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Study Title and Description

Maternal caffeine consumption and small for gestational age births: results from a population-based case-control study.



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 Maternal caffeine consumption and small for gestational age births: results from a population-based case-control study.
Author AT Hoyt,M Browne,S Richardson,P Romitti,C Druschel, ,
Country
Year 2014
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 24288144
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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 analysis examined the association between maternal caffeine consumption and SGA among live born infants using National Birth Defects Prevention Study (NBDPS) data. It also examined potential effect modification by smoking, folic acid use, and vasoconstrictor medication use during pregnancy.
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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) We examined the association between maternal caffeine intake and SGA using National Birth Defects Prevention Study data. Nonmalformed live born infants with an estimated date of delivery from 1997–2007 (n = 7,943) were included in this analysis. Control infants randomly selected and unmatched from hospital records or birth certificates during the same time and geographic area as case subjects. Using computer-assisted telephone interviews, maternal caffeine exposure was examined as total caffeine intake and individual caffeinated beverage type (coffee, tea, and soda); sex-, race/ethnic-, and parityspecific growth curves were constructed to estimate SGA births. Crude and adjusted odds ratios (aORs) and 95 % confidence intervals were estimated using unconditional logistic regression. Interaction with caffeine exposures was assessed for maternal smoking, vasoconstrictor medication use, and folic acid.
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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) SGA/IUGR
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes SGA is generally characterized as a fetal or newborn birth weight below the 10th percentile. SGA status was estimated with sex-, race/ethnic-, and parity-specific growth curves based on the methods of Zhang and Bowes [36 ], and Overpeck et al. [37 ].
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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 SGA is generally characterized as a fetal or newborn birth weight below the 10th percentile. SGA status was estimated with sex-, race/ethnic-, and parity-specific growth curves based on the methods of Zhang and Bowes [36 ], and Overpeck et al. [37 ].
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Caffeine (general) Caffeine (general)
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Coffee Coffee
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Chocolate Chocolate
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Energy drinks 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: <10, 10-<100, 100-<200, 200-<300, >/=300
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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) Covariates examined in the analysis include the following maternal factors: age at delivery (12–19, 20–24, 25–29, 30–34, and 35?); parity (0, 1, 2?); race/ethnicity (non-Hispanic white; non-Hispanic black; Hispanic; other); education (\12, 12, 12? years); pre-pregnancy body mass index defined as weight in kg/height in m2 (\18.5, 18.5 to\25, 25 to\30, and 30?); total caloric intake; high blood pressure during the index pregnancy; folic acid-containing supplement use (yes/no use 1 month prepregnancy through the first month of pregnancy); smoking (yes/no 1 month prepregnancy through the first trimester); and alcohol use (yes/no 1 month prepregnancy through the first trimester); as well as infant sex and mother’s state of residence at the time of the infant’s birth (study site). Maternal exposure to folic acid, alcohol consumption, and tobacco smoking in the second and third trimesters (yes/no use second trimester through the third trimester) were also evaluated
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Provide a general description of results (as reported by the authors). Crude and adjusted odds ratios (aORs) for the association between caffeine intake and SGA were very similar. Increasing aORs were observed for increasing intakes of total caffeine and each caffeinated beverage with statistically significant aORs ranging from 1.3 to 2.1. Results were slightly attenuated after adding the variable for the number of cigarettes smoked per day to our models. Significant increases in our estimates were noted for total caffeine and tea intake in the highest intake categories (300+ mg/day and 3+ servings/day); aORs, 95 % CIs = [(1.57 (1.16–2.13)) and (2.05 (1.50–2.80))], respectively, for the most parsimonious models adjusting for maternal education, high blood pressure during the index pregnancy, and maternal smoking (one month prepregnancy through the first trimester). After additionally adjusting for number of cigarettes smoked per day, estimates remained significant, aORs, 95 % CIs = [(1.52 (1.12–2.08)) and (2.00 (1.46–2.74))]. Results for soda intake were more attenuated, aOR, 95 % CI = 1.20 (0.93- 1.54) for the highest intake category (3+ serving/day), and overall did not reach statistical significance for any of the categories assessed. However, a dose–response trend was noted (p -trend </= 0.05) for the most parsimonious models and those additionally adjusted for number of cigarettes smoked per day).
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Did the authors perform a dose-response analysis (or trend/related analysis)? Yes
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What were the authors's observations re: trend analysis? A dose–response trend was noted (p -trend </= 0.05)
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What were the author's conclusions? In conclusion, a modest increase in SGA births was observed for mothers with higher caffeine intake and, given the limitations of our caffeine assessment, this relationship was likely underestimated. For individual caffeinated beverages, an association was observed for tea intake, although the association was much weaker for increasing amounts of coffee and soda. Overall, this analysis adds strength to the body of evidence that caffeine intake, particularly for women consuming 300+ mg/day, is detrimental for fetal growth.
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What were the sources of funding? This publication was supported through cooperative agreements (U01-DD00048702 and U01-DD000494)) with the Centers for Disease Control and Prevention.
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What conflicts of interest were reported? The authors declare that they have no competing interests, financial or otherwise
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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.  SGA: LOAEL = >/=300 mg/day
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. aOR = 1.52, 95% CI 1.12–2.08
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What is the importance of the study with respect to the adverseness of the outcome? Critcal
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