Teratogen+-+Caffeine

__History of Caffeine__
Coffee originates in Ethiopia and was spread through North African and other Eastern areas. Europeans brought it back from Turkey and Arabia. There are various legends of the discovery of coffee, one being about a goat herder named Kaldi, who observed goats being restless at night after grazing on coffee shrubs. Caffeine was first isolated from coffee in the 1820's by a German chemist named Friedlieb Ferdinand Runge. Caffeine is a central nervous system (CNS) stimulate, and is the most generally used behaviorally active drug in the world (Anderson, Juliano, and Schulkin, 2009). Found in over 60 known species of plants, and dietary sources including: coffee, tea, cocoa beverages, chocolate and soft drinks.

__How Caffeine Affects the Body__
A significant amount of research supports that caffeine is a drug of physical dependence (Anderson et al., 2009). When consumed, caffeine is absorbed by the body and is carried through the bloodstream and its levels peak within 30-60 minutes after consumption (Anderson et al., 2009). Caffeine affects the brain and creates elevated moods, lowers fatigue and builds up attention and alertness. It also increases blood flow, respiratory and heart rate. People who are sensitive to caffeine can find that when frequently consumed, tolerance to caffeine builds up. Caffeine can cause, anxiety, nervousness, upset stomach and insomnia. Caffeine can be mildly addictive and some symptoms include: depression, fatigue, headaches, difficulty concentrating, and mood disturbance.

Table 1:

 * ~ ** CAFFEINE ** IN FOODS AND BEVERAGES. ||
 * ~ ** Food/Beverage ** ||~ Caffeine **(milligrams)** ||
 * Coffee ||
 * Espresso coffee, brewed, 8 fluid ounces || 502 ||
 * Coffee, brewed, 8 fluid ounces || 85 ||
 * Coffee, instant, 8 fluid ounces || 62 ||
 * Coffee, brewed, decaffeinated, 8 fluid ounces || 3 ||
 * Coffee, instant, decaffeinated, 8 fluid ounces || 2 ||
 * ** Tea ** ||
 * Tea, brewed, 8 fluid ounces || 47 ||
 * Tea, herbal, brewed, 8 fluid ounces || 0 ||
 * Tea, instant, 8 fluid ounces || 29 ||
 * Tea, brewed, decaffeinated, 8 fluid ounces || 3 ||
 * ** Chocolate Beverages ** ||
 * Hot chocolate, 8 fluid ounces || 5 ||
 * Chocolate milk, 8 fluid ounces || 5 ||
 * ** Soft Drinks ** ||
 * Cola, 12 ounce can || 37 ||
 * Cola, with higher ** caffeine **, 12 ounce can || 100 ||
 * Cola or pepper-type, diet, 12 ounce can || 49 ||
 * Cola or pepper-type, regular or diet, without ** caffeine **, 12 ounce can || 0 ||
 * Lemon-lime soda, regular or diet, 12 ounce can || 0 ||
 * Lemon-lime soda, with ** caffeine **, 12 ounce can || 55 ||
 * Ginger ale, regular or diet, 12 ounce can || 0 ||
 * Root beer, regular or diet, 12 ounce can || 0 ||
 * ** Chocolate ** ||
 * Milk chocolate bar, 1.55 ounces || 9 ||
 * M & M milk chocolate candies, 1.69 ounces || 5 ||
 * Dark chocolate, semisweet, 1 ounce || 20 ||
 * ** source: ** U.S. Department of Agriculture National Nutrient Database for Standard Reference,Release 16 July 2003. ||

__**Psychological Effects of Caffeine**__
There are four caffeine related syndromes:
 * 1) Caffeine Intoxication
 * 2) Caffeine-induced anxiety disorder
 * 3) Caffeine-induced sleep disorder
 * 4) Caffeine related disorder

