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Open AccessArticle

Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
School of Medicine (Psychology), University of Tasmania, Hobart, TAS 7001, Australia
Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia
Murdoch Children’s Research Institute, Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
Department of Paediatrics, Royal Children’s Hospital, Melbourne University, Melbourne, VIC 3052, Australia
Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, USA
National Drug Research Institute, Curtin University, Perth, WA 6845, Australia
Discipline of Child and Adolescent Health, The University of Sydney, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
Author to whom correspondence should be addressed.
Nutrients 2018, 10(3), 319;
Received: 25 January 2018 / Revised: 24 February 2018 / Accepted: 5 March 2018 / Published: 7 March 2018
(This article belongs to the Special Issue Nutrient Requirements and Dietary Intakes of Women during Pregnancy)
The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births (n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ‘low consumption’ (22%): low probability of any use; ‘within-guideline’ (70%): high probability of guideline adherence; and ‘decreasing heavy use’ (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = −143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted. View Full-Text
Keywords: pregnancy; birth outcomes; birth weight; caffeine; coffee; small for gestational age pregnancy; birth outcomes; birth weight; caffeine; coffee; small for gestational age
MDPI and ACS Style

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.

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