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Pregnancy & Childbirth

Pregnant Women Who Consume At Least Eight Cups of Coffee Per Day Double Risk of Stillbirth, Study Says

[Feb 21, 2003]
Pregnant women who consume eight cups of coffee or more per day have double the risk of a stillbirth, compared with women who drink no coffee during pregnancy, according to a study published in the Feb. 22 issue of the journal BMJ, Reuters/Arizona Republic reports. Researchers from Aarhus University Hospital in Denmark based their findings on a study of more than 18,000 women attending the obstetrics department at the university hospital between 1989 and 1996 who answered questionnaires about their consumption of coffee, alcohol and cigarettes and their medical history (Reuters/Arizona Republic, 2/20). According to the study, 31 stillbirths occurred among the 7,878 women who drank no coffee during pregnancy, and 11 stillbirths occurred among the 950 women who drank eight cups of coffee or more per day during pregnancy. Therefore, without taking into account other factors, women drinking eight cups of coffee per day or more had triple the risk of having a stillbirth; one in 250 pregnancies ended in stillbirth among women who drank no coffee during pregnancy, compared to three stillbirths for every 250 pregnancies among women drinking eight or more cups of coffee per day (Wisborg et al., BMJ, 2/22). After accounting for medical history, maternal age, drinking and smoking habits and other factors, the researchers reported that the risk of stillbirth among the high coffee consumption group was double that among non-coffee drinkers (AP/New York Post, 2/21). "Women who have such a high intake of coffee also come with a set of other characteristics -- like they are more likely to smoke, they have a higher intake of alcohol, they are older, they've had more pregnancies, they've had fewer years of education," Lisa Signorello, an epidemiologist at the International Epidemiology Institute and assistant professor of medicine at Vanderbilt University, said (Ross, AP/Arizona Republic, 2/21). Although the researchers were unsure exactly why high coffee consumption is associated with an increased risk of stillbirth, they hypothesized that caffeine could "spark a release of adrenaline which could contract the blood vessels in the placenta or it may affect the heart beat" (Reuters/Arizona Republic, 2/20).

Further Research Needed

According to Alan Leviton, professor of neurology at Harvard Medical School, one drawback in the study is that the researchers solicited information about coffee consumption only once -- at 16 weeks of pregnancy -- and coffee consumption tends to drop during healthy pregnancies due to pregnancy signal theory. According to Leviton, women tend to reduce coffee intake four to six weeks into pregnancy, possibly because elevated hormones or "signals" made by the placenta cause women to be averse to the smell. "The inference is that the healthier the placenta, the stronger the pregnancy signal. The woman who does not have a good implantation of her placenta doesn't make as many hormones, which puts her at risk of pregnancy problems such as stillbirth," Leviton said. Under this theory, the fact that a pregnant woman is able to continue to consume high amounts of coffee would signal that her pregnancy is already "not going well," according to the Associated Press (Ross, Associated Press, 2/21). The study authors said that more research is necessary to substantiate the link between high coffee intake and an increased risk of stillbirth (AP/Arizona Republic, 2/21). According to the Associated Press, previous studies have linked the consumption of three or more cups of coffee per day with miscarriage and low birthweight infants (Associated Press, 2/20). Roger Cook, who is a spokesperson for the British Coffee Association, said that pregnant women should not be concerned by the study's findings. He added that the study's results "do not alter the advice given to pregnant women by the [British] Food Standards Agency who state that 300 mg caffeine -- equivalent to three mugs or four cups of coffee per day -- is perfectly safe and will have no adverse effect on the mother or the fetus" (Reuters/Arizona Republic, 2/20).
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