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Maternal Caffeine Consumption and Small for Gestational Age Births: Results from a Population-Based Case–Control Study

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Abstract

Caffeine is consumed in various forms during pregnancy, has increased half-life during pregnancy and crosses the placental barrier. Small for gestational age (SGA) is an important perinatal outcome and has been associated with long term complications. We examined the association between maternal caffeine intake and SGA using National Birth Defects Prevention Study data. Non-malformed live born infants with an estimated date of delivery from 1997–2007 (n = 7,943) were included in this analysis. Maternal caffeine exposure was examined as total caffeine intake and individual caffeinated beverage type (coffee, tea, and soda); sex-, race/ethnic-, and parity-specific 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. Six hundred forty-eight infants (8.2 %) were found to be SGA in this analysis. Increasing aORs were observed for increasing intakes of total caffeine and for each caffeinated beverage with aORs (adjusting for maternal education, high blood pressure, and smoking) ranging from 1.3 to 2.1 for the highest intake categories (300+ mg/day total caffeine and 3+ servings/day for each beverage type). Little indication of additive interaction by maternal smoking, vasoconstrictor medication use, or folic acid intake was observed. We observed an increase in SGA births for mothers with higher caffeine intake, particularly for those consuming 300+ mg of caffeine per day. Increased aORs were also observed for tea intake but were more attenuated for coffee and soda intake.

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Notes

  1. Sixteen frequency categories were provided: never or less than 1 per month, 1 per month, 2 per month, 3 per month, 1 per week, 2 per week, 3 per week, 4 per week, 5 per week, 6 per week, 1 per day, 2 per day, 3 per day, 4 per day, 5 per day, 6 + per day.

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Acknowledgments

This publication was supported through cooperative agreements (U01-DD00048702 and U01-DD000494)) with the Centers for Disease Control and Prevention. We thank the participants, staff, and scientists of the National Birth Defects Prevention Study. We would additionally like to thank Dr. Tania Desrosiers from the University of North Carolina Gillings School of Global Public Health and Mrs. Katie Tengelsen from the Texas Department of State Health Services for their assistance with classification of SGA. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the New York State Health Department, nor the Texas Department of State Health Services.

Conflict of interest

The authors declare that they have no competing interests, financial or otherwise.

Author information

Authors and Affiliations

  1. Birth Defects Epidemiology and Surveillance Branch, Texas Center for Birth Defects Research and Prevention, Texas Department of State Health Services, PO Box 149347, MC 1964, Austin, TX, 78714-9347, USA

    Adrienne T. Hoyt

  2. Congenital Malformations Registry, New York State Department of Health, Albany, NY, USA

    Marilyn Browne & Charlotte Druschel

  3. University at Albany School of Public Health, Rensselaer, NY, USA

    Marilyn Browne & Charlotte Druschel

  4. Office of Quality and Patient Safety, New York State Department of Health, Albany, NY, USA

    Sandra Richardson

  5. Department of Epidemiology, The University of Iowa, Iowa City, IA, USA

    Paul Romitti

Authors
  1. Adrienne T. Hoyt
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  2. Marilyn Browne
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  3. Sandra Richardson
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  4. Paul Romitti
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  5. Charlotte Druschel
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The National Birth Defects Prevention Study

Corresponding author

Correspondence to Adrienne T. Hoyt.

Appendices

Appendix 1: National Birth Defects Prevention Study interview questions used to assess caffeine exposure

Caffeinated beverages

  • The next questions are about caffeine. We will be asking you about your average use of coffee, tea, and soda during the year before you became pregnant.

  • How many cups of caffeinated or regular coffee did you usually drink?Footnote 1

  • How many cups of caffeinated or regular tea did you usually drink? (see footnote 1)

  • Did you drink sodas or soft drinks?

    • What brand(s) or types did you usually drink?

    • Is (brand) diet?

    • Is (brand) caffeine free?

    • How many cans/glasses/bottles of (brand) did you usually drink? (see footnote 1)

  • When you were pregnant with … did you drink more, the same, less, or no caffeinated coffee?

  • When you were pregnant with … did you drink more, the same, less, or no caffeinated tea?

  • When you were pregnant with … did you drink more, the same, less, or no caffeinated sodas?

Chocolate

As part of the dietary assessment based on a modified Willett food frequency questionnaire [68], subjects were asked the average frequency of use of food items, including chocolate (1 oz) during the year prior to pregnancy (see footnote 1).

Medications

Subjects were asked about medication use in general and in relation to specific medical conditions: diabetes, high blood pressure, epilepsy, respiratory illnesses, bladder infections, fevers, and other diseases. For each medication reported, subjects were asked about timing and frequency of use.

