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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 - PowerPoint PPT Presentation
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Christy GoffMaternal Infant Nutrition 2012
CAFFEINE INTAKEDURING
PREGNANCY
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].
Caffeine Sources:
Hinds TS, West WL, et al. 1996. The Effect of Caffeine on Pregnancy Outcomes Variables. Nutrition Reviews; 54(7): 203-207.
Caffeine Metabolism--Metabolized in the liver into three primary metabolites
http://en.wikipedia.org/wiki/Caffeine#Metabolism
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
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]
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
• 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].
Caffeine’s Overall Effects
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
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 )
References:[1] Krzysztof, KM. 2009. Caffeine in pregnancy. Arch. Gynecol Obstet; 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=2 Accessed 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 Obstet Gynecol; 198:279e1-279e8. [6] Harris S.S., Dawson-Hughes B. 1994. Caffeine and bone loss in healthy postmenopausal women. Am J Clin Nutr; 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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