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Christy Goff Maternal Infant Nutrition 2012

CAFFEINE INTAKE DURING PREGNANCY. Christy Goff Maternal Infant Nutrition 2012. What is caffeine?. Bitter, white crystalline xanthine alkaloid that acts as a stimulant drug Methylxanthine Found in seeds, leaves and fruits of plants, where it acts as a natural pesticide

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Christy Goff Maternal Infant Nutrition 2012

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  1. CAFFEINE INTAKE DURING PREGNANCY Christy Goff Maternal Infant Nutrition 2012

  2. What is caffeine? • Bitter, white crystalline xanthine alkaloid that acts as a stimulant drug • Methylxanthine • Found in seeds, leaves and fruits of plants, where it acts as a natural pesticide • We get it from tea, coffee, cocoa, colas and energy drinks • Most frequently ingested pharmacologically active substance in the world • 80% of women drink caffeine-containing beverages daily [1]. • 70-95% of pregnant women drink caffeine-containing beverages daily [5].

  3. Caffeine Sources: Hinds TS, West WL, et al. 1996. The Effect of Caffeine on Pregnancy Outcomes Variables. Nutrition Reviews; 54(7): 203-207.

  4. Caffeine Metabolism --Metabolized in the liver into three primary metabolites http://en.wikipedia.org/wiki/Caffeine#Metabolism

  5. Caffeine Metabolism • Potential Sites of Action [2]: • Blockade of adenosine receptors (A1 & A2a) • Blockade of phosphodisesterases • Effects ion channels (regulating intracellular levels of calcium causing muscle contractions) • Absorbed within 45 mins of ingestion, peak blood concentration at 1 hour • Clearance in pregnant woman is longer[5] • Complete metabolism varies in individuals due to age, liver function, enzyme activity, hormonal and medication activity. [1] • Metabolites released through the kidneys

  6. Health Concerns • Caffeine is readily absorbed into the human placenta • Diffuses into breast milk • Breaches blastocyst and may accumulate in the fetal brain [2] • Caffeine been associated with: • Delayed Conception [1] • Spontaneous abortion or miscarriages in first trimester [5] • Fetal growth restriction [4] • Low birth weight and preterm delivery • In animal studies: Disturbances in development of central nervous system - Neutral tube [1]

  7. Nutritional Concerns • Overall Macro & Micronutrient status • Women at risk: little education, low socioeconomic status, and those with present nutritional deficiencies • Calcium: • Study by Harris, S concludes postmenopausal women who have lower Ca intakes than the RDA may be at risk for increased bone loss with 2-3 servings of coffee/d. [6] • Increases urinary calcium excretion for 1-3hrs after ingestion

  8. Caffeine’s Overall Effects • Causes nervous system stimulation, cardiac muscle stimulation, smooth muscle relaxation, increasing gastric acid secretion & increases free fatty acids and glucose in blood plasma [7]. • Fetal brain is more sensitive to caffeine than an adult brain [2]. • Caffeine exposure could presents certain dangers to neurodevelopment during the critical growth period [2].

  9. Current Research and Recommendations • FDA and ADA recommends not exceeding 300mg of caffeine per day while pregnant. [8] • Mayo clinic recommends consuming less than 200mg of caffeine per day [3] Alternative approaches • Education and counseling: caffeine is sometimes not perceived as a substance of abuse • Choose organic, fair trade brands to minimize chemical processing

  10. Challenges in data collection • Experimental studies on pregnant women are unethical • Relies on retrospective data, subjected to recall bias [5]. • Finding an accurate assessment of caffeine intake from subjects • Differences in individual tolerance for caffeine • Not looking at confounding factors (alcohol consumption, smoking, other dietary habits, pregnancy symptoms )

  11. References: [1] Krzysztof, KM. 2009. Caffeine in pregnancy. Arch. GynecolObstet; 280: 695-698. [2] Nehlig, Astrid. Coffee, tea, chocolate and the brain. CRC Press. Boca Raton, FL: 2000. [3] Pregnancy week by week. Mayo Foundation for Medical Education and Research. May 2011. http://www.mayoclinic.com/health/pregnancy-nutrition/PR00109/NSECTIONGROUP=2Accessed Oct 2012. [4] Boylan S, et al. 2008. Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study. BMJ; 3(337): a2332. [5] Xiaoping W., et al. 2008. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J ObstetGynecol; 198:279e1-279e8. [6] Harris S.S., Dawson-Hughes B. 1994. Caffeine and bone loss in healthy postmenopausal women. Am J ClinNutr; 60:73-578. [7] Hinds TS, West WL, et al. 1996. The effect of caffeine on pregnancy outcomes variables. Nutrition Reviews; 54(7): 203-207. [8] ADA Reports. 2008. Position of the American Dietetic Association: Nutrition and lifestyle for a healthy pregnancy outcome. Journal of Am Dietetic Association; 108 (3): 553-561.

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