Appendix 2: Counts and crude odds ratios (cORs) for maternal total caffeine and caffeinated beverage intake and small for gestational age (SGA) status among control infants, National Birth Defects Prevention Study, 1997–2007

 

Crude models

SGA

Non-SGA

cOR

95 % CIa

N

%

N

%

Total

648

8.2

7,295

91.8

  

Total caffeine intake (mg/day)*

 < 10

100

15.4

1,314

18.0

1.00

Referent

 10 to <100

202

31.2

2,640

36.2

1.01

0.78–1.29

 100 to <200

156

24.1

1,676

23.0

1.22

0.94–1.59

 200 to <300

90

13.9

899

12.3

1.32

0.98–1.77

 300+

100

15.4

766

10.5

1.72

1.28–2.30

Tea intake (servings)*

 0 to <1/month

332

51.2

3,954

54.2

1.00

Referent

 1/mo–6/wk

161

24.8

2,045

28.0

0.94

0.77–1.14

 1–2/day

99

15.3

1,002

13.8

1.18

0.93–1.49

 3+/day

56

8.6

294

4.0

2.27

1.67–3.08

Soda intake (servings)*

 0 to <1/month

200

30.9

2,505

34.3

1.00

Referent

 1/mo–6/wk

157

24.2

1,902

26.1

1.03

0.83–1.28

 1–2/day

174

26.8

1,850

25.4

1.18

0.95–1.46

 3+/day

117

18.1

1,038

14.2

1.41

1.11–1.79

Coffee intake (servings)*

 0 to < 1/month

327

50.5

4,010

55.0

1.00

Referent

 1/mo–6/wk

94

14.5

1,084

14.9

1.06

0.84–1.35

 1/day

111

17.1

1,070

14.7

1.27

1.02–1.59

 2/day

63

9.7

639

8.8

1.21

0.91–1.60

 3+/day

53

8.2

492

6.7

1.32

0.97–1.79

  1. Note Significant cORs and corresponding CIs bolded at the p < 0.05 level
  2. Excluded subjects missing data for specific beverage types, gestational age, birth weight, multiple birth, diagnosed with preconceptional type I/II diabetes, or categorized as too big or small according to growth curve criteria [36, 37]
  3. * Test for trend significant (p ≤ 0.05)
  4. a CI confidence interval

Appendix 3: Counts and adjusted odds ratios (aOR) for maternal total caffeine intake and small for gestational age (SGA) status among control infants, cross-classified by maternal smoking status, National Birth Defects Prevention Study, 1997–2007

Total caffeine intake (mg/day)

SGA

Non-SGA

aORa

95 % CIb

ICRc

95 % CIb

N

%

N

%

No smokingd

 <10

95

14.8

1,236

17.1

1.00

Referent

0.07

−0.03 to 0.16

 10 to <100

171

26.5

2,290

31.6

0.94

0.73–1.23

  

 100 to <200

130

20.2

1,352

18.7

1.21

0.92–1.60

  

 200 to <300

60

9.3

660

9.1

1.18

0.84–1.66

  

 300+

40

6.2

421

5.8

1.24

0.84–1.82

  

Smokingd

 <10

4

0.6

68

0.9

0.50

0.17–1.47

  

 10 to <100

30

4.7

336

4.6

0.77

0.44–1.34

  

 100 to <200

26

4.0

310

4.3

0.72

0.40–1.29

  

 200 to <300

28

4.4

236

3.3

1.01

0.56–1.82

  

 300+

60

9.3

339

4.7

1.40

0.79–2.48

  
  1. Excluded subjects missing data for specific beverage types, gestational age, birth weight, multiple birth, diagnosed with preconceptional type I/II diabetes, or categorized as too big or small according to growth curve criteria [36, 37]
  2. aAdjusted for maternal education, high blood pressure during the index pregnancy, and cigarettes smoked per day
  3. b CI confidence interval
  4. c ICR interaction contrast ratio
  5. dMaternal smoking during the period from 1 month prepregnancy through the third month of pregnancy

Appendix 4: Counts and adjusted odds ratios (aOR) for maternal tea intake and small for gestational age (SGA) status among control infants, cross-classified by maternal smoking status, National Birth Defects Prevention Study, 1997–2007

Tea intake (servings)

SGA

Non-SGA

aORa

95 % CIb

ICRc

95 % CIb

N

%

N

%

No smokingd

        

 0 to < 1/month

274

42.6

3,301

45.5

1.00

Referent

0.11

−0.02 to 0.23

 1/mo–6/wk

126

19.6

1,674

23.1

0.92

0.74–1.15

  

 1–2/day

66

10.3

797

11.0

1.00

0.75–1.32

  

