High doses of daily caffeine during pregnancy — whether from coffee, tea, soda or hot chocolate — cause an increased risk of miscarriage.
A study conducted by the Kaiser Permanente Division of Research for the first time controlled pregnancy-related symptoms of nausea, vomiting and caffeine aversion that tended to interfere with the determination of caffeine’s true effect on miscarriage risk. The research appears in the current online issue of American Journal of Obstetrics and Gynecology.
While previous research showed a link between caffeine consumption and miscarriage, this was the first study to control for morning sickness, which typically causes many women to avoid caffeine, explained Dr. De-Kun Li, an investigator with the Kaiser Permanente Division of Research and lead investigator.
The study, which looked at 1,063 pregnant Kaiser Permanente members in San Francisco from October 1996 through October 1998, examined the caffeine effect among women who never changed their pattern of caffeine consumption during their pregnancies.
Women who consumed 200 mg or more of caffeine each day (two or more cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as women who consumed no caffeine, Li said.
Women who consumed less than 200 mg of caffeine daily had more than 40 percent increased risk of miscarriage.
The increased risk of miscarriage appeared to be because of caffeine, rather than other chemicals in coffee, because caffeine intake from non-coffee sources such as soda, tea and hot chocolate showed a similar increased risk of miscarriage.
“The main message for pregnant women from these findings is that they probably should consider stopping caffeine consumption during pregnancy because this research provides clearer and stronger evidence that high doses of caffeine intake during pregnancy can increase the risk of miscarriage,” Li said.
The reasons why caffeine can harm a fetus have been suspected for some time. Caffeine crosses through the placenta to the fetus, but can be difficult for the fetus to metabolize.
Caffeine also might influence cell development and decrease placental blood flow, which could lead to an adverse effect on fetal development.
Women in the study were asked about their intake of caffeinated beverages as well as the type of their drinks, timing of initial drinks, the frequency and amount of intake and whether they had changed consumption patterns since becoming pregnant.
Sources of caffeine included coffee, tea, caffeinated soda and hot chocolate.
Overall, 172 women in the study (16.18 percent) miscarried. While 264 women (25 percent) reported no consumption of any caffeine-containing beverages during pregnancy, 635 women (60 percent) reported up to 200 mg of caffeine intake per day, and 164 women (15 percent) had 200 mg or more of daily caffeine consumption.
Critics had maintained that the association was not so much a high dose of caffeine intake that increased the risk of miscarriage, but that women with a healthy pregnancy are more likely (than those about to miscarry), to reduce their caffeine intake because of nausea, vomiting and aversion to caffeine, Li said.
“Therefore, the critics claimed that the observed association was a result of reduction of caffeine intake by healthy pregnant women,” he said.
So what’s a fatigued mom-to-be supposed to do for her daily energy jolt?
“If you definitely need caffeine to get you going, try keeping it to one cup or less a day,” said Tracy Flanagan, director of Women’s Health, Kaiser Permanente Northern California. “Learn to perk up instead with natural energy boosts like a brisk walk, yoga stretches, snacking on dried fruits and nuts.”
A Colorado Springs call center has earned the J.D. Power and Associates Call Center Certification for customer service.
TriWest was one of seven call centers in the military contractor’s western region to receive the award.
J.D. Power and Associates measures call center effectiveness based on recruiting, training, employee incentives, management roles and responsibilities, performance standards and quality assurance.
TriWest, a Department of Defense contractor, is the administrator of the military’s health care program, Tricare, which serves 2.9 million beneficiaries in 21 western states.
Amy Gillentine covers health care for the Colorado Springs Business Journal.