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Caffeine and Breastfeeding

If anyone needs a little caffeine, it’s a new mom. My labor with Cee took me through two mostly sleepless nights, and when she finally arrived, we took a little time to nurse and get to know one another, and then our whole little family took a long nap. When we woke up, the first thing I did was send my husband to get me a latte. The second thing I did was breastfeed my new baby again. That dose of caffeine felt like good therapy to me, but what about for Cee? Was it good for her?

caffeine structure

Source: Wikimedia Commons

A few weeks ago, I wrote about the safety of caffeine in pregnancy, and several readers wanted to know about the postnatal effects of caffeine – how mom’s caffeine intake might affect her breastfed baby. I promised to take a look at the literature and report back, and so here we are.

When you drink a cup of coffee, how much caffeine ends up in your breast milk?

Several studies have examined this question, and although they are small, they give us a general idea of the transfer of caffeine from mom’s blood to her milk. After a cup of coffee, caffeine is rapidly absorbed into mom’s blood and then passively diffuses across the epithelial layers of the mammary gland. Caffeine appears in milk within 15 minutes of consumption and peaks within an hour. The concentration of caffeine in breast milk ends up being about 8090% of that in mom’s plasma. However, taking into account the amount of breast milk consumed and adjusting for body weight, studies have estimated that the infant receives no more than 10% of the maternal dose of caffeine, and likely much less (see here, here, and here).

Is this amount of caffeine safe for a baby?

Just because levels of caffeine in breast milk are low relative to what adults normally consume doesn’t mean that these amounts are necessarily safe to a baby. Another important factor is how efficiently a baby can metabolize caffeine, and it turns out that newborn caffeine metabolism is really slow. Whereas the half-life of caffeine in adults is around 2-6 hours, it is an average of 3-4 days in newborns and can be even slower in premature babies. In other words, a morning cup of coffee for mom will easily clear her blood by bedtime, but caffeine may linger in her breastfed newborn for much longer. Metabolism gradually ramps up as the baby matures and the necessary enzyme levels come on board, and most babies can metabolize caffeine at rates similar to adults by 5-6 months of age.

However, there is a lot of baby-to-baby variation in caffeine metabolism. For example, in a study measuring the half-life of caffeine in 5 babies between 6 and 8 weeks of age, results ranged from 8 to 41 hours. Mom’s cup of coffee is probably more likely to have an effect on the 41-hour baby than the 8-hour baby.

There’s some evidence that your caffeine consumption in pregnancy might impact your baby’s ability metabolize caffeine. A 2010 study measured the behavior of 13 fetuses at 36-38 weeks of pregnancy. Moms were asked to track their caffeine intake for 1 week, and this was verified with blood caffeine measurements. The moms were then asked to avoid all caffeine for 2 days, after which they all drank 2 cups of black coffee (300 mg caffeine). After this standard dose of caffeine, fetuses of mothers who were usually high caffeine consumers showed no change in behavior. However, those whose moms usually consumed little to no caffeine showed a clear response to the coffee. They were more wakeful, moved more, and had a lower basal heart rate but with greater variation. This is a small study, and we don’t know if this effect continues after birth, but it suggests that babies that are exposed to some caffeine in utero may be more tolerant of caffeine.

Photo by Meliha Gojak.

Photo by Meliha Gojak.

The few studies that have actually looked at breastfed babies’ behavior under the influence of caffeine are reassuring. A 1984 study included 11 mom-baby pairs (3-10 weeks of age) in a crossover design, asking moms to drink 5 cups of decaffeinated coffee per day for 5 days and then 5 cups of caffeinated coffee (500 mg) per day for another 5 days. During the caffeinated period, the infants absorbed caffeine as expected, but there was no difference in their heart rates or sleep times. A more recent study, conducted in Brazil and published in Pediatrics in 2012, carefully tracked maternal caffeine intake through pregnancy and during breastfeeding. The mothers of 885 3-month-old infants recorded their babies’ sleeping patterns for 15 days. There were no significant differences in the sleep patterns of the babies based on maternal caffeine consumption, even in moms consuming more than 300 mg per day. (For estimated caffeine content of various drinks and medications, see the table in my previous post on caffeine safety in pregnancy.)

