Good News About Chocolate and Pregnancy

Famous cartoonist Charles M. Schultz once wrote "all you need is love, but a little chocolate now and then doesn't hurt." But before you channel your inner Lucy and dismiss the notion of indulgence during pregnancy with a disappointing exclamation of oh, Chuck! read on&. In honor of International Chocolate Day (tomorrow, September 13), and for the benefit of all the pregnant women who have wondered about eating chocolate or, worse, denied themselves the sweet treat out of fear that they would be engaging in harmful behavior, now is a great time to dive into this tasty subject.

Non-diabetic pregnant women are occasionally concerned about eating chocolate because of its caffeine content, however, we now know that chocolate is not a major source of caffeine. According to the Center for Science in the Public Interest, nine Hershey's Kisses contain 9 mg of caffeine and one Hershey's Special Dark chocolate bar contains 31 mg. These amounts are far below the recommendations set forth by the 2010 guidelines of the American College of Obstetricians and Gynecologists, which is to limit caffeine intake to less than 200 mgs per day.

Chocolate is not a major source of caffeine and in fact, it is known to have many healthful properties. Studies have suggested that natural chemicals in chocolate may contribute to a more healthful pregnancy by reducing the risk for some pregnancy-related complications like preeclampsia and high blood pressure.

Healthful Properties

Chocolate contains flavanols, which fall under a set of chemicals called flavonoids. These naturally-occurring chemicals are believed to have healthful effects, reducing inflammation and relaxing blood vessels. Chocolate also contains methylxanthine theobromine, a chemical that dilates blood vessels, and relaxes smooth muscle.

Studies published in 2008 and 2010 looked at chocolate in diet and reduction in risk for preeclampsia and gestational hypertension and both had similar findings. In the 2008 study, non-diabetic pregnant women were asked about their daily/weekly consumption of chocolate, including hot cocoa, chocolate milk, cakes, cookies, ice cream, and candy in interviews conducted in their first and third trimesters. When the baby was born, the blood in the umbilical cord was tested for theobromine concentrations. Theobromine is the major metabolite of chocolate. The authors found that when they looked at the mom's self-reported chocolate intake, they found a suggestion of reduced preeclampsia risk. When they looked at the blood theobromine levels, they found a lower risk for preeclampsia. The theobromine levels were highest for those that ate the most chocolate in the third trimester of pregnancy.

There have been other positive associations found in studies involving chocolate and pregnancy. In a Finnish study published in 2012, the authors looked at diet during pregnancy, including chocolate, and the risk for asthma and allergic symptoms in children at five years of age the thought being that prenatal exposures to foods could predispose children to asthma/allergies. The authors found that prenatal diets low in vegetables, low in apples, pears, apricots, peaches and prunes and low in chocolate, were associated with a risk of wheeze in children. Higher intake of berry/fruit juices was associated with a risk for allergic rhinitis in children. They did not find other food associations that were specific to asthma. The diagnosis of wheezing in children is a common one, and is most frequently due to airway disease (asthma, allergies and infections), but could be due to other disease factors as well.

While there could be other reasons that explain the positive chocolate associations observed in these studies, the good news is that the studies do not show adverse effects to pregnancy and eating chocolate and instead show that chocolate may contribute to a healthy pregnancy in non-diabetic women. Additionally, the studies suggest that while dark chocolate contains the highest amounts of flavanols, all chocolate-containing products contain these polyphenols. In the future, it would be interesting to see a study that includes only pregnant diabetic women and consumption of sugar-free chocolate. Diabetic women have a higher risk of preeclampsia.

So in celebration of International Chocolate Day tomorrow, get together with a good friend and share some sweet chocolate treats (in moderation, of course) -- because there's nothing truly better than a good friend... except a good friend with chocolate.

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women's and health professionals' questions regarding exposures during pregnancy/lactation via CTIS' toll-free hotline and email service, she's provided educational talks regarding pregnancy health in community clinics and high schools over the past decade. In addition, Sonia contributes to the service's website, develops training materials for new CTIS staff, and is the supervising Teratogen Information Specialist trainer. Sonia attended San Diego State University and has worked in Tuberculosis Control for San Diego County's Public Health Department. Sonia's work has also been published through several tuberculosis studies. In her spare time, she loves to volunteer with the March of Dimes as an expert speaker on themes related to pregnancy.

CTIS Pregnancy Health Information Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

References:

Saftlas A F et al: Does Chocolate Intake During Pregnancy Reduce the Risk of Preeclampsia and Gestational Hypertension? Ann Epidemiol 2010; 20(8) 584-591.

Triche E W et al: Chocolate Consumption in Pregnancy and Reduced Likelihood of Preeclampsia. Epidemiology 2008;19(3):459-464.