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Study Title and Description

Caffeine intake during pregnancy and risk of problem behavior in 5- to 6-year-old children.



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 Caffeine intake during pregnancy and risk of problem behavior in 5- to 6-year-old children.
Author EM Loomans,L Hofland,O van der Stelt,MF van der Wal,HM Koot,BR Van den Bergh,TG Vrijkotte,
Country
Year 2012
Numbers

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


Extraction Form: Reproductive Toxicity - Design Details
Arms
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Design Details
Question... Follow Up Answer Follow-up Answer
Refid 22778296
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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)? The aim of the current study was to prospectively investigate the association between prenatal maternal dietary caffeine intake and children’s problem behavior in a large multiethnic, community-based birth cohort. We were able to take into account a large number of potential confounding factors, and we included mothers’ as well as teachers’ ratings on multiple dimensions of children’s behavior. Mediation by fetal growth restriction and gestational age as well as effect modification by prenatal smoking and the child’s gender were taken into account.
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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) Part of the Amsterdam Born Children and their Development (ABCD) study; community based multiethnic birth cohort. Dietary caffeine intake (coffee, caffeinated tea, and cola) was measured (maternal self-report, n = 8202) around the 16th week of gestation. Total caffeine intake per day was calculated by using the Dutch Food Composition Database that contains data on the nutritional composition and caffeine content of food and beverages. The type of coffee, tea, or cola (a regular coffee or tea contains 125mL, a regular cola 150mL) determined the total caffeine intake in milligrams per day (one regular coffee = 85 mg; decaffeinated coffee = 3 mg; both regular and decaffeinated coffee = 44 mg; regular tea = 45 mg; regular cola = 35 mg; decaffeinated cola = 0 mg; regular and decaffeinated cola = 17 mg; no cola, coffee, tea, only herbal tea = 0 mg). At age 5, children’s overall problem behavior, emotional problems, conduct problems, hyperactivity/inattention problems, peer relationship problems, and prosocial behavior were rated by both mother and teacher (n = 3439) with the Strengths and Difficulties Questionnaire. Analyses were adjusted for maternal age, ethnicity, cohabitant status, education, smoking and alcohol consumption during pregnancy, child’s gender, family size, and prenatal maternal anxiety. The association between maternal prenatal caffeine intake and problem behavior was analyzed by multiple logistic regression analysis.
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How many outcome-specific endpoints are evaluated? 1
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Child behavior (age 5): overall problem behavior, emotional problems, conduct problems, hyperactivity/inattention problems, peer relationship problems, and prosocial behavior
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes
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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? Cohort
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Both
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Optional: Name of Method or short description Rated by both mother and teacher with the Strengths and Difficulties Questionnaire
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Caffeine (general) 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.) Caffeine mg/day: 0–85, 86–255, 256–425. >425
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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) Potential covariates were selected a priori on a theoretical basis and were included in the regression model at once by using a forced-entry method. First, associations were tested in a crude (unadjusted) model and subsequently maternal age (years), ethnicity (Dutch, Surinamese, Mediterranean, and others), maternal education (years after primary school), maternal stateanxiety (low/high), cohabitant status (yes/ no), smoking (yes/no), alcohol (yes/no), child’s gender, family size (child plus brothers or sisters) were added to the unadjusted model. Thereafter, in the third step, birth weight standardized for gender, gestational age, and parity based on the most recent Dutch reference values,37 and gestational age (based on ultrasound, when unavailable (,10%) on the first day of the last menstrual period) were added to examine potential mediation.
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Provide a general description of results (as reported by the authors). Prenatal caffeine intake was not associated with a higher risk for hyperactivity/inattention problems, emotional symptoms, conduct problems, peer relationship problems, overall problem behavior, or suboptimal prosocial behavior in the adjusted models. Furthermore, no evidence was found for mediation by fetal growth restriction and gestational age. We did not find evidence for effect modification by the child’s gender (tests for interaction, all P > .05). However, maternal smoking during pregnancy moderated the association between caffeine intake and peer relationship problems (test for interaction, P = .02). Caffeine intake >425 mg/d compared with an intake of 0–85 mg/d increased the risk for offspring’s peer relationship problems in women who smoked, whereas an inverse trend was found in women who did not smoke.
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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? Prenatal maternal dietary caffeine intake was not associated with a higher risk for hyperactivity/inattention problems, emotional symptoms, conduct problems, peer relationship problems suboptimal prosocial behavior, and overall problem behavior in their 5-year-old offspring. Consequently, no evidence was found for mediation by fetal growth restriction and gestational age. The child’s gender did not modify the association between intrauterine caffeine intake and children’s problem behavior. Maternal smoking during pregnancy moderated the association between caffeine intake and peer relationship problems.
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What were the sources of funding? This work was supported by the Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; the Department of Epidemiology, Documentation and Health Promotion, Public Health Service Amsterdam, Netherlands; and the Department of Psychology, Tilburg University, Tilburg, Netherlands.
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What conflicts of interest were reported? The authors have indicated they have no financial relationships relevant to this article to disclose.
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Does the exposure (dose) need to be standardized to the SR? No
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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).
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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.  Overall problem behavior, emotional problems, conduct problems, hyperactivity/inattention problems, peer relationship problems, or prosocial behavior (all 6 assessed individually) NOAEL = >425 mg/day
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. Overall problem behavior - adjusted OR = 1.04 (95% CI 0.49-2.22)
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What is the importance of the study with respect to the adverseness of the outcome? Important
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