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Rohweder R, de Oliveira Schmalfuss T, Dos Santos Borniger D, Ferreira CZ, Zanardini MK, Lopes GPTF, Barbosa CP, Moreira TD, Schuler-Faccini L, Sanseverino MTV, da Silva AA, Abeche AM, Vianna FSL, Fraga LR. Caffeine intake during pregnancy and adverse outcomes: An integrative review. Reprod Toxicol 2024; 123:108518. [PMID: 38042437 DOI: 10.1016/j.reprotox.2023.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
Caffeine intake during pregnancy is common. Caffeine crosses the placenta, raising concerns about its possible deleterious effects on the developing embryo/fetus. Studies on this subject show conflicting results, and still there is no consensus on the recommended dose of caffeine during pregnancy. We performed an integrative review with studies from six databases, using broad MESH terms to allow the identification of publications that addressed the outcomes of caffeine use during pregnancy, with no date limit for publications, in English and Portuguese language. The research returned 16,192 articles. After removing duplicates, screening by title, abstract and full-text, we evaluated 257 and included 59 articles. We found association between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. The effects were often dose dependent. No association with prematurity has been demonstrated, but one study showed a small reduction in gestational age with increasing doses of caffeine intake. Defining a safe dose for caffeine intake during pregnancy is a challenging task due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed. In some studies, exposures below the recommended level of caffeine intake during pregnancy (200 mg/day), as suggested by the guidelines, were associated with pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. Well-designed studies with reliable quantification of caffeine intake are needed to assess the safety of low doses during pregnancy.
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Affiliation(s)
- Ricardo Rohweder
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thanyse de Oliveira Schmalfuss
- Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil
| | - Diessy Dos Santos Borniger
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Zanfir Ferreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcos Kobren Zanardini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Paulon Torrano Ferreira Lopes
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Pocharski Barbosa
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Taiane Dornelles Moreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lavinia Schuler-Faccini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas - Universidade do Vale do Taquari - UNIVATES, Lajeado, Brazil; Universidade do Vale do Rio dos Sinos - UNISINOS, São Leopoldo, Brazil
| | - Alberto Mantovani Abeche
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Sales Luiz Vianna
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina - Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Jafari A, Naghshi S, Shahinfar H, Salehi SO, Kiany F, Askari M, Surkan PJ, Azadbakht L. Relationship between maternal caffeine and coffee intake and pregnancy loss: A grading of recommendations assessment, development, and evaluation-assessed, dose-response meta-analysis of observational studies. Front Nutr 2022; 9:886224. [PMID: 36017225 PMCID: PMC9396037 DOI: 10.3389/fnut.2022.886224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Numerous studies report an association between coffee or caffeine consumption and pregnancy loss; however, the nature and strength of this relationship have not been clearly established. Based on recent studies, our meta-analysis aimed to test whether a dose-response relationship between coffee or caffeine consumption and pregnancy loss exists. Methods We searched for articles in PubMed, Web of Science, and Scopus published until May 2022. Two independent reviewers extracted data and rated the quality of the evidence using the GRADE approach. We applied a random-effects, one-stage dose-response meta-analysis. Results A total of 34 articles (18 cohort studies and 16 case-control studies) were included in this review. Results showed a significantly higher risk of pregnancy loss for coffee consumption before (Pooled ES: 1.21; 95% CI: 1.01-1.43) and during pregnancy (Pooled ES: 1.26; 95% CI: 1.04-1.57), and for coffee consumption during pregnancy in case-control studies (Pooled ES: 1.20; 95% CI: 1.19-6.41). Findings from this meta-analysis demonstrated that caffeine intake during pregnancy was associated with a significantly higher risk of pregnancy loss in cohort (Pooled ES: 1.58; 95% CI: 1.23-2.01) and case-control studies (Pooled ES: 2.39; 95% CI: 1.69-3.37, P < 0.001), respectively. A dose-response analysis suggested that an increase of a cup of coffee per day during pregnancy was associated with 3% increased risk of pregnancy loss; 100 mg of caffeine per day during pregnancy was also associated with 14 and 26% increased risk of pregnancy loss in cohort and case-control studies, respectively. A non-linear dose-response association was observed between coffee intake and the risk of pregnancy loss. Conclusion This study confirms that coffee or caffeine consumption raises the risk of pregnancy loss. Researchers are encouraged to conduct more studies to explore the underlying mechanisms and active compounds in coffee and caffeine. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42021267731].
