Effect of postoperative coffee consumption on gastrointestinal function after cesarean section, a systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Existing research on the impact of coffee consumption on post-cesarean section gastrointestinal function has yielded inconclusive results. Therefore, this systematic review and meta-analysis aim to evaluate the effects of postoperative coffee consumption on the recovery of gastrointestinal function in women undergoing cesarean delivery.

Methods

Randomized controlled trials comparing the effects of coffee consumption and other care methods after planned cesarean section on the recovery of gastrointestinal function were included. Studies including women who underwent planned cesarean delivery were eligible, whereas those involving emergency cesarean sections, non-randomized designs, or participants with coffee intolerance were excluded. Pertinent studies were searched in PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Wan Fang and VIP Database, spanning from their inception dates until December 2025. Cochrane Risk of bias instrument was used to assess the quality of included studies. The data analysis was conducted using the Review Manager (Rev Man) version 5.3 software. Subgroup analysis was presented if heterogeneity was observed among the studies. Egger’s regression test was used to evaluated the publication bias.

Results

A total of 6 RCTs (n =555 participants) conducted in Iran and Turkey published between 2017 and 2024 were included in the analysis. The sample sizes in the coffee and control groups ranged from 18 to 95 participants, with ages similar in both groups, spanning from 27 to 31 years old. The intervention involved both caffeinated and decaffeinated coffee, which was administered three times daily following surgery, with access restricted at other times. In most studies, the volume of coffee consumed was standardized at 100 ml. The minimum postoperative duration before the first intervention beverage was 2 hours, while the maximum interval was 8 hours. The control groups in most studies consisted of either water or routine care. Estimates from the meta-analysis revealed that coffee consumption reduced the time to first flatus by 2.75h (95%CI: -5.05- -0.46), defecation by 3.20h (-6.08- -0.32), and bowel sound by 0.68h (-1.11- -0.25). The subgroup analysis indicated that this effect was observed particularly in women who began coffee consumption two hours after cesarean delivery, in contrast to those who initiated coffee intake eight hours.

Conclusion

The findings of this systematic review and meta-analysis indicate that early coffee consumption may enhance the recovery of the gastrointestinal function following cesarean section. The number of studies included in this meta-analysis was small and the quality of evidence was low, so results should be interpreted with some caution.

Trial registration

The protocol for this review was registered with PROSPERO: CRD42024586382.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-26476-4.

Introduction

Cesarean section (CS) is a widely performed surgery around the globe, serving as a crucial intervention for addressing obstructed labor and serious complications, thereby safeguarding the health and lives of women and infants [1]. According to recent estimates, 21.1% of women worldwide deliver via cesarean Section [2]. The rates of cesarean sections vary significantly by country, with average rates ranging from 5% in sub-Saharan Africa to 42.8% in Latin America [2]. Overall, global cesarean section rates have risen over the past three decades [2, 3]. In China, the proportion of women delivering by cesarean section is also on the rise [4]. A study estimated that the CS rate was 28.8% in 2008, 34.9% in 2014, and 36.7% in 2018, reflecting an annual increase of 1.8% [4].

Postoperative ileus (POI) is a commonly encountered post-operative complication after abdominal surgeries, including cesarean sections. It is characterized by impaired intestinal motility with symptoms of intestinal obstruction in the absence of mechanical obstruction [5]. POI is reported to complicate 10% to 30% of abdominal surgeries [6]. Although in the majority of cases intestinal obstruction resolves spontaneously within two to three days after surgery, it remains a significant factor contributing to discomforts, including abdominal distension, nausea, vomiting, pain, intolerance to diet, delayed passage of gas and stool, prolonged hospital stays, consequently increasing medical costs, and even leading to serious morbidity [5, 7]. Despite the lack of a consistent definition, the incidence of post CS ileus ranges from 0.9% to 21.5% [8]. In the context of cesarean section deliveries, POI may also negatively affect the breastfeeding and the mother-baby attachment during the postpartum period [9].

