Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study
Abstract
:1. Introduction
- Caffeine use in each trimester, taking into account point of pregnancy awareness;
- Guideline adherence trajectories (abstinent, within the guideline, exceeding the guideline) across pregnancy;
- Maternal characteristics associated with guideline adherence trajectories; and
- Associations between exceeding the guideline (within each trimester and across pregnancy) with growth restriction at birth.
2. Materials and Methods
2.1. Participants and Procedure
2.2. Measures
2.2.1. Exposure Variables
Maternal Caffeine Use
2.2.2. Outcome Variables
Infant Characteristics/Birth Outcomes
2.2.3. Potential Confounding Variables
Socio-Demographics
Characteristics of Pregnancy
Substance Use and Health
2.3. Data Analysis
3. Results
3.1. Participants
3.2. Maternal and Infant Characteristics
3.3. Caffeine Consumption
3.4. Guideline Adherence Trajectories
3.5. Correlates of Guideline Adherence Trajectory
3.6. Association between Guideline Adherence and Birth Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Outcome | Trimester 1 (Pre-Pregnancy Awareness) | Trimester 1 (Post-Pregnancy Awareness) | Trimester 2 | Trimester 3 |
---|---|---|---|---|
Used any caffeine % (n) | 89 (1091) | 68 (834) | 79 (976) | 80 (980) |
Of those who used caffeine: | ||||
Median typical caffeine intake per consumption day (IQR) | 107 (60–147) | 60 (40–107) | 80 (40–107) | 80 (40–107) |
3+ days a week % (n) | 88 (962) | 74 (616) | 74 (723) | 82 (802) |
Median maximal caffeine intake per consumption day (IQR) | 187 (120–242) | 120 (80–187) | 120 (83.5–187) | 132 (80–200) |
3+ days a week % (n) | 27 (139) | 25 (59) | 22 (72) | 23 (85) |
Typical or maximal caffeine intake exceeds guideline % (n) | 30 (325) | 10 (82) | 4 (35) | 5 (50) |
Typical intake exceeds guideline (>200 mg in a day) % (n) | 16 (170) | 4 (36) | 8 (78) | 9 (92) |
Maximal intake exceeds guideline (>200 mg in a day) % (n) | 22 (236) | 7 (54) | 11 (102) | 13 (125) |
Fit Indices | AIC | BIC | SSaBIC | Entropy | Adjusted LRT | p | 1 Class | 2 Class | 3 Class | 4 Class |
---|---|---|---|---|---|---|---|---|---|---|
1 class | 8523.21 | 8538.56 | 8529.03 | - | - | - | 1.00 | - | - | - |
2 class | 7764.07 | 7794.77 | 7775.71 | 0.800 | 730.91 | <0.001 | 0.22 | 0.78 | - | - |
3 class | 7480.06 | 7526.11 | 7497.52 | 0.822 | 277.03 | <0.001 | 0.22 | 0.70 | 0.08 | - |
4 class | 7407.18 | 7468.58 | 7430.46 | 0.871 | 75.35 | 0.113 | 0.11 | 0.05 | 0.74 | 0.10 |
Total Sample (
n = 1232) % (n) | A. Low Consumption Group
(n = 266) % (n) | B. Within Guideline Group
(n = 866) % (n) | C. Decreasing Heavy Use Group
(n = 100) % (n) | B vs. A (ref)
RRR (95% CI) | C vs. A (ref)
