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Study Title and Description

Parental smoking, maternal alcohol, coffee and tea consumption during pregnancy and childhood malignant central nervous system tumours: the ESCALE study (SFCE).



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on reproductive and developmental outcomes?
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Primary Publication Information
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TitleData
Title Parental smoking, maternal alcohol, coffee and tea consumption during pregnancy and childhood malignant central nervous system tumours: the ESCALE study (SFCE).
Author M Plichart,F Menegaux,B Lacour,O Hartmann,D Frappaz,F Doz,AI Bertozzi,AS Defaschelles,A Pierre-Kahn,C Icher,P Chastagner,D Plantaz,X Rialland,D Hémon,J Clavel,
Country
Year 2008
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Reproductive Toxicity - Design Details
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 18562965
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What outcome is being evaluated in this paper? Reproductive and Development
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What is the objective of the study (as reported by the authors)? This paper analyses the role of parental tobacco smoking and maternal alcohol and caffeinated beverage consumption during pregnancy with respect to childhood CNS tumours using data generated by the ESCALE study. The latter investigated the role of environmental and genetic factors with regard to the four most frequent types of childhood cancers: leukaemias, lymphomas, CNS tumours and neuroblastomas.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) Cases were identified from the Epidemiological Study on childhood Cancer and Leukemia ESCALE study, a national population-based case–control study carried out in France. 209 incident cases classified as malignant CNS tumors according to ICD-O-3 were included and grouped using the International Classification of Childhood Cancer. 1681 population-based controls were frequency matched with the cases by age and sex. The data were collected through a standardized telephone interview of the biological mothers. Mothers were asked whether they had ever drunk coffee, tea, chocolate or cola during pregnancy. If so, further questions were asked to elicit the daily or weekly amount consumed, for each of the items. Odds ratios (ORs) and 95% confidence intervals were estimated by nonconditional logistic regression for all CNS tumors, with systematic adjustment for the stratification variables, age and sex. Adjustment for potential confounding factors, such as the place of residence at the time of diagnosis, maternal and paternal educational level and socioeconomic category, was also conducted. Analyses of tumor histological subgroups were conducted using polytomous regression models.
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How many outcome-specific endpoints are evaluated? 2
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) childhood malignant central nervous system tumors (all, PNET, ependymomas, astrocytomas, other gliomas)
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes The cases consisted of 100 cases (48%) of embryonal tumour (ICD-O-3 codes 9470/3, 9471/3, 9473/3, 9474/3, 9480/3, 9508/3), 33 cases (16%) of ependymoma (9390/3–9393/3), 26 cases (12%) of astrocytoma (9380/3, 9400/3, 9420/3, 9424/3, 9440/3) and 45 cases (21%) of other glioma (9380/3, 9382/3, 9430/3, 9450/3, 9451/3). The remaining cases were distributed as follows: three (2%) not otherwise specified tumours and two (1%) otherwise specified tumours.
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Clinical Clinical
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Physiological
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Other
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What is the study design? Case-Control
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Objective
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Optional: Name of Method or short description classified as malignant CNS tumours (/3 behaviour) according to ICD-O-3 were included and grouped using the International Classification of Childhood Cancer (Steliarova-Foucher et al., 2005).
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Caffeine (general)
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Coffee Coffee
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Chocolate
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Energy drinks
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Gum
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Medicine/Supplement
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Soda Soda
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Tea Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults
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Pregnant Women Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) Coffee and tea (cups/day) 0 coffee and 0 tea </=3 coffee and</=1 tea >3 coffee and</=1 tea </=3 coffee and >1 tea >3 coffee and >1 tea
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) Age and sex. Adjustment for potential confounding factors, such as the place of residence at the time of diagnosis, maternal and paternal educational level and socioeconomic category, was also conducted.
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Provide a general description of results (as reported by the authors). ABSTRACT: A strong association between CNS tumours and the highest maternal consumption of both coffee and tea during pregnancy was observed [OR: 4.4 (1.5–13)]. RESULTS: No association between CNS tumors taken as a whole and consumption of caffeinated beverages by the mother during pregnancy was detected. (REVIEWER NOTE: Concur with abstract based on data in Table 4). Slightly, but not significantly, increased ORs were associated with the highest consumption of coffee [OR: 1.4 (0.8–2.4)] and tea [OR: 1.4 (0.9–2.1)]. Higher ORs were observed for ependymoma, but the number of cases was small. The associations were more marked for the highest maternal consumption of both coffee (more than three cups per day) and tea (more than one cup per day). Adjustment for maternal and paternal smoking did not change the results.
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? Maternal coffee and tea consumption during pregnancy were significantly associated with CNS tumours and particularly with ependymomas.
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What were the sources of funding? This study was supported by grants from INSERM, the Fondation de France, the Association pour la Recherche contre le Cancer (ARC), the Agence Franc¸aise de Se´curite´ Sanitaire des Produits de Sante´ (AFSSAPS), the Agence Franc¸aise de Se´curite´ Sanitaire de l’Environnement et du Travail (AFSSET) and the association ‘Cent pour sang la vie’.
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What conflicts of interest were reported? None reported
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Does the exposure (dose) need to be standardized to the SR? Yes
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest). ALL CNS tumors: LOAEL = >3 coffee and >1 tea 3 cups coffee/day x 95 mg/cup = 285 mg/day 1 cup tea/day x 47.2 mg/cup = 47.2 mg/day 285 + 47.2 = >332.2 mg/day Ependymomas: LOAEL = tea only, >1 cup/day = >47.2 mg/day
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  ALL CNS tumors: LOAEL = >332.2 mg/day Ependymomas: LOAEL = >47.2 mg/day
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. All CNS tumors: combined coffee and tea were selected as only significant finding (OR = 4.4, 95% CI 1.5,13) Ependymomas: tea only was selected as it was more conservative than coffee+tea (i.e., less caffeine) (OR = 2.5, CI 1.1, 5.9)
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What is the importance of the study with respect to the adverseness of the outcome? Critcal
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