Coffee is one of the most widely consumed beverages globally. It is well established that coffee intake increases colon activity, resulting in more pressure waves and propagated contractions compared to water [10, 11]. Researches involving patients undergoing colorectal surgery and those with gynecological cancers have demonstrated that postoperative coffee consumption can enhance gastrointestinal recovery, reduce the duration of POI, shorten the time for first flatus and the bowel movement, and decrease the length of hospital stay [12–15]. The Enhanced Recovery after Elective Colorectal Surgery and Gynecologic/oncology guidelines also recommend postoperative coffee consumption to facilitate gastrointestinal recovery [16, 17]. However, findings regarding the effects of coffee in cesarean section patients have been inconclusive. Typically, the first passage of flatus or first defecation after surgery is regarded as an indicator of gastrointestinal recovery. Some studies have indicated that consuming coffee following a cesarean section may accelerate the time to first flatus and first defecation [18, 19]; however, other research has yielded contrasting findings [20]. Furthermore, a meta-analysis evaluating the effect of postoperative coffee intake on ileus in patients undergoing abdominal surgery reported that coffee significantly reduced the time to the first defecation; however, subgroup analysis indicated that the effect was particularly pronounced in cases of colorectal resection and gynecological resection, not in cesarean delivery [21]. There is insufficient evidence to support the notion that coffee consumption promotes the gastrointestinal function recovery in cesarean section patients. In addition, compared to gynecological and colorectal surgeries, women who undergo cesarean sections can typically return to normal eating sooner. The Enhanced Recovery After Surgery (ERAS) guidelines for postoperative care in cesarean delivery recommend that patients resume a regular diet two hours after surgery [22]. However, in clinical practice, the timing for women to resume oral intake after cesarean sections varies, and it remains unclear whether this variability impacts the recovery of gastrointestinal function.

Therefore, the objective of this study was to review randomized controlled trials to assess the effects of postoperative coffee consumption on gastrointestinal function recovery in women undergoing cesarean section. Furthermore, we will evaluate the potential impact of factors, such as the timing of the first coffee consumption after surgery, on the outcomes.

Methods

The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO), and registration number is CRD42024586382.

Search strategy

A comprehensive literature search was carried out to identify randomized controlled trials (RCTs) that evaluating the effects of postoperative coffee intake on gastrointestinal function in women undergoing cesarean section. The search encompassed major databases, including PubMed, Web of Science, Embase, the Cochrane library, CINAHL, Clinical Trials. gov, Chinese National Knowledge Infrastructure (CNKI), Wan Fang and VIP Database, spanning from their inception dates until 30 December 2025. We combined the terms (“cesarean section” OR “cesarean delivery” OR “abdominal delivery” OR “cesarean birth” OR “c-section” OR “cesarean” OR “caesarean”) AND (“coffee” OR “caffeine”) AND (“randomized controlled trial”). No restrictions were placed on the sample size or publication date. The complete search strategy was seen Supplementary materials online. This review was reported in accordance with the PRISMA statement [23] and the PRISMA checklist is attached in Supplementary materials online.

Eligibility criteria

The following PICOS criteria were employed to screen eligible trials: (P) participants: women undergoing planned cesarean sections; (I)interventions: coffee consumption after cesarean sections; (C)control: water, routine care or no treatment; (O)outcomes: indicators of the recovery of gastrointestinal function, such as time for first flatus, time for first defecation, time for first bowel sound, the incidence of postoperative ileus and so on.(S) study design: only RCTs were included. The exclusion criteria were as follows: (1) emergency cesarean section; (2) pregnancy complications; (3) studies reporting results from the same sample, for which we excluded duplicates and included the most complete data; and (4) case-reports, guidelines, comments or editorial studies. Studies were also excluded if the full text was unavailable or if they were published in a language other than English or Chinese. Compared to women who undergo planned cesarean sections, those who experience emergency cesarean sections often exhibit significant psychological stress responses. Additionally, they face a higher risk of injury to surrounding organs, postpartum hemorrhage, and anesthesia complications during the procedure, all of which may adversely affect the recovery of gastrointestinal function [24]. Consequently, when developing the inclusion criteria for the study, we focused exclusively on women who experienced planned cesarean sections.

Study selection

After the removal of duplicate records, potentially eligible studies underwent a screening process conducted by two independent reviewers (XM Yao, DF Han) who evaluated the titles and abstracts. Full-text articles were subsequently obtained and reviewed by the same reviewers to determine adherence to the inclusion criteria. In cases of disagreement, a third reviewer (QR Lu) was consulted to facilitate discussion and reach a consensus.

