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December 22, 1993, Vol 270, No. 24 >
ARTICLE | December 22, 1993

Caffeine During Pregnancy: Grounds for Concern? FREE

Brenda Eskenazi, PhD
[+] Author Affiliations

Reprint requests to University of California at Berkeley, School of Public Health, 312 Warren Hall, Berkeley, CA 94720 (Dr Eskenazi).


JAMA. 1993;270(24):2973-2974. doi:10.1001/jama.1993.03510240085039
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Article
References

Is caffeine consumption safe during pregnancy? Caffeine, the most widely used psychotropic drug, is consumed by at least 75% of pregnant women via caffeinated beverages.1 In spite of its widespread use, the safety of this habit during pregnancy is unresolved.

See also p 2940.

In the last year, JAMA has published two excellent studies that assessed the safety of caffeine consumption during pregnancy. The conclusions of these studies somewhat conflict. In February, Mills and colleagues,2 in a prospective cohort study of 431 pregnant women, reported that moderate caffeine consumption of less than 300 mg/d (or about three cups of coffee) did not increase the risk for spontaneous abortion (SAB), intrauterine growth retardation (IUGR), or microcephaly. Although the heavy consumption group was small and the power limited, caffeine consumption above 300 mg/d did appear to be related to IUGR.3,4 In this issue of JAMA, Infante-Rivard and colleagues5

