咖啡因摄入量与孕早期自然流产风险

Caffeine intake and the risk of first-trimester spontaneous abortion.

作者信息

Cnattingius S, Signorello L B, Annerén G, Clausson B, Ekbom A, Ljunger E, Blot W J, McLaughlin J K, Petersson G, Rane A, Granath F

机构信息

Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden.

出版信息

N Engl J Med. 2000 Dec 21;343(25):1839-45. doi: 10.1056/NEJM200012213432503.

DOI:10.1056/NEJM200012213432503

PMID:11117975

Abstract

BACKGROUND

Some epidemiologic studies have suggested that the ingestion of caffeine increases the risk of spontaneous abortion, but the results have been inconsistent.

METHODS

We performed a population-based, case-control study of early spontaneous abortion in Uppsala County, Sweden. The subjects were 562 women who had spontaneous abortion at 6 to 12 completed weeks of gestation (the case patients) and 953 women who did not have spontaneous abortion and were matched to the case patients according to the week of gestation (controls). Information on the ingestion of caffeine was obtained from in-person interviews. Plasma cotinine was measured as an indicator of cigarette smoking, and fetal karyotypes were determined from tissue samples. Multivariate analysis was used to estimate the relative risks associated with caffeine ingestion after adjustment for smoking and symptoms of pregnancy such as nausea, vomiting, and tiredness.

RESULTS

Among nonsmokers, more spontaneous abortions occurred in women who ingested at least 100 mg of caffeine per day than in women who ingested less than 100 mg per day, with the increase in risk related to the amount ingested (100 to 299 mg per day: odds ratio, 1.3; 95 percent confidence interval, 0.9 to 1.8; 300 to 499 mg per day: odds ratio, 1.4; 95 percent confidence interval, 0.9 to 2.0; and 500 mg or more per day: odds ratio, 2.2; 95 percent confidence interval, 1.3 to 3.8). Among smokers, caffeine ingestion was not associated with an excess risk of spontaneous abortion. When the analyses were stratified according to the results of karyotyping, the ingestion of moderate or high levels of caffeine was found to be associated with an excess risk of spontaneous abortion when the fetus had a normal or unknown karyotype but not when the fetal karyotype was abnormal.

CONCLUSIONS

The ingestion of caffeine may increase the risk of an early spontaneous abortion among non-smoking women carrying fetuses with normal karyotypes.

摘要

背景

一些流行病学研究表明，摄入咖啡因会增加自然流产的风险，但结果并不一致。

方法

我们在瑞典乌普萨拉县进行了一项基于人群的早期自然流产病例对照研究。研究对象为562名在妊娠6至12周自然流产的妇女（病例组）和953名未自然流产且根据孕周与病例组匹配的妇女（对照组）。通过面对面访谈获取咖啡因摄入信息。测定血浆可替宁作为吸烟指标，并从组织样本中确定胎儿核型。多因素分析用于估计在调整吸烟及妊娠症状（如恶心、呕吐和疲劳）后与咖啡因摄入相关的相对风险。

结果

在非吸烟者中，每天摄入至少100毫克咖啡因的妇女比每天摄入少于100毫克咖啡因的妇女自然流产的发生率更高，风险增加与摄入量有关（每天100至299毫克：比值比为1.3；95%置信区间为0.9至1.8；每天300至499毫克：比值比为1.4；95%置信区间为0.9至2.0；每天500毫克或更多：比值比为2.2；95%置信区间为1.3至3.8）。在吸烟者中，咖啡因摄入与自然流产的额外风险无关。根据核型分析结果进行分层分析时，发现当胎儿核型正常或未知时，摄入中度或高水平咖啡因与自然流产的额外风险相关，而当胎儿核型异常时则不然。