Data extraction

The data extraction process was conducted independently by two reviewers (XM Yao, DF Han) who extracted relevant information using a standardized data extraction form. The extracted data included the first author’s name, publication year, country, baseline characteristics of participants (e.g. age, BMI, number of live births, number of pregnancy), sample size, methods of coffee consumption, interventions in controls (e.g. water, routine care or no interventions). Outcomes, including time for the first flatus, time for the first defecation, time for the first bowel movement, time to tolerate liquid/solid food, length of hospital stays, additional analgesic requirement and antiemetic requirement were also retrieved. All time-related outcomes are expressed in hours. In cases of divergent opinions, a third reviewer (QR Lu) made a final decision to resolve any discrepancies.

Quality assessment of included studies

The methodological quality of the included studies was assessed by two reviewers (XM Yao, DF Han) using the Cochrane Risk of bias instrument [25]. The tool evaluates the risk of bias through seven items across six domains: selection (including random sequence generation and allocation concealment), implementation (referring to participant blinding), measurement (concerning outcome assessment blinding), follow-up (integrity of outcome data), reporting (selective reporting of study results), and other (pertaining to additional sources of bias). The results for each item were classified as ‘low risk of bias’, ‘high risk of bias’, or ‘unclear’, in accordance with the established criteria for bias risk assessment. Egger’s regression test was used to assess the publication bias, and Egger’s p value >0.05 suggests that there is no evidence of publication bias.

Data analysis

The meta-analysis was conducted using the Review Manager (Rev Man) version 5.3 software. Effect estimates were presented as mean difference (MD) with 95% confidence intervals (95%CI) for continuous outcomes and risk ratios (RRs) for dichotomous data with 95% CI. The data presented as “median and range” values were computed to mean and standard deviation (SD) data with the equations described by Hou and Shi to ensure that all of the relevant data could be included in the final quantitative synthesis [26]. In cases where the units varied, standardized mean difference (SMD) was employed. This approach ensured that means and SD were preserved for continuous variables, whereas for categorical outcomes, both the event number and total number of participants were divided. Heterogeneity was quantified through I² statistics, as recommended in the Cochrane handbook. Given the variation in clinical settings and interventions, a random effects model was used for this meta-analysis. Subgroup analysis was presented if heterogeneity was observed among the studies. A sensitivity analysis by excluding each study one by one was also conducted.

Certainty of evidence

The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to evaluate the certainty of evidence for all primary and secondary outcomes. The level of evidence certainty was considered ‘high’, ‘moderate’, ‘low’, or ‘very low’ based on the risk of bias, inconsistency, indirectness, imprecision, publication bias, and additional domains.

Results

Of the initial 343 records obtained from the databases, 98 were eliminated because of duplications. Among the remaining 245 records, 238 were deemed ineligible based on the evaluation of their titles and abstracts. Additionally, 13 studies were excluded because they were solely registered trials that had not yet reported results. Following a complete full-text screening of the remaining seven studies, one study was excluded due to its publication in Arabic. Overall, a total of 6 RCTs (n = 555 participants) conducted in Iran and Turkey published between 2017 and 2024 were included in the analysis. Fig. 1 shows the study search process.

Fig. 1.

Flowchart of study search process

Characteristics of included studies

The characteristics of the six studies included in this meta-analysis are summarized in Table 1. The sample size in the coffee group ranged from 18 to 91 participants, while ranging from 18 to 95 participants in control group. Participants in both groups were of similar age across the studies, ranging from 27 to 31 years old. Three studies reported the BMI of the participants [9, 27, 28]. Additionally, three studies provided data on the number of live births among the participants [18, 19, 27], while four studies reported data on the number of pregnancies experienced by participants [18–20, 27]. Of the six trials, one employed a triple-arm study design [28].

Table 1.

Characteristics of included studies (n = 6)