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Affiliation(s)
- Alireza Jafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sina Naghshi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Faculty of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed Omid Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Kiany
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Science, Isfahan, Iran
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Llopis-Morales A, Llopis-González A. Risk of Gestational Diabetes Due to Maternal and Partner Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020925. [PMID: 35055745 PMCID: PMC8775944 DOI: 10.3390/ijerph19020925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Abstract
Pregnant women are among the most vulnerable to environmental exposure to tobacco smoke (EET); which has been linked to problems in the mothers’ health; one of the most frequent is gestational diabetes (GD). For this reason, there are specific interventions and prevention strategies designed to reduce this exposure risk. However, currently, they are mostly aimed only at aiding the pregnant women with smoking cessation during pregnancy and do not assess or address the risk from passive exposure due to partner smoking. The aim of this work is to study the exposure to EET of pregnant women considering active and passive smoking and to evaluate its effect on the development of GD. This is an observational case-control study within a retrospective cohort of pregnant women. Information on smoking habits was obtained from both personal interviews and recorded medical history. In total, 16.2% of mothers and 28.3% of partners declared having been active smokers during pregnancy; 36.5% of the women presented EET during pregnancy when both active and passive smoking were considered. After adjustments, the association with the EET and GD of the mother was (aOR 1.10 95% CI: 0.64–1.92); for the EET of the partner, it was (aOR 1.66 95% CI: 1.01–2.77); for both partners, it was (aOR 1.82 95% CI: 1.15–2.89), adjusted by the mother’s age and body mass index. There is a lack of education regarding the effects of passive exposure to tobacco smoke. It is essential that pregnant women and their partners are educated on the risks of active and passive smoking; this could improve the effectiveness of other GD prevention strategies.
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Affiliation(s)
- María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-96-3544951
| | - Isabel Peraita-Costa
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Polytechnic Hospital, 46026 Valencia, Spain;
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Agustín Llopis-Morales
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
| | - Agustín Llopis-González
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Smoking, alcohol and coffee consumption and pregnancy loss: a Mendelian randomization investigation. Fertil Steril 2021; 116:1061-1067. [PMID: 34187701 DOI: 10.1016/j.fertnstert.2021.05.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the associations of smoking and alcohol and coffee consumption with pregnancy loss. DESIGN Mendelian randomization study. SETTING The UK Biobank study and FinnGen consortium. PATIENTS A total of 60,565 cases with pregnancy loss and 130,687 noncases from UK Biobank and 3,312 cases with pregnancy loss and 64,578 noncases from FinnGen. INTERVENTION(S) None. MAINS OUTCOME MEASURE Pregnancy loss. RESULT(S) Genetic predisposition to smoking initiation was associated with an increased risk of pregnancy loss in both UK Biobank and FinnGen. The combined odds ratio (OR) was 1.31 (95% confidence interval [CI], 1.25-1.37) for one standard deviation increase in the prevalence of smoking initiation. There were no significant associations of genetically predicted consumption of alcohol (OR, 1.09; 95% CI, 0.93-1.27) or coffee (OR, 0.96; 95% CI, 0.87-1.06) with pregnancy loss. CONCLUSION(S) This study on the basis of genetic data suggests the causal potential of the association of smoking but not moderate alcohol and coffee consumption with pregnancy loss.
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Qu Y, Chen S, Pan H, Zhu H, Yan C, Zhang S, Jiang Y. Risk factors of stillbirth in rural China: A national cohort study. Sci Rep 2019; 9:365. [PMID: 30674901 PMCID: PMC6344639 DOI: 10.1038/s41598-018-35931-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
People living in rural China are more frequently exposed to some specific risk factors which made stillbirth rate higher than urban areas. National Free Preconception Health Examination Project was launched to investigate these risk factors and collected a representative sample of 248501 participants from 31 provinces in China from 2010 to 2013. Parental risk factors were ascertained twice before and during pregnancy respectively by questionnaires. Stillbirth or live birth were recorded by trained physicians. In the analysis, nested case-control study was conducted, and propensity score matching method was used to adjust the confounding. Multi-level logistic regression was used to fit for multi-level sampling. The overall stillbirth rate was 0.35% in rural China, it was higher in North (0.42%) and West (0.64%) areas. Maternal exposure to pesticide (OR (95%CI 1.06, 3.39)), hypertension (OR = 1.58 (95%CI 1.07, 2.34)), lack of appetite for vegetables (OR = 1.99 (95%CI 1.00, 3.93)), stress (compared with no pressure, OR of a little pressure was 1.34(95% CI 1.02, 1.76)); paternal exposure to smoking (OR = 1.22 (95% CI 1.02, 1.46)), organic solvents (OR = 1.64 (95% CI 1.01, 2.69)) were found independent risk factors of stillbirth. Folacin intake 3 months before pregnancy (OR = 0.72 (95%) CI 0.59, 0.89), folacin intake 1-2 months before pregnancy (OR = 0.71 (95% CI 0.55, 0.92)), folacin intake after pregnancy (OR = 0.81 (95% CI 0.65, 1.02) for) were protect factors of stillbirth. Maternal pesticide exposure, lack of vegetables, stress, paternal smoking and exposure to organic solvents were risk factors of stillbirth. Folic acid intake was protective factor of stillbirth, no matter when the intake began.
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Affiliation(s)
- Yimin Qu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Chen
- Department of Endocrinology, Key Lab of Endocrinology, Ministry of Health,Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Hui Pan
- Department of Endocrinology, Key Lab of Endocrinology, Ministry of Health,Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Huijuan Zhu
- Department of Endocrinology, Key Lab of Endocrinology, Ministry of Health,Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China
| | - Chengsheng Yan
- Hebei Center for women and children's health, Shijiazhuang, 050031, China
| | - Shikun Zhang
- Research association for women and children's health, Beijing, 100081, China
| | - Yu Jiang
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
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