Caffeine is also routinely used to treat apnea in premature babies. It’s one of the 10 most frequently prescribed medications in the NICU, and this use gives us a little more information about safety. The daily dose used in the NICU, often continued for several weeks, is as much as 10-20 times the amount absorbed by a breastfed baby whose mom drinks a single cup of coffee, and this is on top of the slowed metabolism of caffeine in premature babies. Side effects are sometimes seen at this dose: increased heart rate, trouble feeding, and slower weight gain. However, a randomized controlled trial of more than 2000 infants found that caffeine was effective at reducing apnea and that it also reduced the incidence of cerebral palsy and cognitive delay at 18-21 months of age. There was no difference in death or disability at age 5 years.

Together, these studies tell us that for most babies, moderate caffeine consumption (i.e. about 300 mg per day) by mom is unlikely to hurt a breastfeeding baby. However, these conclusions are limited by the small size of most of these studies. It’s too bad – and a little surprising – that we don’t have better data with which to advise women about one of the most common drugs used by breastfeeding moms.

Regardless of what the studies say, your most important data point is always your own baby. Your baby could be one of those with really slow caffeine metabolism and may be more sensitive to your caffeine intake. Since you’re unlikely to have the opportunity to measure your baby’s caffeine half-life (and probably wouldn’t want to, because this requires repeated blood draws), your best indicator is your baby’s behavior. If your baby is jittery or irritable and has trouble sleeping, then it might be worth trying to cut out caffeine for several days to see if this helps. Knowing that your baby’s caffeine metabolism will mature with age, you can try adding caffeine back into your life in a month or two. Of course, keep in mind that it’s also totally normal for an infant to be irritable and have trouble sleeping, with or without caffeine.

How much caffeine have you used while breastfeeding? Have you noticed that your baby is sensitive to your caffeine intake?

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42 Comments
  1. Dahlee #

    I drank a cup of coffee almost every day while pregnant and after. In the first month or so my dd seemed to be affected a little as she was more irritable after I drank it. I cut down on how much I drank (about half the amount) and she seemed to not be affected anymore.

    Like

    August 8, 2014
  2. Julie J #

    I’m interested to know if these results are similar for alcohol? Does the baby get about 10% of the maternal dose and is the half life longer in newborns and the same in older babies? Any thoughts?

    Like

    August 8, 2014
    • Megan #

      I’ve read that alcohol does not stay in the breast milk. It filters out with time the same way it filters out of your blood. The amount of alcohol in your blood is the same as the alcohol in your milk- so higher right after a drink and little to none after a certain amount of time has passed which varies depending on your weight, metabolism and the amount of alcohol consumed.

      Like

      August 8, 2014
  3. What is a mother to do for energy if her child is sensitive to caffeine?

    Like

    August 8, 2014
    • Theresa #

      My son is EXTREMELY sensitive to caffeine. I cannot have any caffeine whatsoever. I sleep when he sleeps. I have been lucky. He has been sleeping 6-8 hours everynight since he turned 2 months old. For energy, I have a light snack after each feeding (watermelon, granola, yogurt), nap when I start to feel tired (don’t wait til you’re too exhausted), and drink plenty of water.

      Liked by 1 person

      December 17, 2015
  4. Did you find anything about maternal caffeine consumption and a change in the risk of SIDS? I’ve often wondered if some of the supposedly protective effect of breastfeeding is due to transfer of caffeine which, as you point out, is a respiratory stimulant. Anyway I drank decaf with number one and full caf with abandon with number two. Standards lower? More fatigue…and I was less willing to give up stuff I enjoyed and that helped me function based on no data! #Secondtimeisbetter.

    Like

    August 8, 2014
  5. AEM #

    Super interesting post, thank you! I’d love to know similar stats on both alcohol and milk protein. I got a lot of conflicting advice about alcohol while breast-feeding and when my first daughter was suspected of having a milk protein allergy I was told it would take between 2 and 14 days to clear my milk once I stopped dairy, depending on who you asked.