Author, year	Country	Sample size		Age		BMI		No. of live births		No. of pregnancy
		coffee	control	coffee	control	coffee	control	coffee	control	coffee	control
Vafaei 2024 [18]	Iran	91	95	31.31 ± 5.34	30.55 ± 6.04	NA	NA	1.96 ± 1.14	2.33 ± 1.07	2.55 ± 1.14	2.51 ± 1.17
Bozkurt 2020 [19]	Turkey	51	52	28.70 ± 5.42	29.25 ± 5.74	NA	NA	1.33 ± 1.01	1.23 ± 1.23	2.50 ± 1.00	2.20 ± 1.00
Rabiepoor 2018 [20]	Iran	50	50	28.22 ± 5.14	28.46 ± 5.35	NA	NA	NA	NA	1.78 ± 0.73	2.06 ± 1.28
Zamanabadi 2021 [27]	Iran	18	18	28.72 ± 3.82	27.44 ± 3.94	25.62 ± 1.79	25.34 ± 1.11	0.78 ± 0.88	0.33 ± 0.60	1.83 ± 0.92	1.50 ± 0.71
Göymen, A 2017 [28]	Turkey	25	25/25a	30.00 ± 3.40	29.00 ± 5.10/ 31.00 ± 2.20	26.75 ± 1.75	26.00 ± 2.00/ 26.00 ± 2.00	NA	NA	NA	NA
Kanza 2020 [9]	Turkey	40	40	29.00 ± 3.75	29.00 ± 5.00	29.4 ± 2.67	26.80 ± 3.20	NA	NA	NA	NA

NA Not available

^aTriple-arm study design

Table 2 shows further details of the interventions used in the included studies. The intervention was caffeinated coffee in two studies [19, 27] and decaffeinated coffee in another two studies [9, 28]. Coffee was administered three times daily following surgery, with access restricted at other times. With the exception of one study [27], the consumption volume in the remaining studies was standardized at 100 ml. The minimum postoperative time before the first intervention beverage was 2 hours [9, 19, 28]. The longest interval before intervention was recorded in the studies conducted by Vafaei and Rabiepoor, which commenced 8 h post-surgery [18, 20]. Another study specified the timing of coffee consumption but did not clarify the duration post-surgery [27]. Participants in the control group either consumed only water or received usual treatment. The primary outcomes measured in each study included the time to first flatus, time to first defecation, time to first bowel sound, and length of hospital stay. Other outcomes included time to first tolerance of solid food, incidence of postoperative ileus, additional analgesic requirement; additional antiemetic requirement; and time to first mobilization. Five studies employed three or more outcome measures [9, 18–20, 28], while one studies utilized two [27]. Among these outcomes, bowel sound was auscultated by the researchers in the majority of studies, while others, such as the time to first flatus and defecation, were self-reported by the patients [18–20, 28].

Table 2.

Details of interventions

Author, year	Coffee	Volume, ml	Frequency	Time	Control	Outcomes reported
Vafaei 2024 [18]	NA	100	TDS	8 h,12 h and 24 h after CS	Water	①②③④
Bozkurt 2020 [19]	Caffeine	100	TDS	2 h, 6 h, and 18 h h after CS	No intervention	①②③⑤⑥⑦⑧
Rabiepoor 2018 [20]	NA	100	TDS	8 h,12 h and 20 h after CS	Water	①②③④
Zamanabadi 2021 [27]	Caffeine	111	TDS	11am, 3pm and 7pm	Water	②③
Göymen, A 2017 [28]	Decaf	100	TDS	from 2 h after CS, at least 4 h intervals until defecation	Water/No intervention	①②③
Kanza 2020 [9]	Decaf	100	TDS	from 2 h after CS, at 4 h intervals	No interventions	①②⑨

①: Time to first flatus; ②: Time to first defecation; ③: Time to first bowel sound; ④: Length of hospital stay; ⑤: Time to tolerance solid food; ⑥ Incidence of postoperative ileus; ⑦: Additional analgesic requirement; ⑧: Additional antiemetic requirement; ⑨: Time to first mobilization

TDS Three times per day, CS Cesarean section, NA Nnot available

Risk of bias assessment

Figure 2A and B shows the results of the risk of bias assessment. Of the six studies, four studies involved generating random sequences using computers [9, 18, 19, 28], and one study grouped patients based on their data of hospital admission [20]. In addition, one study used allocation concealment [20], one study used blinding of participants and personnel [18], two studies used blinding of outcome assessment [18, 19], six studies had a low risk of incomplete outcome data [9, 18–20, 27, 28], three studies had a low risk of selective reporting [9, 19, 20], and one study was considered have other bias [27].

Fig. 2.

A Risk of bias summary. B Risk of bias graph

Primary and secondary outcomes

Primary outcome: time to first flatus, defecation and bowel sound.

