December 8th, 2009 
For years, medical professionals have been telling pregnant women to reduce their caffeine intake, and that by doing so they could reduce their risks for problems such as premature delivery, low birth-weight babies and miscarriage.
However, for some pregnant women giving up caffeine completely simply is not realistic. For them, how much caffeine is too much?
A report from the British Medical Journal tried to answer this question. Researchers followed more than 2,600 low-risk women at two large teaching hospitals in England from 2003 to 2006. They screened pregnant women for caffeine, tobacco and other drug use. Close monitoring also noted miscarriages, low birth-weight deliveries, preterm delivery, elevated blood pressure and stillbirths.
In attempting to determine a safe upper limit of caffeine intake, the researchers looked for pregnant women who admittedly ingested significant amounts of caffeine as coffee, tea, soda or chocolate. In those women, the average amount of caffeine intake prior to pregnancy was almost 240 milligrams per day. That dropped to an average of 140 milligrams of caffeine during their pregnancies.
To put caffeine levels in perspective, a soda or cup of coffee has about 30 to 40 milligrams of caffeine.
What the researchers found answered some questions, but also raised some new ones. In comparing the women who ingested more than 300 milligrams of caffeine vs. those who ingested 30 milligrams of caffeine per day, the most dramatic differences were noted in infant birth weights. Higher amounts of caffeine ingestion were associated with lower birth weights.
From past studies we have also seen a correlation of higher caffeine usage with miscarriage and premature delivery.
So the British researchers confirmed what we already knew – that less caffeine is better when it comes to pregnancy. Unfortunately, they were not able to determine if there is a safe upper limit of caffeine ingestion.
The American College of Obstetricians and Gynecologists suggests a maximum of 300 milligrams per day. The British government’s Food Standards Agency recommends no more than 200 milligrams per day. Some doctors say to patients who just cannot say no to that morning cup of coffee is to try to keep their caffeine ingestion to less than 100 milligrams per day.
Of course, we have to keep the results of this British study in context. While levels of caffeine usage greater than 30 milligrams per day were associated with smaller birth weight babies, these differences in weight were fairly small (a few ounces).
Of course, when combined with the use of tobacco, alcohol or other substances, a few ounces could make a big difference.
Related
- Heavy caffeine intake may mean smaller babies
Pregnant women who down six coffee cups’ worth of caffeine every day may have smaller babies than those who consume less caffeine, a new study finds.
Researchers found that among more than 7,300 Dutch women followed from early pregnancy onward, between 2 and 3 percent said they consumed the caffeine equivalent of six cups of coffee per day during any trimester. On average, their babies’ length at birth was slightly shorter than that of newborns whose mothers had consumed less caffeine during pregnancy.
Heavy caffeine consumers also had an increased risk of having a baby who was small for gestational age — smaller than the norm for the baby’s sex and the week of pregnancy during which he or she was born.
That finding, however, was based on a small number of babies, and the significance is uncertain. Of 104 infants born to women with the highest caffeine intakes, seven were small for gestational age.
The findings, reported in the American Journal of Clinical Nutrition, add to the conflicting body of research into whether caffeine during pregnancy affects fetal growth.
Some studies, for instance, have linked regular caffeine consumption during pregnancy — even a relatively modest one or two cups of coffee a day — to an increased risk of low birth weight. But other studies have found no such effects. Researchers have also come to conflicting conclusions as to whether caffeine affects the risk of miscarriage.
In this latest study, Rachel Bakker and colleagues at Erasmus Medical Center in Rotterdam used ultrasound scans to monitor fetal growth over the course of pregnancy in 7,346 women.
At each trimester, the women reported on their usual intake of coffee and tea. Most women consumed less than the equivalent of four cups of coffee per day at any point in pregnancy, but between 2 and 3 percent downed six or more cups’ worth of caffeine.
Overall, babies born to heavy caffeine consumers were slightly shorter, on average, at birth and during all three trimesters of fetal development, based on the ultrasound tests.
“Caffeine intake seems to affect length growth of the fetus from the first trimester onwards,” Bakker told Reuters Health in an email.
The implication, she said, is that pregnant women should not consume more than six cups of coffee per day. However, the findings also do not mean that less coffee is generally “safe” during pregnancy.
“We only studied the effect of caffeine on fetal growth,” Bakker said. “Future studies on possible other effects of maternal caffeine intake are therefore needed.”
Given the uncertainty about whether and how caffeine might affect pregnancy and fetal development, experts generally recommend that to be safe, pregnant women limit their intake.
The March of Dimes, for example, suggests that, based on research into miscarriage risk, pregnant women get no more than 200 milligrams of caffeine per day — roughly the amount in 12 ounces of coffee.
- Excess weight raises pregnancy risks: study
Being overweight or obese increases a woman’s chances of having an extra-big baby, even after the effects of pregnancy-related, or “gestational,” diabetes are taken into account, new research shows.
Excess weight in and of itself also sharply increased a woman’s risk of pre-eclampsia, a potentially deadly pregnancy complication, Dr. Boyd E. Metzger of Northwestern University Feinberg School of Medicine in Chicago and his colleagues found.
Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother’s weight from those of gestational diabetes, Metzger and his colleagues note in the British Journal of Obstetrics and Gynecology.
This led them to investigate whether body mass index (BMI) — a standard measure of weight in relation to height used to gauge how fat or thin a person is — might influence pregnancy risks and fetal and newborn health, independently of a woman’s blood sugar levels.
The study involved 23,316 women from 15 different medical centers in nine different countries. All had undergone an oral glucose tolerance test, which is used to identify women with, or at risk for, pregnancy-related diabetes; at that time, their height and weight were measured, too.
