Zhang R, et al. - This investigation draws on data from the Adolescent Brain and Cognitive Development Study (n = 11,875 children aged 9–11 years from 22 sites across the United States) to explore the connections between prenatal caffeine exposure and various developmental outcomes including birth outcomes, physical health, behavior problems, cognition, substance use and brain structure in children, and evaluated dose effects. Among the 9,978 children (4,745 females) with valid data for prenatal caffeine exposure and whose mothers did not use drugs of abuse after learning of the pregnancy, 4,170 (41.79%) had no prenatal caffeine exposure, 2,292 (22.97%) had daily, 1,933 (19.37%) had weekly, and 1,583 (15.86%) had less than weekly exposures. The recommended ‘safe' caffeine dose during pregnancy should be carefully studied to determine whether the behavioral and brain correlates observed here are clinically relevant and if it needs to be adjusted. Caffeine use should be included as a covariate in studies on prenatal exposure to drugs of abuse due to the high prevalence of caffeine use in the general population.