孕期喝咖啡和宝宝日后行为发育有关,但科学家拿五六岁的宝宝做过测试,发现总体来说他们的行为、情绪都没有问题,注意力可以正常集中,和小伙伴的关系也正常,亲社会……

 

更让人迷惑的是,有的研究不仅没做出害处,反而说适量咖啡因对胎儿有好处,比如给小动物喂咖啡因,发现孕早期摄入咖啡能一定程度上预防缺氧造成的脑损伤。

 

咖啡对孕期妈妈的作用也“喜忧参半”。有研究说大量(真的是狂多、接近半致死剂量的)咖啡因摄入,降低了怀孕大鼠的骨密度,让它们的小细骨头更不抗压抗拉……相反,一些研究说适量咖啡摄入能降低孕期糖尿病的风险。

 

总之……

 

科研界的答卷不算黑白分明。那到底应该听谁的呢?我的医生说“两杯”并不是随口说的。世界卫生组织(WHO)建议孕期每天咖啡因摄入不超过300毫克。北欧营养推荐量(NNR)给出的数值是每天不超过200毫克,这些数值经过很多人长期检验,被大多数研究认定为安全剂量,甚至是比较保守的安全剂量。具体标准可以因人而异,如果准妈妈非常需要咖啡提神,或者能从咖啡因产品(比如可可、巧克力)中获得不少幸福感,就不必因为少量摄入而焦虑。

 

除了科学“大问题”,喝咖啡更立竿见影的是影响睡眠,这一点就需要准妈妈们自己斟酌了。孕期睡眠规律可能会改变,比如我,到了孕晚期夜里会醒几次,早上不到6点就能醒,上班反而精力充沛不犯困,也就没有需要咖啡提神的需求。时不常来个小半杯咖啡,过过嘴瘾,也并不觉得损失了什么啊。

咖啡是咖啡豆的提取物,其中的成分不下几百种。其中,咖啡因无疑是最重要的。虽然有“脱咖啡因”的咖啡,对多数咖啡爱好者而言,它算不上“真正”的咖啡。咖啡因能刺激神经兴奋,所以咖啡的作用首先就是“提神”。尤其是咖啡因加葡萄糖,能互相促进使得提神效果更好。很多运动饮料中,也会添加咖啡因作为合法的“兴奋剂”。

 

咖啡因是不是有其他的“保健功能”,也吸引了科学家们的许多目光。这类研究很多,总体而言,有一些研究显示了“没准有效”。比如有的老人饭后会因为低血压而出现晕眩,如果喝一杯含有咖啡因的饮料,就可能减轻这种症状。所谓“含咖啡因的饮料”,除了咖啡之外,茶或者可可也可以。帕金森氏症是一种常见的老年病,有调查显示咖啡因对降低其发生风险相当有效。男性每天喝三到四杯会达到最大效果,而每天一两杯也有明显作用。女性则跟饮用量关系不大,每天一到三杯就达到最大效果。不过有趣的是,这种效果对于吸烟的人就不存在。此外,咖啡因对于降低胆结石也有一定帮助,每天400毫克咖啡因(大致三四杯咖啡),可以显示出效果来。有意思的是,对二型糖尿病的影响与摄入量的关系跟人种关系比较大。在欧美人群中,每天喝六杯咖啡,男性的风险可以降低50%以上,而女性则降低30%左右。而在日本人中,每天喝三杯就可降低42%。

 

咖啡中除了咖啡因,还含有许多其他的“活性成分”,比如抗氧化剂。尤其是经过烘炒的咖啡豆,抗氧化剂的含量会增高。抗氧化剂有助于心血管健康,但是咖啡中也有“有害物质”,比如双萜烯类化合物,会增加心血管疾病的风险。在这种“左右互搏”的情况下,就看哪方占主导了。好在,双萜烯类化合物可以被咖啡纸滤掉,所以不推荐未经过滤的咖啡或者用金属网过滤。“抗癌”作用也有类似的情况,有调查显示每天三杯咖啡,可能降低直肠癌的风险。但是,烘烤使抗氧化剂含量增高的同时,也会产生丙烯酰胺,而大剂量的丙烯酰胺在动物实验中显示了致癌性。

 

咖啡的“不良表现”远不止这些。如果每天喝太多咖啡(比如六杯以上),可能导致上瘾,对咖啡的敏感性下降,又会进一步喝得更多。喝太多,可能会导致失眠、紧张、胃部不适、恶心、呕吐、心率与呼吸加快、头痛、耳鸣都等症状。对心脏病人,每天五杯就达到“不安全”的量。

 

很多人关心孕妇产妇能否喝咖啡。基于目前的科学证据,一般认为:每天不超过两杯(大概200毫克咖啡因)还是可以接受的。孕妇超过这个量,会增加流产、早产或者婴儿体重不足的风险。而母乳喂养的产妇,超过这个量可能会带来刺激婴儿的消化道,以及影响婴儿睡眠等风险。

 

一般而言,儿童对咖啡因比成人更为敏感。考虑到回避副作用对儿童更加重要,所以建议儿童最好不要喝咖啡。

 

虽然有调查数据显示咖啡能降低二型糖尿病的风险,但是咖啡因对血糖的影响比较复杂,增加和降低的研究结果都有。所以,对于糖尿病人,如果要喝咖啡的话,一定要注意监控自己的血糖变化,及时作出调整。

 

此外,咖啡也能增加钙流失。如果有骨质疏松症状,每天的咖啡因摄入就不要超过300毫克(相当于两三杯咖啡)。老年女性很容易出现骨质疏松,也就需要更加注意。

 

对于喝咖啡来说,更应该注意的是与药物的反应。最需要小心的是麻黄碱,它具有刺激神经兴奋的作用。如果加上咖啡,其效果就会大大加强,从而出现“过量服药”的症状。而含有麻黄碱的感冒药很常见,比如康泰克、白加黑等等。(编者注:可参考阅读《感冒药攻略》)

 

除此以外,很多药物的代谢会跟咖啡因的代谢互相影响。这种影响有的是增加咖啡因的作用(当然包括副作用),有的是增加药物的效果,有的是降低药物的效果。药物的剂量是按照正常使用的效果来设计的,不管是增强还是减弱,都会影响治疗。能够与咖啡因互相影响的药物太多,普通人大概无法记住,所以,最简单的做法就是:在服用各种药物期间,都不要喝咖啡。

 

作为成分复杂的天然提取物,不同的成分有不同的作用,不同的实验得到不同的结果并不惊人惊讶。作为饮料,咖啡可能有惊人心动的“保健功能”,也可能有让人担心的“副作用”。这些研究结果多是流行病学调查,结论也谈不上盖棺定论。综合这些正反方面的研究,目前比较广为接受的推荐是:健康成年人,每天喝两三杯咖啡,“益处”超过了“风险”;对于孕妇产妇,不超过两杯,也可以接受。其他的人群,就需要根据具体情况来权衡了。

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喜欢的咖啡图片

 

http://cdn.songshuhui.net/wp-content/uploads/2013/01/tumblr_m47ru3pRwi1rtrjuvo1_400.gif

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