 3+/day

30

4.7

187

2.6

1.86

1.24–2.79

  

Smokingd

 0 to < 1/month

55

8.5

631

8.7

0.63

0.38–1.03

  

 1/mo–6/wk

35

5.4

363

5.0

0.73

0.43–1.23

  

 1–2/day

33

5.1

191

2.6

1.22

0.70–2.13

  

 3+/day

25

3.9

104

1.4

1.54

0.82–2.90

  
  1. Note Significant aORs and corresponding CIs bolded at the p < 0.05 level
  2. Excluded subjects missing data for specific beverage types, gestational age, birth weight, multiple birth, diagnosed with preconceptional type I/II diabetes, or categorized as too big or small according to growth curve criteria [36, 37]
  3. aAdjusted for maternal education, high blood pressure during the index pregnancy, and cigarettes smoked per day
  4. b CI confidence interval
  5. c ICR interaction contrast ratio
  6. dMaternal smoking during the period from 1 month prepregnancy through the third month of pregnancy

Appendix 5: Counts and adjusted odds ratios (aOR) for maternal soda intake and small for gestational age (SGA) status among control infants, cross-classified by maternal smoking status, National Birth Defects Prevention Study, 1997–2007

Soda intake (servings)

SGA

Non-SGA

aORa

95 % CIb

ICRc

95 % CIb

N

%

N

%

No smokingd

        

 0 to < 1/month

166

25.8

2,221

30.6

1.00

Referent

−0.01

−0.20 to 0.11

 1/mo–6/wk

139

21.6

1,654

22.8

1.11

0.88–1.40

  

 1–2/day

135

21.0

1,456

20.1

1.17

0.92–1.49

  

 3+/day

56

8.7

628

8.7

1.09

0.79–1.50

  

Smokingd

 0 to < 1/month

33

5.1

265

3.7

1.01

0.58–1.73

  

 1/mo–6/wk

18

2.8

241

3.3

0.62

0.33–1.16

  

 1–2/day

37

5.8

383

5.3

0.76

0.45–1.30

  

 3+/day

60

9.3

400

5.5

1.06

0.62–1.81

  
  1. Excluded subjects missing data for specific beverage types, gestational age, birth weight, multiple birth, diagnosed with preconceptional type I/II diabetes, or categorized as too big or small according to growth curve criteria [36, 37]
  2. aAdjusted for maternal education, high blood pressure during the index pregnancy, and cigarettes smoked per day
  3. b CI confidence interval
  4. c ICR interaction contrast ratio
  5. dMaternal smoking during the period from 1 month prepregnancy through the third month of pregnancy

Appendix 6: Counts and adjusted odds ratios (aOR) for maternal coffee intake and small for gestational age (SGA) status among control infants, cross-classified by maternal smoking status, National Birth Defects Prevention Study, 1997–2007

Coffee intake (servings)

SGA

Non-SGA

aORa

95 % CIb

ICRc

95 % CIb

N

%

N

%

No smokingd

        

 0 to < 1/month

263

40.8

3,407

47.0

1.00

Referent

0.02

−0.09 to 0.10

 1/mo–6/wk

81

12.6

908

12.5

1.13

0.87–1.47

  

 1/day

90

14.0

884

12.2

1.32

1.03–1.70

  

 2/day

41

6.4

482

6.7

1.19

0.84–1.68

  

 3+/day

21

3.3

278

3.8

1.05

0.66–1.66

  

Smokingd

        

 0 to < 1/month

60

9.3

570

7.9

0.78

0.48–1.28

  

 1/mo–6/wk

13

2.0

174

2.4

0.59

0.30–1.17

  

 1/day

21

3.3

179

2.5

0.97

0.54–1.73

  

 2/day

22

3.4

154

2.1

1.13

0.61–2.11

  

 3+/day

32

5.0

212

2.9

0.93

0.47–1.83

  
  1. Excluded subjects missing data for specific beverage types, gestational age, birth weight, multiple birth, diagnosed with preconceptional type I/II diabetes, or categorized as too big or small according to growth curve criteria [36, 37]
  2. aAdjusted for maternal education, high blood pressure during the index pregnancy, and cigarettes smoked per day
  3. b CI confidence interval
  4. c ICR interaction contrast ratio
  5. dMaternal smoking during the period from 1 month prepregnancy through the third month of pregnancy

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Hoyt, A.T., Browne, M., Richardson, S. et al. Maternal Caffeine Consumption and Small for Gestational Age Births: Results from a Population-Based Case–Control Study. Matern Child Health J 18, 1540–1551 (2014). https://doi.org/10.1007/s10995-013-1397-4

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