RRR (95% CI) | |
---|---|---|---|---|---|---|
Socio-Demographics | ||||||
Age (at birth; M, IQR) | 33 (29–36) | 32.5 (29–36) | 33 (29–36) | 33 (30–36) | 1.01 (0.98–1.04), p = 0.419 | 1.03 (0.99–1.08), p = 0.161 |
SES (T3) | ||||||
Low/Moderate | 36 (444) | 39 (103) | 36 (309) | 32 (32) | - | - |
High | 64 (788) | 61 (163) | 64 (557) | 68 (68) | 1.14 (0.86–1.51), p = 0.368 | 1.34 (0.83–2.19), p = 0.236 |
Country of birth (T3) | ||||||
Australia | 56 (690) | 51 (136) | 57 (494) | 60 (60) | - | - |
Other English-speaking | 19 (235) | 17 (46) | 19 (164) | 25 (25) | 0.98 (0.67–1.43), p = 0.923 | 1.23 (0.69–2.19), p = 0.476 |
NESB | 25 (306) | 32 (84) | 24 (207) | 15 (15) | 0.68 (0.49–0.93), p = 0.016 | 0.41 (0.22–0.76), p = 0.005 |
Employment (T3) | ||||||
Not in paid employment | 32 (398) | 32 (84) | 32 (274) | 40 (40) | - | - |
Paid employment (including self-employ) | 68 (833) | 68 (182) | 68 (591) | 60 (60) | 1.00 (0.74–1.34), p = 0.976 | 0.69 (0.43–1.12), p = 0.130 |
University Qualification (T3) | ||||||
No | 34 (421) | 30 (79) | 35 (302) | 40 (40) | - | - |
Yes | 66 (810) | 70 (187) | 65 (563) | 60 (60) | 0.79 (0.59–1.06), p = 0.116 | 0.63 (0.39–1.02), p = 0.062 |
Living with partner (T3) | ||||||
No | 7 (90) | 6 (15) | 8 (65) | 10 (10) | - | - |
Yes | 93 (1142) | 94 (251) | 93 (801) | 90 (90) | 0.74 (0.41–1.31), p = 0.300 | 0.54 (0.23–1.24), p = 0.146 |
Pregnancy Characteristics | ||||||
Parity (T3) | ||||||
0 | 57 (703) | 67 (178) | 55 (479) | 46 (46) | - | - |
≥1 previous children carried full-term | 43 (527) | 33 (88) | 45 (385) | 54 (54) | 1.63 (1.22–2.17), p = 0.001 | 2.38 (1.49–3.80), p < 0.001 |
Pregnancy planned (T3) | ||||||
No | 22 (273) | 17 (44) | 23 (199) | 30 (30) | - | - |
Yes | 78 (958) | 84 (222) | 77 (666) | 70 (70) | 0.66 (0.46–0.95), p = 0.025 | 0.46 (0.27–0.79), p = 0.005 |
Fertility Problems (T3) | ||||||
No | 92 (1103) | 88 (227) | 93 (783) | 95 (93) | - | - |
Yes | 8 (94) | 12 (30) | 7 (59) | 5 (5) | 0.57 (0.36–0.91), p = 0.018 | 0.41 (0.15–1.08), p = 0.071 |
Substance Use | ||||||
Tobacco use during pregnancy (T1–T3) | ||||||
No | 84 (1028) | 94 (251) | 82 (709) | 68 (68) | - | - |
Yes | 17 (203) | 6 (15) | 18 (156) | 32 (32) | 3.68 (2.13–6.38), p < 0.001 | 7.88 (4.03–15.38), p < 0.001 |
Alcohol use during pregnancy (T1–T3) | ||||||
No | 32 (391) | 49 (131) | 29 (247) | 13 (13) | - | - |
Yes | 68 (841) | 51 (135) | 72 (619) | 87 (87) | 2.43 (1.83–3.22), p < 0.001 | 6.49 (3.46–12.20), p < 0.001 |
Illicit drug use during pregnancy (T1–T3) | ||||||
No | 94 (1151) | 96 (254) | 94 (808) | 89 (89) | - | - |
Yes | 6 (77) | 4 (11) | 6 (55) | 11 (11) | 1.57 (0.81–3.05), p = 0.181 | 2.85 (1.20–6.81), p = 0.018 |
Health | ||||||