Time to first flatus

Regarding the time to first flatus, the meta-analysis included data from 519 participants, with 257 in the coffee group and 262 in the control group [9, 18–20, 28]. The results (Fig. 3A) revealed that the time to first flatus was shorter in participants who consumed coffee compared to those in control group (mean Difference (MD): − 2.75 h, 95% CI: −5.05-−0.46, p = 0.02, I² = 87%).

Fig. 3.

A Forest plot of the time to first flatus. B Forest plot of the time to first defecation. C Forest plot of the time to first bowel sound. D Forest plot of the time to length of hospital stay

Time to first defecation

All studies assessed the time to first defecation [9, 18–20, 27, 28], and the analysis of 555 participants demonstrated that (Fig. 3B) the time to first defecation was significantly shorter than that of control group (MD: −3.20 h, 95% CI: −6.08 −0.32, p = 0.03, I² = 87%).

Time to first bowel sound

Five studies evaluated the time to first bowel movement [18–20, 27, 28], and the analysis of 475 participants (Fig. 3C) indicated a reduction in time to first bowel sound (MD: −0.68 h, 95% CI: −1.11 −0.25, p = 0.002, I² = 13%) in coffee group.

Secondary outcome measures

Length of hospital stay

Only two studies compared the length of hospital stay [18, 20], and the results (Fig. 3D) indicated that there was no significant difference between the coffee group and control group (MD=−6.5 h, 95% CI:−14.87- 1.86, p = 0.13, I² = 91%)

Subgroup analyses

Timing of the first coffee consumption following cesarean section

Five out of the six studies clearly specified the timing of the first coffee consumption following cesarean section, categorizing it into two groups: 2 hours [9, 19, 28] and 8 hours [18, 20] post-surgery. The results of the subgroup analysis, based on these five studies, indicated that the timing of the first coffee consumption does not significantly affect the time of the first defecation. However, a notable reduction in the time to the first flatus was observed in women who began consuming coffee 2hours (MD: −1.12 h, 95% CI: −1.893- −0.36, p = 0.004, I²= 48%) and 8 h (MD: −5.06 h, 95% CI: −6.33- −3.78, p<0.001, I²= 0%) after the surgery. Additionally, the effect on time to first bowel sound was only noted in those who began consuming coffee 2 hours post-surgery (MD: −0.78 h, 95% CI: −1.44- −0.11, p = 0.02, I² = 0%) (see Supplementary figure S1-S3 online).

Types of consumed coffee

Four out of the six studies detailed the types of coffee consumed, specifically caffeinated coffee [19, 27] and decaffeinated coffee [9, 28]. It was observed for the first time that caffeinated coffee shortened the exhaust time (MD: −2.70 h, 95% CI: −4.93 −0.47, p = 0.02) and influenced the timing of the first defecation (MD: −5.58 h, 95% CI: −9.85- −1.30, p = 0.01, I² = 61%) (see Supplementary figure S4 and S5 online). Additionally, the first time to bowel sound was observed earlier in decaffeinated coffee group (MD: −0.81 h, 95% CI: −1.61- −0.01) (see Supplementary figure S6 online).

Publication bias, as accessed by Egger’s test, showed no publication bias in this analysis (P for Egger’s test was 0.762) (see Supplementary Table S2 online). Sensitivity analysis was performed by systematically excluding the influence of individual studies on the overall estimates. We assessed the impact of omitting each study on the pooled MD. The results remained consistent, indicating that this meta-analysis is statistically robust (seen Supplementary Table 1).

Certainty of evidence

Supplementary Table 3 summarizes the certainty of evidence for primary and secondary outcomes, revealing that the certainty levels range from very low to moderate (seen Supplementary Table 3). Reasons for this are primarily attributed to risk of bias and inconsistency.

Discussion

The systematic review and meta-analysis identified 6 randomized controlled trials involving a total of 555 women, which evaluated the effect of coffee consumption after cesarean section on the recovery of gastrointestinal function. The results indicate that this intervention may have reduced the time to the first flatus, defecation, and bowel sound. Additionally, subgroup analyses showed that the timing of the first coffee consumption and types of coffee following cesarean section might influence this effect.