    Like

    August 8, 2014
  6. Katie #

    I have never been a consumer of caffeine except for chocolate and the occasional sip/gulp of my husband’s coke. When I have tried coffee or soda I never noticed caffeine having any effect on me at all. However I have had an inkling that my son may be super sensitive to it (he’s almost five mos and I’ve wondered about this as recently as yesterday). I’ll admit though it’s probably my imagination/ a scapegoat for his being a sucky sleeper. I first got the idea from a nurse who conducted our nonstress at 36 wks: she commented that he was quite jumpy.. I had eaten exactly 4 chocolate eggs (maybe an oz.?) on my way to the appt, haha. But anyway through most of my pregnancy I had little to no caff.. So the conditioning effect idea interests me.

    Like

    August 8, 2014
  7. Rana #

    I drank a cup of tea every morning after the first trimester (it was unappealing then) and continued after birth; I have since added an afternoon cup of coffee to my daily intake, with my baby currently 9 months old.

    I can’t say that I’ve noticed any changes in her behavior one way or another. I find the information about possible desensitization interesting – one of the reasons I drink tea regularly is to maintain a low level of desensitization in myself, as I endure “panic attacks” (they’re more adrenaline surges than mental freak-outs) and a single cup will trigger one if I’ve been abstaining.

    It also makes me wonder about other things mothers consume while pregnant, particularly allergenic foods – might there be a similar effect?

    Like

    August 8, 2014
  8. Danielle #

    My baby has not been a good sleeper since about 3.5 months old; I did not consume any caffeine during pregnancy and added it back around the same time his night sleep started to be bad. He is 8 months old and still wakes multiple times in the night. I wonder if he is one of those baby’s who are more sensitive to caffeine. I am going to stop drinking coffee for a few days and just see if it improves. Its’ worth a shot!

    Like

    August 8, 2014
  9. I drank coffee every day while pregnant (after the first trimester, because morning sickness and coffee didn’t mix) with both kids. And more after they were born. I never noticed any effects, and I’m really not sure if I could have done without it, especially after baby #2.

    Like

    August 8, 2014
    • miaozi #

      So both of your babies are quite well even if you drink coffee every day with breastfeeding? How lucky you are. I am addicted to coffee, but my baby seems sensitive to it….not sure what to do….

      Like

      May 19, 2016
  10. kylynara #

    With my older son, I dropped all caffine (except chocolate) during pregnancy and he was super sensitive to it as a baby. Even one occasional cup of tea or soda consumed by me would keep him up all night as opposed to his usual half.

    With my second, I had tea (1-2 cups a day, 4 a couple times when I got a sore throat) regularly during pregnancy and caffeine doesn’t seem to affect his sleep at all. I alternate tea one morning, coffee the next, etc. I also sometimes have iced tea at restaurants as well. He’s only 3 months old, but he sleeps pretty much all night. Wakes up to nurse 2-3 times but goes right back to sleep with no fuss.

    Like

    August 8, 2014
  11. Great article! Both mine were super sensitive to caffeine, my second less so which I attributed to drinking coffee throughout pregnancy.

    Like

    August 9, 2014
  12. i had chocolate through my pregnancy – more than i would usually have, but still a normal amount (pre pregnancy i would have it every so often almost on rare occasions. during pregnancy i often had some daily).

    when little one was born i soon noticed she would sometimes have trouble going to sleep. i cut out my chocolate and she did much better. i had a small bit of other caffeine one night when we were going to have to do a long late drive when she was about 2 months – it still affected her.

    i when i had chocolate i tried to do no processed sugar – so sweetened with dates or agave or something else. no clue if this makes any difference.

    i am currently waiting until solids are her main food to add chocolate back in (maybe a year). i don’t think i have any other caffeine – not a coffee drinker and my tea is chamomile to help me and little one relax

    Like

    August 9, 2014
  13. I am of the few trans men out there who birthed his own child. Unfortunately, I couldn’t breastfeed due to an inability to lactate. I had half-caf regularly when I carried him. I would recommend for any woman breastfeeding, though, to eat as clean as possible until you wean your child–anything you eat or drink, the child gets, too. Do you really want your child absorbing all the caffeine, especially after realizing how slowly they metabolize, and thus build up? I would say either switch to half-caf and half your usual dosage, tell your partner to help out more often, and that should really help you recoup and energize.

    Like

    August 9, 2014
  14. Thankfully me newest one seems to be ok with my caffeine intake. Which is good as it keeps me functioning at the moment.

