Moderate Caffeine Consumption During Pregnancy - ACOG

Although caffeine does cross the placenta, it has been shown that caffeine does not cause a decrease in uterine blood flow or fetal oxygenation 8. Two studies ... 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ABSTRACT:Moderatecaffeineconsumption(lessthan200mgperday)doesnotappeartobeamajorcontributingfactorinmiscarriageorpretermbirth.Therelationshipofcaffeinetogrowthrestrictionremainsundetermined.Afinalconclusioncannotbemadeatthistimeastowhetherthereisacorrelationbetweenhighcaffeineintakeandmiscarriage. Becausecaffeinecrossestheplacenta1andincreasesmaternalcatecholaminelevels,concernshavebeenraisedaboutapotentialrelationshipbetweencaffeineexposureandtheincidenceofspontaneousmiscarriage.However,studiesinvestigatingtheassociationbetweencaffeineintakeandmiscarriagehavebeenlimitedbysmallsamplesizeandtheretrospectivecollectionofdatainfluencedbyrecallbias,particularlyinpatientsinterviewedafterpregnancyloss23.Tworecentstudieshaveattemptedtoovercomethislimitationbyprospectivelymonitoringalargepopulationofwomenreceivingprenatalcarebefore16weeksofgestation,collectingdataoncaffeineconsumptionduringearlygestation,andadjustingforrelevantconfounders.AstudyconductedbySavitzetalexamined2,407pregnanciesthatresultedin258pregnancylossesbefore20weeksofgestation4.Caffeineexposurewasanalyzedwithrespecttointake:none;lessthanorequaltothemedianconsumption,whichwasapproximately200mgperday;orgreaterthan200mgperdayTable1.Threetimepointswereanalyzed:1)beforepregnancy;2)4weeksafterthemostrecentmenstrualperiod;and3)atthetimeoftheinterview,whichoccurredbefore16weeksofgestation.Applyinganadjustedsurvivalmodel,levelsofcaffeineconsumptionatallthreetimepointsandatalllevelsofconsumptionwereunrelatedtotheriskofmiscarriage.Reportedcaffeineexposureatthetimeoftheinterviewwasassociatedwithanincreasedmiscarriageriskamongthosewomenwithpregnancylossesbeforetheinterview.Thiswasthoughttoreflectrecallbias.Ultimately,thestudydidnotshowanassociationbetweencaffeineconsumptionandmiscarriage,regardlessoftheamountconsumed.Wengetalperformedapopulation-basedprospectivecohortstudyinwhichwomenwereinterviewedregardingcaffeineexposureatamediangestationalageof71days(10weeks)5.Caffeineexposurewasdividedintonone,lessthan200mgperday,andgreaterthan200mgperday.Ofthe1,063pregnantwomeninterviewed,172experiencedamiscarriageduringtheirpregnancies.Theinvestigatorsfoundanincreasedriskofmiscarriagewithhigherlevelsofcaffeineconsumption,withanadjustedhazardratioof2.23(95%confidenceinterval[CI]1.34–3.69)forintakeof200mgperdayormore.IncontrasttothefindingsoftheSavitzetalstudy,thetimingoftheinterviewinrelationtoamiscarriagedidnotaffectthepositiveassociationidentifiedbetweencaffeineconsumptionandmiscarriage.Table1.CaffeineContentofFoodsandBeveragesAlthoughbothstudiesinvolvedappropriatestatisticalanalysesandlargestudypopulations,theyreachedcontradictoryconclusions.Factorsthatmayaccountforthediscrepancyinclude1)differencesinpopulationsstudied,2)differentanalyticapproaches,and3)issuesrelatedtothebaselineriskofmiscarriageandcorrespondingstatisticalpower.Becauseoftheconflictingresultsofthesetwolargestudies,arecommendationregardinghigherlevelsofcaffeineconsumptionandtheriskofmiscarriagecannotbemadeatthistime.Neitherreportdemonstratedasignificantincreaseintheriskofmiscarriagewithlevelsofcaffeineintakelessthan200mgperday.Twolargestudieshavebeenperformedtoassesstherelationshipbetweencaffeineintakeandpretermbirth.Arandomizeddouble-blindcontrolledtrialofcaffeinereductionin1,207womenevaluatedbirthdatafor1,153singletonlivebirths6.Anaverageintakeof182mgperdayofcaffeinedidnotaffectlengthofgestation.Additionally,aprospective,population-basedcohortstudyconductedbyClaussonetalevaluatedtheeffectofcaffeineconsumptionongestationalageatdeliveryin873singletonbirths7.Again,noassociationwasfoundbetweencaffeineandpretermbirth.Consequently,itdoesnotappearthatmoderatecaffeineintakeisacontributortopretermbirth.Studiesalsohaveinvestigatedwhethercaffeinecontributestointrauterinegrowthrestriction(IUGR).Althoughcaffeinedoescrosstheplacenta,ithasbeenshownthatcaffeinedoesnotcauseadecreaseinuterinebloodfloworfetaloxygenation8.Twostudieshaveassessedtherelationshipbetweencaffeineconsumptionandmeanbirthweightdifferences67,andtwoothershaverecentlyreportedonIUGR.Astudyof2,635low-riskpregnantwomenrecruitedbetween8weeksand12weeksofgestationwasperformedtodetermineifarelationshipexistsbetweencaffeineconsumptionandIUGR9.Intrauterinegrowthrestrictionwastheprimaryoutcomemeasureandwasdefinedbybirthweightlessthanthe10thpercentileonapersonalizedgrowthchart.Ofthe2,635women,IUGRwasidentifiedin343(13%)ofthenewborns.TheassociationofcaffeineintakewiththeincidenceofIUGRwasequivocalatalllevelsofcaffeineconsumption.Comparedwithanaveragedailyconsumptionoflessthan100mg,oddsratios(OR)forIUGRatincreasinglevelsofcaffeineintakeareasfollows:consumptionof100–199mgperday(OR,1.2;95%CI,0.9–1.6),200–299mgperday(OR,1.5;95%CI,1.1–2.1),andmorethan300mgperday(OR,1.4;95%CI,1.0–2.0).AprospectivecohortstudyfoundnoassociationbetweencaffeineconsumptionandIUGR3.Thus,atthistime,thereisnoclearevidencethatcaffeineexposureincreasestheriskofIUGR.Moderatecaffeineconsumption(lessthan200mgperday)doesnotappeartobeamajorcontributingfactorinmiscarriageorpretermbirth.TherelationshipofcaffeinetoIUGRremainsundetermined.Afinalconclusioncannotbemadeatthistimeastowhetherthereisacorrelationbetweenhighcaffeineintakeandmiscarriage. 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Topics Fetalgrowthrestriction Pregnancy Pregnancyoutcome Prematureobstetriclabor Spontaneousabortion DownloadPDF SearchPage Jumpto: Abstract References PleaseConfirm Confirm Cancel Bulkpricingwasnotfoundforitem.Pleasetryreloadingpage. Price MemberPrice Foradditionalquantities,pleasecontact[email protected] orcalltoll-freefromU.S.:(800)762-2264or(240)547-2156 (MondaythroughFriday,8:30a.m.to5p.m.ET)