Caffeine intake during pregnancy and early growth …...Caffeine intake during pregnancy and early...
Transcript of Caffeine intake during pregnancy and early growth …...Caffeine intake during pregnancy and early...
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Caffeine intake during pregnancy and early growth and obesity in childhood
Verena Sengpiel, MD PhD
Jag har ingen jäv-/intressekonflikt att deklarera.
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Bakgrund
CYP 1A2
Livsmedelverket:När man är gravid bör man (…) inte få i sig mer än 300 milligram koffein per dag. Det motsvarar (…) tre kopparkaffe (…).
CYP 1A2CYP 1A2
Adapted from Maltepe et al J.Clin Invest 2
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Bakgrund
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Bakgrund
Neither total nor coffee caffeine was associated with spontaneous PTD risk.
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Bakgrund
Neither total nor coffee caffeine was associated with spontaneous PTD risk.
Caffeine intake from different sources (…) was associated with lower birthweight. Caffeine intake of 200 to 300 mg/day increased the odds for SGA (OR Marsal 1.62, Skjaerven 1.44, Gardosi 1.27, P <0.05), compared to 0 to 50 mg/day.
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Frågeställning
Är mammans koffeinintag under graviditeten relaterat till:
1. barnets tillväxt?
2. barnets risk för övervikt?
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Material & Metoder
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Vecka 17 Vecka 22 Vecka 30 Förlossning
RUL
Barn Födelse-register
NavelsträngsprovPKU test
Moder Födelse-register
Fader
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v17v22
v30
6m
http://www.fhi.no/studier/den-norske-mor-og-barn-undersokelsen
18m36m
5å7å
8å
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v17v22
v30
6m
Mammorna har rapporterat barnets vikt samt längd/höjd för åldrarna: 6 veckor, 3, 5-6, 8 och 15-18 månader samt 2, 3, 5, 7 och 8 års åldern
18m36m
5å7å
8å
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Studiepopulation
• Fullgångna enkelbörd
• Inga missbildningar
• Koffein- , graviditets- och tillväxtdata
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Food frequency questionnaire
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Koffein i olika näringsämnen
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Utfall: tillväxt & övervikt
Tillväxtkurvor baserat på WHO’s: ”Multicenter Growth Reference Study” (www.who.int/childgrowth)
• Weight-for-age z-scores
• “catch-up growth”:ökning av weight-for-age z-score >0.67
• övervikt: BMI >85e percentil
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Rekommenderatkoffeinintag(<200mg/d)
Högtkoffeinintag(200-300mg/d)
Myckethögtkoffeinintag(>300mg/d)
Antalkvinnor(totaln=83705) 74587 6287 2831
Mammansålder(år)<2525-2930-34≥35
11343916
6254227
7223931
FamiljeinkomstBådapartnerlågtEnpartnerhögBådapartnerhögDatasaknas
2641303
2441333
3342214
Mammansutbildning(år)
≤1213-16≥17datasaknas
2942262
3140272
4835152
BMI(kg/m2)<18.518.5-24.925-29.9≥30datasaknas
3642193
3642193
35824124
Graviditetsillamående2atrimJaNej
8912
928
9010
SGA(Marsal)1593(1.9%) 1.8 2.0 3.0
Resultat: studiepopulationen
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Utfall: barnens tillväxt
0
5
10
15
20
25
30
35
födelse 0.5 år 1 år 1.5 år 2 år 3 år 5 år 7 år 8 år
rekommenderat koffein intag
högt koffein intag
mycket högt koffein intag
Vikt (kg)
Ålder (år)
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Utfall: catch-up growth
0
5
10
15
20
25
30
35
40
6 månader 1 år 2 år 3 år 5 år
rekommenderat koffein intag
högt koffein intag
mycket högt koffein intag
%
Ålder
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Utfall: övervikt
0
5
10
15
20
25
6 månader 1 år 2 år 3 år 5 år
rekommenderat koffein intag
högt koffein intag
mycket högt koffein intag
Ålder
%
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Resultat Catch-uptillväxt Övervikt
OR 95%CI OR 95%CI
6månaderrekommenderatkoffeinintag
högtkoffeinintagmyckethögtkoffeinintag
1.00
1.181.24
1.07-1.301.08-1.44
1.00
1.011.14
0.91-1.110.99-1.32
1årrekommenderatkoffeinintaghögtkoffeinintagmyckethögtkoffeinintag
1.001.181.34
1.08-1.291.17-1.52
1.001.041.33
0.94-1.151.16-1.54
2årrekommenderatkoffeinintaghögtkoffeinintagmyckethögtkoffeinintag
1.001.161.27
1.03-1.301.07-1.51
1.001.171.26
1.01-1.341.02-1.55
3årrekommenderatkoffeinintaghögtkoffeinintagmyckethögtkoffeinintag
1.001.251.31
1.13-1.381.12-1.53
1.001.251.26
1.12-1.401.06-1.50
5årrekommenderatkoffeinintaghögtkoffeinintagmyckethögtkoffeinintag
1.001.171.48
1.04-1.321.23-1.78
1.001.311.47
1.15-1.511.19-1.81
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Styrkor & Svagheter
• Stor studiepopulation • Högutbildade överrepresenterat
• Exponering-utfall validitet i MoBa
• Prospektiv datainsamling
• Koffein från olika källor
• Validerat frågeformulär • Inga biologiska markörer
• Justering för många confounders • Ingen RCT: okänd confounding
• Inga data om genetisk uppsättning
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Konklusion
• Koffeinintag under graviditeten är relaterat till tillväxten under barndomen.
• Koffeinintag under graviditeten är relaterat till övervikt i förskoleåldern.
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Tack till alla medförfattarna:
Norwegian Institute of Public Health, Department of Exposure and Risk Assessment, Division of Environmental Medicine, Oslo, Norway: EleniPapadopoulou, Anne Lise Brantsæter, Margaretha Haugen, Helle MargreteMeltzer
Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden: Bo Jacobsson, Jonas Bacelis
Department of Pediatrics, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden: Anders Elfvin
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Tack för uppmärksamheten!
Frågor?
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Google bilder sökning “Verena Sengpiel” 140228
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Koffeinkällor beroende på mängdentotal koffein
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Koffeinintag vid olika tidpunkter
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Exponering