    Like

    August 9, 2014
  15. Reblogged this on East Alabama Breastfeeding Support and commented:
    Very good information put together over at Science of Mom

    Like

    August 9, 2014
  16. Kate #

    Thank you so much for summarizing what I’ve found to be an extremely lacking and frustrating body of research! This is a “must share” post! One thing I’m curious about, as I am no chemist, is the “stability” of the caffeine molecule. Is my baby’s exposure to caffeine the same when I express milk and my baby consumes that milk the next day? I would assume yes, but I know there may also be differences depending on how the molecule behaves in milk.

    Like

    August 11, 2014
  17. rchcubed #

    Thanks for your post! You provide very helpful information. I’m a new mom (my daughter will be 5 months next week!) and I drink a half cup to a cup of coffee almost every day. When I was pregnant coffee was one of the hardest things for me to cut out early on, but I still drank a half cup to a cup about every other day when my doctor gave me the green light to do so. However, caffeine comes in many forms and I had chocolate (and an occasional soda) while pregnant and I do now, even while breastfeeding (although I’ve been trying to wean my baby off). Thanks again for sharing!

    Like

    August 14, 2014
  18. maggie #

    My ob/gyn gave me coffee in the hospital 12 hours after my daughter was born. He said that in his experience, mother who had coffee during pregnancy should continue to drink it while breastfeeding. (He was almost 80 years old, been around the block a few times). My daughter was and is a champion sleeper.

    In the NICU study, what was the incidence of “trouble sleeping” and how does that compare to the statistical _variation_ of “trouble sleeping” in the NICU population? since it is a prescription medication, there would have to be an FDA filing on side effects somewhere…

    Like

    August 22, 2014
  19. To manage your caffeine intake, though, you’ll need to be aware of other sources, like tea, soft drinks, energy drinks, chocolate, and coffee ice cream. Caffeine also shows up in herbal products and over-the-counter drugs, including some headache, cold, and allergy remedies. Read labels carefully. Thanks for sharing!

    Like

    September 6, 2014
  20. Janyo, K.M. Thompson #

    This is great information I have been wondering about it myself!

    Like

    September 13, 2014
  21. JustAnotherParent #

    Caffeine is pretty stable but it will break down over time depending on many factors. In this case I think the extraction and storage method would be the significant factor. Sterility, volume of air to milk for oxidation, and transitional period to lowest temperature point. The enzymes and proteins in milk are not not really present in concentrations that would break it down fast enough to make a difference over night since you would most likely be storing it in a cold environment and slowing the process down. But again. Let’s say that you didn’t sterilize your pump and then put it in a a rigid, maybe glass, high volume container that is at room temperature. It will take a while to get to its coldest point and in the mean time it has plenty of air (oxygen) to work with. Even with this I wouldn’t expect to see a large amount of the caffeine decompose, oxidize or consumed in that period of time. Change that to expressing directly into one of those disposable bags. No air and quick transition especially it you toss it into the freezer for a few minutes. The caffeine level will pretty much be the same as what you started with.

    No I am not saying to let it degrade but because all of the other useful elements of the breast milk will degrade as well. What I am really saying is that it would be better to not have the caffeine there in the first place.

    Here are a couple of interesting articles if you are bored and want to sleep.
    http://eawag-bbd.ethz.ch/caf/caf_map.html
    http://udel.edu/~danikoll/metabolism.html

    BTW — EtOH A.K.A. Alcohol would absolutely still be in the milk and is readily expressed with the milk hence needing to pump-n-dump.

    Last note… There are some scholarly articles out there on the specifics caffeine and metabolism in pre-natal and post-natal women. Pre-natal women have a very long half-life of caffeine in the body.

    Like

    September 27, 2014
  22. Thanks so much for this! I’ve been really curious about this question, since I love my morning (and afternoon) coffee and am wondering how/if it’s effecting my baby. I drank coffee all through the 2nd and 3rd trimesters (too sick in the first) and I do think that may have made my baby more tolerant to it.

    This is such a great blog – thank you!