REFERENCES

1 +
Watkinson B, Fried PA.  Maternal caffeine use before, during and after pregnancy and effects upon offspring. Neurobehav Toxicol Teratol . 1985;;7:9-17.
2 +
Mills JL, Holmes LB, Aarons JH, et al.  Moderate caffeine use and the risk of spontaneous abortion and intrauterine growth retardation. JAMA . 1993;;269:593-597.
3 +
Hatch EE, Bracken MB.  Caffeine use during pregnancy: what is safe? JAMA . 1993;;270:46-47.
4 +
Eskenazi B, Fenster L, Samuels SJ, Swan S.  Caffeine use during pregnancy: what is safe? JAMA . 1993;;270:47.
5 +
Infante-Rivard C, Fernández A, Gauthier R, David M, Rivard GE.  Fetal loss associated with caffeine intake before and during pregnancy. JAMA . 1993;;270:2940-2943.
6 +
Dlugosz L, Bracken MB.  Reproductive effects of caffeine: a review and theoretical analysis. Epidemiol Rev . 1992;;14:83-100.
7 +
Wilcox AJ, Weinberg CR, O'Connor JF, et al.  Incidence of early loss of pregnancy. N Engl J Med . 1988;;319:189-194.
8 +
Hook EB.  Dietary cravings and aversions during pregnancy. Am J Clin Nutr . 1978;;31:1355-1362.
9 +
Mackenzie SC, Lippman A.  An investigation of report bias in a case-control study of pregnancy outcome. Am J Epidemiol . 1989;;129:65-75.
10 +
Brandes JM.  First-trimester nausea and vomiting as related to outcome of pregnancy. Obstet Gynecol . 1967;;30:427-431.
11 +
Fenster L, Eskenazi B, Windham GC, Swan SH.  Caffeine consumption during pregnancy and spontaneous abortion. Epidemiology . 1991;;2:168-174.
12 +
Stein Z, Susser M.  Miscarriage, caffeine, and the epiphenomena of pregnancy: the causal model. Epidemiology . 1991;;2:85-87.
13 +
Gilbert RM, Marshman JA, Schweider M, Berg R.  Caffeine content of beverages as consumed. Can Med Assoc J . 1976;;114:205-208.
14 +
Kato T, Takahashi S, Kiugawa K.  Generation of heterocyclic amine-like mutagens during the roasting of coffee beans. Eisei Kagaku . 1989;;35:370-376.
15 +
Yesair DW, Branfman AR, Callahan MM.  Human disposition and some biochemical aspects of methylxanthines.  In: Spiller GE, ed. The Methylxanthine Beverages and Foods: Chemistry, Consumption, and Health Effects . New York, NY: Alan R Liss Inc; 1984;:215-233.
16 +
Shiono PH, Klebanoff MA.  Invited commentary: caffeine and birth outcomes. Am J Epidemiol . 1993;;137:951-954.
17 +
Gilbert S, Reuhl K, Rice D, Stavric B.  Chronic caffeine exposure adversely affects reproductive outcome in the monkey. Toxicology . 1988;;8:239.
18 +
Aldridge A, Bailey J, Neims AH.  The disposition of caffeine during and after pregnancy. Semin Perinatol . 1981;;5:310-314.
19 +
Knutti R, Rothweiler H, Schlatter C.  The effect of pregnancy on the pharmacokinetics of caffeine. Arch Toxicol . 1982;;5:187-192.
20 +
Thayer PS, Palm PE.  A current assessment of the mutagenic and teratogenic effects of caffeine. Crit Rev Toxicol . 1975;;3:345-369.
21 +
Tornaletti S, Russo P, Parodi S, Pedrini AM.  Studies on DNA binding of caffeine and derivatives: evidence of intercalation by DNA-unwinding experiments. Biochim Biophys Acta . 1989;;1007:112-115.
22 +
Massey LK, Wise KJ.  The effect of dietary caffeine on urinary excretion of calcium, magnesium, sodium and potassium in healthy young females. Nutr Res . 1984;; 4:43-50.
23 +
Petridou E, Katsouyanni K, Spanos E, Skalkidis Y, Panagiotopoulou K, Trichopoulous D.  Pregnancy estrogens in relation to coffee and alcohol intake. Ann Epidemiol . 1992;;2:241-247.
24 +
Morris MB, Weinstein L.  Caffeine and the fetus: is trouble brewing? Am J Obstet Gynecol . 1981;;140:607-610.
25 +
Temples TE, Geoffray DJ, Nakamoto T, Hartman AD, Miller HI.  Effect of chronic caffeine intake on myocardial function during early growth. Pediatr Res . 1987;;21:391-395.
26 +
Weathersbee PS, Lodge JR.  Caffeine: its direct and indirect influence on reproduction. J Reprod Med . 1977;;19:55-63.
27 +
Grimm VE, Frieder B.  Prenatal caffeine causes long-lasting behavioral and neurochemical changes. Int J Neurosci . 1988;;41:15-28.
28 +
Streissguth AP, Barr HM, Martin DC, Herman CS.  Effects of maternal alcohol, nicotine, and caffeine use during pregnancy on infant mental and motor development at eight months. Alcohol Clin Exp Res . 1980;;4:152-164.
29 +
Barr HM, Streissguth AP.  Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicol Teratol . 1991;;13:441-448.
30 +
Jacobson SW, Fein GG, Jacobson JL, Schwartz PM, Dowler JK.  Neonatal correlates of prenatal exposure to smoking, caffeine, and alcohol. Inf Behav Dev . 1984;; 7:253-265.
31 +
Tuomilehto J, Tuomilehto-Wolf E, Virtala E, LaPorte R.  Coffee consumption as trigger for insulin dependent diabetes mellitus in childhood. BMJ . 1990;;300:642-643.
32 +
Wilcox A, Weinberg C, Baird D.  Caffeinated beverages and decreased fertility. Lancet . 1988;;2:1453-1456.
33 +
Joesoef MR, Beral V, Rolfs RT, Aral SO.  Are caffeinated beverages risk factors for delayed conception? Lancet . 1990;;1:136-137.
34 +
Olsen J.  Cigarette smoking, tea and coffee drinking, and subfecundity. Am J Epidemiol . 1991;;133:734-739.
35 +
Pollard I, Smallshaw J.  Male mediated caffeine effects over two generations of rats. J Dev Physiol . 1988;;10:271-281.
36 +
Goyan JE. Food and Drug Administration , news release No. P80-36. Washington, DC: Food and Drug Administration; September 4, 1980;.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Watkinson B, Fried PA.  Maternal caffeine use before, during and after pregnancy and effects upon offspring. Neurobehav Toxicol Teratol . 1985;;7:9-17.
