European Journal of Obstetrics & Gynecology and Reproductive Biology
Full length articleAssociations between consumption of coffee and caffeinated soft drinks and late stillbirth—Findings from the Midland and North of England stillbirth case-control study
Introduction
Stillbirth is an important public health problem with enduring impact not only in terms of lives lost but also with economic, psychological and social impacts upon affected families. [1,2] One approach to reducing stillbirth is to identify factors associated with increased risk so that their effects may be reduced. Epidemiological studies have identified risk factors for stillbirth, some of which are modifiable (e.g. cigarette smoking, drug misuse) and others which are not (e.g. maternal age, ethnicity) [3].
The Stillbirth Priority Setting Partnership identified a research need to ascertain modifiable risk factors for late stillbirth [4]. The Midland and North of England Stillbirth Study (MiNESS) was a case control study which aimed to identify modifiable risk factors for late stillbirth (≥28 weeks’ gestation) [5]. Due to their ubiquitous consumption, 80 % of the UK population drinks instant coffee and on average 211.5 L of soft drinks (many of which contain high levels of caffeine) were consumed per capita per year [6]. Accordingly, this study included questions about intake of caffeinated drinks and soft drinks during pregnancy. To date, the evidence linking caffeine intake and stillbirth shows variable effect size and some studies focus on coffee consumption rather than consumption of any source of caffeine [[7], [8], [9]]. Presently, the World Health Organisation recommends that high caffeine intake (>300 mg/day) is decreased to reduce the risk of pregnancy loss and the UK National Health Service recommends caffeine intake is <200 mg/day during pregnancy [10]. Given that caffeinated drinks, are widely consumed we aimed to investigate whether there is a relationship between consumption of these beverages and the risk of late stillbirth.
Section snippets
Methods
MiNESS was a prospective case-control study undertaken in 41 secondary and tertiary maternity units in the UK [5]. The methodology has been described in detail previously and was conducted in accordance with the published protocol [5,11]. Following ethical approval (Ref 13/NW/0174) and study registration (NCT02025530) participants were recruited between April 2014 and March 2016. Cases were singleton stillbirths occurring ≥28 weeks’ gestation with no evidence of congenital anomaly. Women who
Results
During the recruitment period, 3490 women were identified as potentially eligible participants for MiNESS (660 cases and 2830 controls, Fig. 1), 760 women could not be contacted (77 cases (11 %), and 683 controls (24 %)) and 1700 women did not consent to participate (287 cases (43 %) and 1413 controls (50 %)). Six participants were excluded after data collection as five stillbirths had previously unidentified congenital abnormalities detected on post-mortem and one control participant had a
Discussion
This study found an association between caffeine intake and late stillbirth; this appears to be mediated through an increased intake of instant coffee, cola and energy drinks in cases compared to controls. Tea consumption, the most widely consumed caffeinated drink (1.44 servings/day in controls) did not differ between cases and controls. Although the majority of participants (54.5 %) reduced their caffeine intake during pregnancy, a small proportion (3%) increased it and over 15 % of cases and
Funding
The Midland and North of England Stillbirth Study was funded by grant GN2156 from Action Medical Research, Cure Kids and Sands. AH receives salary support from Tommy’s. EM and JT were supported by Cure Kids.
Declaration of Competing Interest
All authors declare that they have no competing interests.
Contribution to authorship
AH, TS, BM, DR, EM & LM contributed to all aspects of the study design and obtained funding. AH had overall responsibility for the study. JB coordinated the running of the study. KT and LR analysed the data with input from AH. All authors were responsible for the drafting of the manuscript. All authors gave approval for the final version of the manuscript.
Details of ethical approval
This study was reviewed by NRES Committee North West - Greater Manchester Central Reference (13/NW/0874) on 24th January 2014.
Data sharing statement
No additional data from the MiNESS study are available from a repository. Anonymised data is available on request to the corresponding author.
Acknowledgements
The authors thank all the participants who participated in interviews in order to help us better understand stillbirth. The authors would also like to thank the Principal Investigators, Research Midwives and Nurses at the following institutions for their hard work and dedication to this study: Airedale NHS Foundation Trust, Birmingham Women’s NHS Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust,
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