Pre-pregnancy body mass index (T1; M, IQR) | 22.7 (20.5–26.0) | 22.5 (20.2–25.9) | 22.7 (20.5–26.0) | 23.6 (21.7–28.0) | 1.01 (0.98–1.03), p = 0.598 | 1.06 (1.02–1.10), p = 0.004 |
Anxiety elevated (T1) | ||||||
No | 89 (1091) | 88 (233) | 89 (767) | 91 (91) | - | - |
Yes | 11 (138) | 12 (33) | 11 (96) | 9 (9) | 0.88 (0.58–1.35), p = 0.884 | 0.70 (0.32–1.52), p = 0.698 |
Stress elevated (T1) | ||||||
No | 90 (1104) | 92 (245) | 90 (772) | 87 (87) | - | - |
Yes | 10 (124) | 8 (21) | 10 (90) | 13 (13) | 1.36 (0.83–2.23), p = 0.224 | 1.74 (0.84–3.63), p = 0.138 |
Depression elevated (T1) | ||||||
No | 81 (992) | 82 (218) | 81 (695) | 79 (79) | - | - |
Yes | 19 (234) | 18 (47) | 19 (166) | 21 (21) | 1.11 (0.78–1.58), p = 0.575 | 1.23 (0.69–2.19), p = 0.476 |
Models a | Birth Weight (Grams) b (n = 1155) | SGA c (n = 1155) | Head Circumference (cm) b (n = 1012) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Step 1 (Unadjusted) | Step 2 (Adjusted) | Step 3 (Adjusted) | Step 1 (Unadjusted) | Step 2 (Adjusted) d | Step 3 (Adjusted) d | Step 1 (Unadjusted) | Step 2 (Adjusted) | Step 3 (Adjusted) | ||||||||||
b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | b (SE) | p | |
T1 Pre-Awareness | R2 = 0.001 | R2 = 0.035 | R2 = 0.083 | R2 = 0.001 | R2 = 0.021 | R2 = 0.056 | ||||||||||||
Abstinent | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Within | −41.55 (49.61) | 0.402 | −48.93 (48.21) | 0.310 | −86.79 (48.63) | 0.075 | 0.29 (0.34) | 0.385 | 0.33 (0.33) | 0.324 | 0.35 (0.34) | 0.304 | −0.14 (0.16) | 0.380 | −0.14 (0.16) | 0.383 | −0.21 (0.16) | 0.186 |
In excess | −56.84 (53.75) | 0.291 | −68.58 (52.72) | 0.149 | −143.16 (55.95) | 0.011 | 0.15 (0.37) | 0.696 | 0.20 (0.37) | 0.585 | 0.27 (0.40) | 0.502 | −0.11 (0.17) | 0.510 | −0.12 (0.17) | 0.476 | −0.31 (0.18) | 0.089 |
T1 Post-Awareness | R2 = 0.001 | R2 = 0.034 | R2 = 0.080 | R2 = 0.001 | R2 = 0.021 | R2 = 0.054 | ||||||||||||
Abstinent | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Within | −6.20 (33.42) | 0.853 | −10.25 (32.71) | 0.754 | −27.69 (32.93) | 0.401 | 0.04 (0.22) | 0.864 | 0.08 (0.21) | 0.731 | 0.08 (0.22) | 0.727 | −0.08 (0.13) | 0.517 | −0.07 (0.13) | 0.601 | −0.08 (0.13) | 0.517 |
In excess | −57.40 (70.38) | 0.415 | −69.55 (70.02) | 0.321 | −128.71 (69.04) | 0.063 | 0.30 (0.38) | 0.429 | 0.35 (0.38) | 0.355 | 0.41 (0.41) | 0.319 | 0.07 (0.24) | 0.774 | 0.06 (0.25) | 0.815 | −0.08 (0.25) | 0.754 |
T2 | R2 = 0.003 | R2 = 0.036 | R2 = 0.081 | R2 < 0.001 | R2 = 0.021 | R2 = 0.055 | ||||||||||||
Abstinent | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Within | 56.57 (39.04) | 0.148 | 52,96 (38.47) | 0.169 | 23.76 (38.75) | 0.540 | −0.14 (0.24) | 0.562 | −0.11 (0.23) | 0.642 | −0.04 (0.25) | 0.861 | −0.08 (0.16) | 0.596 | −0.07 (0.16) | 0.641 | −0.13 (0.18) | 0.397 |