As one of the most common surgical procedures performed, the rate of cesarean sections has risen sharply in many areas of the world in recent years [2, 4]. Being an open abdominal surgery associated with high average blood loss volume, cesarean section may inherently place women at increased risk for developing postoperative ileus [7].The recovery of gastrointestinal function in women following cesarean section is closely associated with their comfort, nutrition, mother-infant attachment and lactation [5, 7, 9]. Generally, the passage of gas or defecation is considered a sign of recovery of gastrointestinal function and an indicator of the resolution of POI. This study found that coffee consumption following cesarean sections promotes the recovery of gastrointestinal function in women, specifically by shortening the time to the first flatus, defecation, and bowel movement. The similar effect was also observed in patients undergoing abdominal surgery, specifically those who underwent colorectal cancer resection and gynecological surgery [21, 29, 30]. The evidence suggests that coffee may serve as a promising method to promote the recovery of gastrointestinal function in patients who have undergone abdominal surgery.

The ERAS guidelines for postoperative care in cesarean delivery strongly advocate resuming a regular diet within two hours after the procedure [22]. This approach not only alleviates symptoms of thirst and hunger in parturient but also enhances the recovery of intestinal activity, reduces hospital stays, and improves maternal satisfaction [31, 32]. The results of the subgroup analysis in this meta-analysis indicate that the beneficial effect of coffee on gastrointestinal recovery was observed particularly in women who began coffee consumption two hours after cesarean delivery, in contrast to those who initiated coffee intake eight hours. This finding aligns with the recommendations of the ERAS guidelines, suggesting that early coffee consumption following a cesarean section may enhance the recovery of gastrointestinal function in women. However, current evidence is insufficient to confirm that coffee has a beneficial effect on the incidence of complications or maternal satisfaction. In the six trials included in this study, patients consumed coffee three times daily, beginning two to eight hours post-surgery. The exact timing of coffee consumption remains unclear. Coffee is a stimulant, and excessive intake or consumption too late after surgery may disrupt sleep patterns and hinder recovery. Unfortunately, these studies did not report patients’ sleep status following surgery. Additionally, coffee may elevate heart rate and blood pressure; however, changes in these parameters before and after coffee consumption were not reported.

The results present an inconsistency regarding the effect of coffee intake, both with and without caffeine, on the recovery of gastrointestinal function in patients. Some study indicate that decaffeinated coffee may be more effective in promoting the recovery of gastrointestinal function in patients following abdominal surgery [33]. However, there are also research reports that this effect was similar among caffeinated and decaffeinated coffee [29]. The subgroup analysis of this study revealed that the time required for women in both groups to recover from various indicators of gastrointestinal function was reduced. These findings suggest that caffeine may not be the sole component in coffee that positively influences gastrointestinal function. However, caution is advised in interpreting these results due to the limited number of studies included in this analysis.

Researches suggested that the physiological impacts of coffee may largely be attributed to its complex composition. Coffee contains various bioactive compounds, such as caffeine, chlorogenic acid, and caffeic acid [34]. Gastrointestinal smooth muscle responses depend on both excitatory and inhibitory neurotransmitters. Caffeine enhances vagal autonomic nerve activity and promotes the release of acetylcholine, the most prominent excitatory neurotransmitter, thereby stimulating intestinal peristalsis [35]. Surgical trauma and gut manipulation elicit an inflammatory response in the muscularis externa involving various of immune and inflammatory cells. This neuroinflammatory response subsequently results in gastrointestinal dysfunction and POI [21, 36]. Caffeine, chlorogenic acid and caffeic caid have demonstrated anti-inflammatory effects by inhibiting the release of pro-inflammatory cytokines and enhancing the production of IL-10 [37, 38]. Additionally, the dietary fibers presented in coffee are primarily composed of nondigestible polysaccharides. Upon intake, these fibers directly influence both the composition and diversity of the intestinal microbiota [34]. The gut microbiota plays a significant role in regulating intestinal motility through microbial metabolites, such as short-chain fatty acids (SCFAs) and tryptophan metabolites [39]. Human volunteer studies have shown that consumption of coffee or coffee extracts can lead to notable changes in the intestinal microbiota, specifically an increase in the abundance of Firmicutes, Bifidobacterium, and Actinobacteria [40, 41]. Consequently, the alterations in the intestinal microbiota induced by coffee may elucidate its impact on gastrointestinal motility.