    Christina

    Like

    September 30, 2014
  23. With my first child, I avoided all caffeine until I caved somewhere in the 2nd trimester. At that point, I had a daily cup of coffee, all the way through birth (and early breastfeeding). Because I was addicted, and working at the time – I continued having this daily cup through about 5 months (when I quit my job); I was also eating a lot of chocolate during this time. This resulted, in the first 5 months of my son’s life – in very interrupted sleep. I am not sure whether this was just how he normally would be as an infant – but, around 5 months, when I cut out all coffee AND chocolate (extremely hard for me) – his colic magically seemed to go away. I felt so guilty, and to this day I put it down to the chocolate/coffee combination – yes even at 1 cup, and even with just a few bites of chocolate. Coincidentally, I also had to cut out broccoli and garlic to help cut down on his gas (that actually did help).

    Unfortunately, by 10 months or so, I reverted to adding my cup of coffee back. I continued doing this till my son was 12 months. However, I had difficulty conceiving our second child at this time, and read that stopping coffee consumption might help. I stopped all coffee at around 13 months, and when my son was 14 months, I also stopped breastfeeding him. Was able to conceive when my son was 18 months, and I am proud/ashamed to say, up till today, I managed to remain coffee free (my son is 21 months). So that’s nearly 8 months of being totally coffee free. I’m 15 weeks pregnant with our second child, and my husband made a pot of coffee yesterday. I thought about it for a long time, and then caved and had some today when he made coffee again today. I feel like this is a suboptimal choice, and that I should stop. I can’t justify that it has some nutritional value, and I have long been accustomed to the sleep deprivation, so I can’t use that as an excuse.

    I guess my primary feeling of guilt comes from the complicated delivery I had with my first son. I exercised all throughout my first pregnancy, but still gained 46 lbs (which I all lost) – but despite this gain my son was only 7lbs 8 ounces AND his umbillical cord was so small they were unable to draw blood for cord blood collection. He was also born with an APGAR of 1, and had to spend 4 days in the level 2 nursery after being basically resuscitated so he could breathe. All this after 29 hours of labor, and an emergency C section. I know it may be correlation and not causation, but I always think “was it the coffee”? Did I not eat well enough, exercise enough? I take some solace in that his head is 2 standard of deviations above 99% but – his father is tall, and he is not; I always worry that his growth was stunted by my drinking coffee. Trying to keep all these things in mind, and not have another cup this time around. Probably will not hold up during sleep deprivation after delivery – but at least for the pregnancy I should manage to control myself. After all, if it can impede fertility, it can’t be all that great can it?

    Like

    October 19, 2014
  24. I have read that the caffeine in green tea has a different type of effect on the baby during pregnancy. Is this true? If so, would this be similar with breastfeeding?

    Like

    November 13, 2014
  25. Judy #

    Hello, I am just wondering if I am doing okay with my caffeine intake while still breastfeeding my 16 month old. She never has had any reaction but I am finding I am starting to drink a bit more and she is heading toward weening some. She is still nursing 5 times a day but is only now becoming easily distracted. I just want to be sure my caffeine intake isn’t going to cause less production and become more of a you have to ween because of lack of production. I have an older one that nursed 18 months but I chose to make her ween at the time which turne d out to be a big mistake. This time I am wanting to nurse as long as she wants. Any advice would be nice. Thank you. All the information I can find only talks about new borns.

    Like

    May 7, 2015
  26. Janey #

    I came across your blog today after a google search on this topic. You had me at “take a look at the literature.” 🙂 Looking forward to perusing the archives!

    Like

    July 8, 2015
  27. Taylor #

    I drank one cup of coffee a day a few times a week during my pregnancy and continued after my son was born. He showed no effects the first month, around the second month of breastfeeding he started staying awake more during the day and not taking naps, so i stopped caffeine all together for about 2 weeks and i noticed that he is taking more naps during the day and is falling asleep before midnight at night. He is now 11 weeks old and i have gradually introduced caffeine back into my diet. A glass of tea or coke with lunch and i have not noticed a change in his sleeping. He i

    Like

    August 11, 2015
  28. I drank a cup of coffee everyday during my third trimester and after. The morning my son was born (a long all nighter delivery) my doctor came in to do a quick check. She brought along a coffee for me as well. I figured if my obstetrician was giving me a coffee, it was okay. I have never noticed it affect my son.

