Caffeine during pregnancy increases miscarriage risk

High doses of daily caffeine during pregnancy ? whether from coffee, tea, caffeinated soda or hot chocolate ? cause an increased risk of miscarriage, according a new study by the Kaiser Permanente Division of Research. The study controlled, for the first time, pregnancy-related symptoms of nausea, vomiting and caffeine aversion that tended to interfere with the determination of caffeine’s true effect on miscarriage risk.

The research appears in the current online issue of American Journal of Obstetrics and Gynecology.

While previous research showed a link between caffeine consumption and miscarriage, this is the first study to thoroughly control for morning sickness, which typically causes many women to avoid caffeine, explained De-Kun Li, MD, Ph.D., an investigator with the Kaiser Permanente Division of Research and lead investigator of the study. “This study strengthens the association between caffeine and miscarriage risk because it removes speculation that the association was due to reduced caffeine intake by healthy pregnant women,” Li said.

To address that speculation, the study, which looked at 1,063 pregnant Kaiser Permanente members in San Francisco from October 1996 through October 1998, examined the caffeine effect among women who never changed their pattern of caffeine consumption during their pregnancy.

Women who consumed 200 mg or more of caffeine per day (two or more cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as women who consumed no caffeine, said Li.

The increased risk of miscarriage appeared to be due to the caffeine itself, rather than other possible chemicals in coffee because caffeine intake from non-coffee sources such as caffeinated soda, tea and hot chocolate showed a similar increased risk of miscarriage.

“The main message for pregnant women from these findings is that they probably should consider stopping caffeine consumption during pregnancy because this research provides clearer and stronger evidence that high doses of caffeine intake during pregnancy can increase the risk of miscarriage,” said Li.

The reasons that caffeine can harm a fetus have been suspected for some time. Caffeine crosses through the placenta to the fetus, but can be difficult for the fetus to metabolize because of the under-developed metabolic system. Caffeine also may influence cell development and decrease placental blood flow, which may lead to an adverse effect on fetal development.

Women in the study were asked about their intake of caffeinated beverages as well as the type of their drinks, timing of initial drink, the frequency and amount of intake, and whether they changed consumption patterns since becoming pregnant. Sources of caffeine included coffee, tea, caffeinated soda and hot chocolate.

Researchers estimated the amount of caffeine intake in various types of beverages using the following conversion: For every 150 milliliters of beverage, 100 milligrams for caffeinated coffee, 2 milligrams for decaffeinated coffee, 39 milligrams for caffeinated tea, 15 milligrams for caffeinated soda, and 2 milligrams for hot chocolate. Information on other potential risk factors for miscarriage ? including maternal age, race, education, household income marital status, smoking, alcohol consumption, hot tub use, exposure to magnetic fields during pregnancy, and symptoms related to pregnancy such as nausea and vomited ? also were collected during the in-person interview and controlled during analyses. Pregnancy outcomes up to 20 weeks of gestation were determined for all participants.

Co-authors on the study included Xiaoping Weng, Ph.D. and Roxana Odouli, MSPH, also with the Kaiser Permanente Division of Research. The Study was supported in part by the California Public Health Foundation.

Source: Kaiser Permanente, USA

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