This meta-analysis indicates that postoperative coffee consumption may enhance the recovery of gastrointestinal function in women undergoing cesarean sections. Moreover, exploratory subgroup analyses reveal that this beneficial effect is particularly pronounced in women who begin drinking coffee within 2 h post-surgery. However, it is important to note that only a limited number of studies, specifically two, were included in these subgroups, necessitating caution in the interpretation of these results. Additionally, the methodological quality of the included studies and the certainty of the evidence regarding outcome measures were both assessed to be low, further compromise the validity of the research findings. Future research should prioritize higher-quality randomized controlled trials to better support and verify these results. In light of cultural beliefs and metabolic adaptations, new mothers exhibit heightened attention to their dietary choices following childbirth, particularly regarding the potential effects on breastfeeding. This careful consideration underscores the importance of nutrition during the postpartum period, as it can significantly influence both maternal recovery and infant health. Evidence suggests that many women feel it is necessary to limit their intake of caffeine, garlic, onions, spicy foods, and legumes during the postpartum period [42]. These dietary perceptions may significantly influence the willingness of postpartum women to consume coffee. Furthermore, studies have shown that caffeine can be transferred to infants through breast milk [43].While the included trials have not thoroughly documented breastfeeding outcomes or neonatal health status in relation to maternal coffee consumption, these factors warrant careful attention. Therefore, future studies should evaluate the acceptability of coffee among postpartum women across diverse cultural contexts and systematically assess its potential impact on infant well-being.

Strengths and limitations

This study used multiple electronic databases to retrieve studies. The quality of these studies was assessed using standard instrument for quality assessment of randomized controlled trails (Cochrane Risk of bias instrument). Furthermore, this study was conducted using PRISMA guidelines or protocols for systematic review and meta-analysis. However, there were several limitations. First, although the results of this meta-analysis demonstrated the enhancing effect of coffee consumption on the recovery of gastrointestinal function in women following cesarean sections, the number of studies included was relatively small, consisting of only six studies conducted in Turkey and Iran. This limitation might restrict the extrapolation of the findings to other populations with diverse racial and geographical backgrounds, as well as the varying healthcare environment. Secondly, the significant variation in sample size (ranging from 18 to 91 participants in the coffee group and from 18 to 95 participants in the control group) may have compromised the statistical power and accuracy of the results. Third, the quality of evidence for this result was classified as low because the risk of bias in most studies was high, mainly due to allocation concealment and the lack of blinding.

Higher-quality randomized controlled trials were needed to further support and verify these findings. Forth, research indicates that individuals who regularly consume coffee tend to be less sensitive to its effects compared to those who consume it infrequently, due to metabolic and neuroadaptive changes [44]. In all the included studies, none explicitly stated whether the participants had a habitual consumption of coffee. Consequently, it remains unclear whether habitual coffee intake influences the beneficial effects on gastrointestinal function.

Fifth, ideally, all language studies should be included; however, due to practical challenges, a study on Arabic was excluded from this research. This represents a methodological trade-off, and future research should prioritize overcoming language barriers to provide more comprehensive global evidence.

Conclusions

The findings of this systematic review and meta-analysis indicate that early coffee consumption may enhance the recovery of the gastrointestinal function following cesarean section. This simple, cost-effective and beneficial intervention could be recommended to women post-cesarean. However, due to the limited number of studies included and low quality of this evidence, future large-scale and well-designed studies are necessary to enhance the robustness of the evidence supporting this intervention. Moreover, further research is essential to determine the optimal regimen for promoting gastrointestinal function recovery through coffee consumption, including the timing, frequency, and quantity of coffee intake, as well as to evaluate potential adverse effects and women’s satisfaction with this intervention.

Abbreviations

CS

Cesarean section

POI

Postoperative ileus

RCT

Randomized controlled trial

SD

Standard deviation

BMI

Body mass index

NA

Not available

TDS

Three times per day

MD

Mean difference

CI

Confidence intervals

Authors’ contributions

Xumei Yao contributed to conceptualization, methodology, data curation, formal analysis, investigation, writing—original draft, funding acquisition. Dongfang Han contributed to methodology, investigation, writing—review and editing. Qinrui Lu contributed to investigation, writing—review and editing, supervision.

Funding

This work was supported by the Hospital Foundation of The First Affiliated Hospital of Xi’an Jiaotong University (2024-HL-20).

Data availability

All data relevant to the study are included in the article and supplementary materials.

Declarations

Ethics approval and consent to participate

As this review did not involve animals, neither ethical review board approval nor patient consent was required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.