Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study

Objective: To examine the association of maternal caffeine intake with fetal growth restriction. Design Prospective longitudinal observational study. Setting: Two large UK hospital maternity units. Participants: 2635 low risk pregnant women recruited between 8-12 weeks of pregnancy. Investigations: Quantification of total caffeine intake from 4 weeks before conception and throughout pregnancy was undertaken with a validated caffeine assessment tool. Caffeine half life (proxy for clearance) was determined by measuring caffeine in saliva after a caffeine challenge. Smoking and alcohol were assessed by self reported status and by measuring salivary cotinine concentrations. Main outcome measures: Fetal growth restriction, as defined by customised birth weight centile, adjusted for alcohol intake and salivary cotinine concentrations. Results: Caffeine consumption throughout pregnancy was associated with an increased risk of fetal growth restriction (odds ratios 1.2 (95% CI 0.9 to 1.6) for 100-199 mg/day, 1.5 (1.1 to 2.1) for 200-299 mg/day, and 1.4 (1.0 to 2.0) for >300 mg/day compared with <100 mg/day; test for trend P<0.001). Mean caffeine consumption decreased in the first trimester and increased in the third. The association between caffeine and fetal growth restriction was stronger in women with a faster compared to a slower caffeine clearance (test for interaction, P=0.06). Conclusions: Caffeine consumption during pregnancy was associated with an increased risk of fetal growth restriction and this association continued throughout pregnancy. Sensible advice would be to reduce caffeine intake before conception and throughout pregnancy

Core outcomes in gestational diabetes for treatment trials: The Gestational Metabolic Group treatment set

Aims With the rising number of outcomes being reported following gestational diabetes (GDM), the outcomes in existing studies vary widely making it challenging to compare and contrast the effectiveness of different interventions for GDM. The purpose of this study was to develop a core outcome and measurement set (COS) for GDM treatment trials. Materials & Methods A Delphi study with structured consultation with stakeholders and discussion within a specialist Gestational Metabolic Group (GEM) were combined with a comprehensive systematic search across different databases (PubMed, Cochrane Library, and Embase). Several Delphi rounds over 2 years were conducted culminating in this report. Results The process resulted in a targeted set of outcomes constituting a “GEM treatment set” aligned with expert opinion. The final COS also included a measurement set for the 11 important clinical outcomes from three major domains: maternal metabolic, fetal, and pregnancy related. Conclusions Based on the results of this study, it is recommended that future clinical trials on GDM report outcomes uniformly keeping to the recommended COS outcomes.Members of the GEM Group who did not qualify for authorship but who contributed to the QMI meetings include: Maha Abdulla H I Al?Asmakh, PhD, Department of Biomedical Sciences, Qatar University. Stephen Atkin, Professor of Medicine; Weill Cornell Medicine?Qatar; Senior Consultant in Endocrinology, Hamad Medical Corporation, Doha, Qatar. Ilham Bettahi, PhD, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar. Odette Chagoury, PhD, Associate Director Clinical Research at Weill Cornell Medicine, Doha, Qatar. Tarik El Hadd, MD, Department of Endocrinology, Qatar Metabolic Institute, Hamad Medical Corporation (Hamad Teaching Hospital), Doha, Qatar. Ibrahim M. Ibrahim, MD, Endocrine Department, Sidra Medicine, Doha, Qatar. Gianfranco Pintus, PhD, College of Health Sciences, Qatar University, Doha, Qatar. Manjunath Ramanjaneya, BPharm, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar. Hiba Mahmoud Hassan Satti, MD, Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar. Hessa Ibrahim Shahbic, MD, Assistant Director of Women's Health Clinical Affairs Department, Primary Health Care Corporation, Doha, Qatar. Fatin Taha, MD, Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar. Shahrad Taheri, BSc, MSc, MBBS, PhD, FRCP; Professor of Medicine; Weill Cornell Medicine?Qatar Senior Consultant in Endocrinology, Hamad Medical Corporation, Doha, Qatar. This study was made possible by program grant NPRP 10?0129?170274 from Qatar National Research Fund (a member of Qatar Foundation) to Suhail A. Doi. The findings herein reflect the work and are solely the responsibility of the authors. Open Access funding provided by the Qatar National Library.Scopu

What's so bad about teenage pregnancy?

A systematic literature review identified the most frequently cited medical consequences of teenage pregnancy as anaemia, pregnancy-induced hypertension, low birth weight, prematurity, intra-uterine growth retardation and neonatal mortality. Critical appraisal suggested that increased risks of these outcomes were predominantly caused by the social, economic, and behavioural factors that predispose some young women to pregnancy. Maternal age less than 16 years was associated with a modest (1.2-2.7 fold) increase in prematurity, low birth weight and neonatal death