The researchers then used statistical techniques to control for women’s oral glucose tolerance test results. Even after this adjustment, they found that the women with BMIs of 42 or greater, denoting severe obesity (for example, a 5-foot-5-inch tall woman weighing at least 250 pounds), were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study, who had BMIs of 22.6 or less (a 5′5″ woman weighing less than 138 pounds).
The heaviest women’s risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women. However, the heaviest women’s risk for delivering a preterm baby was actually cut in half.
These findings help sort out the role BMI and gestational diabetes each play in the risk of complications of pregnancy and delivery, Metzger told Reuters Health in an interview.
He noted that recent studies have shown that dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.
“We’re pretty confident that treating gestational diabetes going forward is going to continue to be beneficial,” the researcher said. “We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome.”
What is becoming clear, he added, is that it’s probably a woman’s weight before she gets pregnant, rather than how much she gains during pregnancy, that’s important in determining risk.
- Migraine drugs don’t up birth defect risk: study
A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.
However, the researchers did find a “slight increase” in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.
Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.
While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.
However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.
“While it is important to exert caution when using any medications during pregnancy, this study indicates” that pregnant women can either start or continue taking triptans without “any major risk” of miscarriage, premature delivery, or other bad outcomes, the authors conclude.
Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.
Less than one percent — 373 women — had used the drugs before getting pregnant but not during pregnancy.
The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn’t have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.
The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.
However, the rate of major birth defects – such as serious problems of the limbs or internal organs — was 3 percent for all three groups. That rate – about one in 33 births – is about what would be expected for all birth defects in the general population.
The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.
And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.
While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don’t improve by then aren’t likely to get better.
- Antidepressants Raise Risk of Pre-Term Birth: Study
Danish women who took antidepressants during pregnancy had twice the risk of pre-term delivery as other women, and their babies were more likely to be admitted to an intensive care unit than those of women who did not take the drugs, researchers reported on Monday.
They said antidepressants, known as selective serotonin reuptake inhibitors or SSRIs, which affect a message-carrying brain chemical called serotonin, may raise the risk of pre-term delivery and affect a baby’s health at birth.
Some prior studies have found that drugs in this class can cross the placenta and appear in the umbilical cord blood of babies whose mothers have taken them.
“The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants,” Dr. Najaaraq Lund of the Bandim Health Project in Guinea-Bissau, and colleagues wrote in the Archives of Pediatrics and Adolescent Medicine.
About one in 10 pregnant women experience depression during pregnancy. Because depression can jeopardize a pregnant woman’s health, doctors often prescribe antidepressants, but it is not yet clear how these drugs affect a baby’s health.
To study this, Lund and colleagues analyzed data on 57,000 pregnancies and deliveries at Aarhus University Hospital in Skejby, Denmark, between 1989 to 2006.
They identified 329 pregnancies in which the mothers took an SSRI medication, another 4,902 with a history of psychiatric illness not treated with an antidepressant, and 51,700 with no history of psychiatric illness.
Women who took antidepressants while pregnant delivered their babies five days earlier than other women in the study, and had twice the risk of pre-term delivery than women with no history of psychiatric illness.
Babies exposed to antidepressants during pregnancy were far more likely than those in the other two groups to have a five-minute Apgar score — a measure of a newborn’s health — of seven or below. Seven is typically an indicator of a healthy baby.
They were also more likely to be admitted to the neonatal intensive care unit, and some of these babies showed signs of withdrawal, such as jitters, seizures, respiratory problems, infections and jaundice.
The team found no differences in the babies’ head size or birth weight among the three groups.
Antidepressants used by women in the study included Pfizer Inc’s Zoloft, known generically as sertraline; Forest Laboratories Inc’s Celexa, or citalopram, and Lexapro, or escitalopram; Eli Lilly and Co’s Prozac or fluoxetine; and GlaxoSmithKline’s Paxil or paroxetine.
- Obese Women Have Increased Pregnancy and Postpartum Risks
Women who are obese during pregnancy are at increased risk for preterm birth, preeclampsia, gestational diabetes, cesarean delivery and postpartum weight retention, according to data presented today.
Kimberly K. Vesco, MD, MPH, obstetrician-gynecologist at Mount Talbert Medical Office and Kaiser Sunnyside Medical Center, presented data on pregnancy outcomes and postpartum weight retention for 5,551 normal-weight women and 3,110 obese women included in an HMO database.
Weight gain at one year defined the difference between baseline weight during pregnancy and weight at 300 to 420 days postpartum.
Mean baseline weight was 131 lb for normal-weight women vs. 214 lb for obese women. Mean gestational weight gain was lower among obese women compared with normal-weight women (22 lb vs. 32 lb; P<.001). However, 33% of obese women gained more than 10 lb at one year postpartum compared with 22% of normal-weight women (P=.0001).
Obese women had an increased risk for preterm birth (10% vs. 8%), preeclampsia (15% vs. 6%), gestational diabetes (8% vs. 3%) and cesarean delivery (36% vs. 20%; P<.001).
Further, infants born to obese women had a higher mean birth weight when compared with infants born to normal-weight women (P<.001).
Study results also revealed that obese women were more likely to smoke (7% vs. 10%), have a diagnosis of depression (7% vs. 11%) and hypertension during pregnancy (9% vs. 22%), and have diabetes (1% vs. 5%; P=.0001) compared with leaner women.
“There should be inquiries to prevent weight loss among obese reproductive-age women, particularly those planning a pregnancy,” Vesco said during the oral presentation. “In addition, programs should be developed to limit gestational weight gain during pregnancy and to assist with weight loss after delivery.”