In excess | −16.72 (58.80) | 0.776 | −28.48 (58.40) | 0.626 | −96.45 (60.70) | 0.112 | −0.09 (0.39) | 0.812 | −0.04 (0.39) | 0.928 | 0.06 (0.42) | 0.889 | −0.11 (0.22) | 0.626 | −0.13 (0.22) | 0.539 | −0.31 (0.24) | 0.169 |
T3 | R2 = 0.008 | R2 = 0.039 | R2 = 0.080 | R2 = 0.001 | R2 = 0.035 | R2 = 0.083 | ||||||||||||
Abstinent | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Within | 66.17 (38.28) | 0.084 | 63.05 (37.56) | 0.094 | 38.70 (37.45) | 0.302 | −0.24 (0.23) | 0.315 | −0.21 (0.24) | 0.362 | −0.15 (0.25) | 0.537 | −0.03 (0.15) | 0.821 | 0.04 (0.15) | 0.813 | −0.01 (0.15) | 0.951 |
In excess | 179.47 (52.13) | 0.001 | 155.58 (52.76) | 0.003 | 107.83 (53.20) | 0.043 | −0.54 (0.40) | 0.177 | −0.44 (0.41) | 0.275 | −0.37 (0.41) | 0.365 | 0.13 (0.18) | 0.472 | 0.11 (0.19) | 0.574 | 0.01 (0.20) | 0.977 |
Trajectory Group | R2 = 0.002 | R2 = 0.035 | R2 = 0.081 | R2 = 0.001 | R2 = 0.021 | R2 = 0.056 | ||||||||||||
Low Consumption group | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Within Guideline group | 40.84 (38.63) | 0.291 | 34.88 (37.66) | 0.354 | −1.35 (38.08) | 0.972 | −0.02 (0.24) | 0.926 | 0.03 (0.24) | 0.907 | 0.09 (0.25) | 0.718 | −0.11 (0.15) | 0.458 | −0.10 (0.15) | 0.53 | −0.18 (0.17) | 0.241 |
Decreasing Heavy Use group | −29.86 (65.27) | 0.647 | −41.28 (65.20) | 0.527 | −120.04 (65.11) | 0.065 | −0.24 (0.42) | 0.580 | −0.16 (0.42) | 0.715 | −0.04 (0.44) | 0.938 | −0.15 (0.21) | 0.469 | −0.15 (0.21) | 0.471 | −0.38 (0.22) | 0.086 |
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Peacock, A.; Hutchinson, D.; Wilson, J.; McCormack, C.; Bruno, R.; Olsson, C.A.; Allsop, S.; Elliott, E.; Burns, L.; Mattick, R.P. Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study. Nutrients 2018, 10, 319. https://doi.org/10.3390/nu10030319
Peacock A, Hutchinson D, Wilson J, McCormack C, Bruno R, Olsson CA, Allsop S, Elliott E, Burns L, Mattick RP. Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study. Nutrients. 2018; 10(3):319. https://doi.org/10.3390/nu10030319
Chicago/Turabian StylePeacock, Amy, Delyse Hutchinson, Judy Wilson, Clare McCormack, Raimondo Bruno, Craig A. Olsson, Steve Allsop, Elizabeth Elliott, Lucinda Burns, and Richard P. Mattick. 2018. "Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study" Nutrients 10, no. 3: 319. https://doi.org/10.3390/nu10030319
APA StylePeacock, A., Hutchinson, D., Wilson, J., McCormack, C., Bruno, R., Olsson, C. A., Allsop, S., Elliott, E., Burns, L., & Mattick, R. P. (2018). Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study. Nutrients, 10(3), 319. https://doi.org/10.3390/nu10030319