2 +
Mills JL, Holmes LB, Aarons JH, et al.  Moderate caffeine use and the risk of spontaneous abortion and intrauterine growth retardation. JAMA . 1993;;269:593-597.
3 +
Hatch EE, Bracken MB.  Caffeine use during pregnancy: what is safe? JAMA . 1993;;270:46-47.
4 +
Eskenazi B, Fenster L, Samuels SJ, Swan S.  Caffeine use during pregnancy: what is safe? JAMA . 1993;;270:47.
5 +
Infante-Rivard C, Fernández A, Gauthier R, David M, Rivard GE.  Fetal loss associated with caffeine intake before and during pregnancy. JAMA . 1993;;270:2940-2943.
6 +
Dlugosz L, Bracken MB.  Reproductive effects of caffeine: a review and theoretical analysis. Epidemiol Rev . 1992;;14:83-100.
7 +
Wilcox AJ, Weinberg CR, O'Connor JF, et al.  Incidence of early loss of pregnancy. N Engl J Med . 1988;;319:189-194.
8 +
Hook EB.  Dietary cravings and aversions during pregnancy. Am J Clin Nutr . 1978;;31:1355-1362.
9 +
Mackenzie SC, Lippman A.  An investigation of report bias in a case-control study of pregnancy outcome. Am J Epidemiol . 1989;;129:65-75.
10 +
Brandes JM.  First-trimester nausea and vomiting as related to outcome of pregnancy. Obstet Gynecol . 1967;;30:427-431.
11 +
Fenster L, Eskenazi B, Windham GC, Swan SH.  Caffeine consumption during pregnancy and spontaneous abortion. Epidemiology . 1991;;2:168-174.
12 +
Stein Z, Susser M.  Miscarriage, caffeine, and the epiphenomena of pregnancy: the causal model. Epidemiology . 1991;;2:85-87.
13 +
Gilbert RM, Marshman JA, Schweider M, Berg R.  Caffeine content of beverages as consumed. Can Med Assoc J . 1976;;114:205-208.
14 +
Kato T, Takahashi S, Kiugawa K.  Generation of heterocyclic amine-like mutagens during the roasting of coffee beans. Eisei Kagaku . 1989;;35:370-376.
15 +
Yesair DW, Branfman AR, Callahan MM.  Human disposition and some biochemical aspects of methylxanthines.  In: Spiller GE, ed. The Methylxanthine Beverages and Foods: Chemistry, Consumption, and Health Effects . New York, NY: Alan R Liss Inc; 1984;:215-233.
16 +
Shiono PH, Klebanoff MA.  Invited commentary: caffeine and birth outcomes. Am J Epidemiol . 1993;;137:951-954.
17 +
Gilbert S, Reuhl K, Rice D, Stavric B.  Chronic caffeine exposure adversely affects reproductive outcome in the monkey. Toxicology . 1988;;8:239.
18 +
Aldridge A, Bailey J, Neims AH.  The disposition of caffeine during and after pregnancy. Semin Perinatol . 1981;;5:310-314.
19 +
Knutti R, Rothweiler H, Schlatter C.  The effect of pregnancy on the pharmacokinetics of caffeine. Arch Toxicol . 1982;;5:187-192.
20 +
Thayer PS, Palm PE.  A current assessment of the mutagenic and teratogenic effects of caffeine. Crit Rev Toxicol . 1975;;3:345-369.
21 +
Tornaletti S, Russo P, Parodi S, Pedrini AM.  Studies on DNA binding of caffeine and derivatives: evidence of intercalation by DNA-unwinding experiments. Biochim Biophys Acta . 1989;;1007:112-115.
22 +
Massey LK, Wise KJ.  The effect of dietary caffeine on urinary excretion of calcium, magnesium, sodium and potassium in healthy young females. Nutr Res . 1984;; 4:43-50.
23 +
Petridou E, Katsouyanni K, Spanos E, Skalkidis Y, Panagiotopoulou K, Trichopoulous D.  Pregnancy estrogens in relation to coffee and alcohol intake. Ann Epidemiol . 1992;;2:241-247.
24 +
Morris MB, Weinstein L.  Caffeine and the fetus: is trouble brewing? Am J Obstet Gynecol . 1981;;140:607-610.
25 +
Temples TE, Geoffray DJ, Nakamoto T, Hartman AD, Miller HI.  Effect of chronic caffeine intake on myocardial function during early growth. Pediatr Res . 1987;;21:391-395.
26 +
Weathersbee PS, Lodge JR.  Caffeine: its direct and indirect influence on reproduction. J Reprod Med . 1977;;19:55-63.
27 +
Grimm VE, Frieder B.  Prenatal caffeine causes long-lasting behavioral and neurochemical changes. Int J Neurosci . 1988;;41:15-28.
28 +
Streissguth AP, Barr HM, Martin DC, Herman CS.  Effects of maternal alcohol, nicotine, and caffeine use during pregnancy on infant mental and motor development at eight months. Alcohol Clin Exp Res . 1980;;4:152-164.
29 +
Barr HM, Streissguth AP.  Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicol Teratol . 1991;;13:441-448.
30 +
Jacobson SW, Fein GG, Jacobson JL, Schwartz PM, Dowler JK.  Neonatal correlates of prenatal exposure to smoking, caffeine, and alcohol. Inf Behav Dev . 1984;; 7:253-265.
31 +
Tuomilehto J, Tuomilehto-Wolf E, Virtala E, LaPorte R.  Coffee consumption as trigger for insulin dependent diabetes mellitus in childhood. BMJ . 1990;;300:642-643.
32 +
Wilcox A, Weinberg C, Baird D.  Caffeinated beverages and decreased fertility. Lancet . 1988;;2:1453-1456.
33 +
Joesoef MR, Beral V, Rolfs RT, Aral SO.  Are caffeinated beverages risk factors for delayed conception? Lancet . 1990;;1:136-137.
34 +
Olsen J.  Cigarette smoking, tea and coffee drinking, and subfecundity. Am J Epidemiol . 1991;;133:734-739.
35 +
Pollard I, Smallshaw J.  Male mediated caffeine effects over two generations of rats. J Dev Physiol . 1988;;10:271-281.
36 +
Goyan JE. Food and Drug Administration , news release No. P80-36. Washington, DC: Food and Drug Administration; September 4, 1980;.

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