    Like

    September 19, 2015
  29. Julia #

    I am a first time mom at 40 who is a coffee fiend (i love it!), and I skipped coffee during pregnancy except an occasional latte type drink, soda, tea, or bit of chocolate. (Meaning over the 248 days of my pregnancy, I had choc or coffee, or soda/tea for maybe 20 of those days and randomly.) Since my son’s delivery, I have gotten back into drinking coffee- about a cup per day or two. I do not exclusively breastfeed, frankly he has become quite fond of his formula, but I do breastfeed him with nearly every feeding. My son is 7wks.

    My son seems sensitive, he is more alert if I have had a coffee, but it doesn’t seem to affect him terribly negatively. In fact, he just seems more alert.

    I still avoid breastfeeding for that feeding if I have been drinking coffee or eating chocolate, and I wait until the next feeding to nurse. (2-3 hrs). I wonder if I am worrying more than I need to still. According to the article, there isn’t need to worry, but am I doing the right thing by not breastfeeding immediately after I consume caffeine, or is the benefit of breastmilk greater than the cost of caffeine?

    Like

    October 27, 2015
  30. Aby #

    I will be having my child next week but I’ve been drinking nothing but soda & Starbucks coffee here & there… And just now finding out that it effects to breast milk. Soo does this mean my baby won’t like my breast milk??because of to much caffeine I drink while pregnant.

    Like

    November 18, 2015
    • Theresa #

      My first two children I still consumed caffeine and it didn’t affect them. My third, I cut out all caffeine (except chocolate) and he is sensitive so I can’t have any while I am breastfeeding. Baby loves the breastmilk, he just gets fussy and won’t sleep.

      Chances are if you consumed caffeinated beverages while pregnant, they will have little affect on the baby when breastfeeding.

      Like

      December 17, 2015
  31. Theresa #

    During my pregnancy, I cut caffeine completely out of my diet. There was a few rare occasions when I might have a cup of tea or cheat and drink a Coke at the movies. But other than that, I had no caffeine during pregnancy. My baby will be 3 months old on Dec 24th and is extremely sensitive to caffeine. I have not been able to have any since he was born because he is noticeably irritable and has trouble sleeping. Our baby is a very happy baby who rarely fusses or cries (unless he is hungry).

    My husband and I have tested (to be sure it is the caffeine). I cut caffeine out of my diet since he was two weeks old and I suspected that it was affecting him. Once my son turned two months old, he rarely fusses unless hungry. We have a night time routine and he goes to sleep easily on his own around 11p-midnight and sleeps 6-8 hours per night. He did this consistently for more than two weeks at 2 months old. So for experiment sake, I drank a Dr. Pepper with dinner. Baby thrashed his arms and legs while breastfeeding for his last feeding and was noticably irritable. He would fuss and cry and nothing we did could console him or get him to stop. When we held him he seemed to want to cuddle and sleep but was wide awake. After two hours, we were forced to let him cry himself to sleep (something we have never really had to do). 😦

    The following three nights, he was back to his normal self and went to bed as usual. Last night we tried again,this time I only drank 1/2 can of Dr. Pepper. Baby was again noticeably fussy. Didn’t even want to sit in his swing (which he LOVES). He thrashed his arms and legs while breastfeeding making it difficult to feed him. Another night of having to let him cry himself to sleep. We will see if baby goes to sleep as normal tonight, but I suspect he will.

    I have two older children (10 and 12). During those pregnancies, I cut back on caffeine, but did drink a cup of coffee or soda a few times a week during their pregnancies. Neither had a sensitivity to caffeine after they were born.

    Perhaps it is coincidence, but my husband and I feel that because I did not consume caffeine during this pregnancy it has caused our new son to have a caffeine sensitivity. It was very difficult to get through these first few months without ANY caffeine, but having a happy baby has been worth it. Thank God he has been sleeping 6-8 hours per night since two months old or might not have survived! 🙂

    Like

    December 17, 2015
  32. Isa #

    I was wondering if Caffein leaves the breastmilk freely as the concentration in the mom’s blood decrases. Kind of how alcohol is exchanged between the milk and the blood. In one paper I read, says that caffeine does not pass freely into the breastmilk, here in your article you said it does and it made me think about caffeine diffusion both ways.

    Like

    April 7, 2016
  33. Sunshine #

    I’m intolerant to coffee and I was breastfed while my mom did (and still does) consume too much coffee. I am wondering if this is correlated? Epigenetically perhaps?

    Like

    May 24, 2016

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