__Effects of Caffeine on the developing baby__


[] The overall effects of caffeine on the developing baby have been studied and the findings substantial. Caffeine crosses the placental barrier and is distributed toall fetus tissues, including the CNS, allowing the fetus to be exposed to caffeine at levels similar to the mother (Anderson et al., 2009) for this reason, women who are pregnant should be extremely cautious when consuming caffeine. Research has found that caffeine can metabolis three times slower in pregnant women (Anderson, et al., 2009; Luke, 1995). Luke (1995) investigated experiments performed on animlas that showed a relationship between caffeine and birth defects including spontaneous abortion, and lowered birth-weights (Anderson et al, 2009). Consumption of caffeine has also been associated with more stress behaviors in noenates and could affect fetal central nervous system development (Diego, field, Hernanndez-Reif, Vera, Gil, and Gonzalez-Garcia, 2007). Due to these results the FDA (Food and Drug Administration) and the NAS (National Academt of Sciences) have extended a caution to all pregnant women and women who are trying to conceive to limit their intake of caffeine to less than 200-300mg per day (Diego et al., 2007).

__**Caffeine and Spontaneous Abortion**__
Studies have found a link between spontaneous abortions and caffeine intake. In one study over three thousand women reported a 70 percent increase in spontaneous abortions between 8 and 26 weeks' gestation in moderate coffee drinkers compared to non coffee drinkers. Another study reported a two-thirds increase in sponatneous abortions among caffeine drinkers versus non caffeine drinkers. And a third study found a 50 percent higher incidence of spontaneous abortions with heavy coffee consumption (six or more cups per day) (Luke, 1995). Caffeine consumption while pregnant should not exceed 300mg, though some argure it should not exceed 200mg per day (Anderson et al, 2009). This information should warn women that caffeine, although not the most serious teratogen, can have a serious impact on spontaneous abortion.

__Caffeine and its Relationship to Birthweight__
Pregnant women should also be aware of the relationship between caffeine and low birthweight. The majority of studies that have been carried out show that a high consumption of caffeine can lead to a low birthweight in newborns. "The increased risk of low birthweight babies ranfes from 20 percent to more than 460 percent for drinkers of more than three cups of coffee per day" (Luke, 1995, p. 106). When considering the risks of caffeine during pregnancy, women should realize that caffeine has many adverse effects when consumed in high amounts, and perhaps adding decaffinated coffee to their drinks, or diluting their coffee with milk is a step that can be taken to avoid the risks that are evident. For women who consume more than 300 miligrams of caffeine per day (which is the equivalent of around 3 or more 6oz cups of coffee), reports of a higher proportion of babies born below the 10th percentile for weight have been shown. This should be an indicator that caffeine consumption, particularly coffee, does appear to have an effect on birth-weight, especially when taken at higher levels.

Caffeine can also indirectly reduce the birthweight of an infant by decreasing the mother's weight before she becomes pregnant, but also by inhibiting her ability to gain weight during her pregnancy due to the effects that caffeine has on the metabolism. Clinical studies have shown caffeine to have anorectic (appetite-reducing), thermogenic (increase body temperature), and lipoytic (breakdown of body fat) effects in humans, and for these reasons it is frequently a component in weight-reduction medications. Other studies have found that caffeine reduces blood flow to the placenta as well as increasing maternal blood pressure and fetal heart rate, suggesting additional indirect explanations for the reduction in flow to the uterus (Anderson et al, 2009; Diego et al, 2007; Luke, 1995).

The effects that caffeine has on the body are extremely alarming, even for non-pregnant women. To consume caffeine is putting your developing baby at risk, and it is also going to inhibit the blood flow to the uterus and the placenta. For a developing fetus, the transfer of blood through the placenta is extremely important as essential vitamins and nutrients are passed from mother to child through the placenta. If caffeine has been shown to reduce the blood flow to the placenta, this will adversely effect this exchange of nuitrients which is extremely detrimental to the developing baby (Diego et al, 2007).

__Caffeine and its Relationship to Prematurity__
There have been recent studies looking into the effects of caffeine and its relationship with premature births. The overall findings suggest that there is a small association between the two. A study of over 40, 000 women in Canada showed that there was a slight risk for prematurity when 5 to 9 cups of coffee were consumed per day. This number jumped to a 24% increase when 10 or more cupes were consumed per day ( Luke, 1995). A study has also evaulated the relationship between PROM (premature repture of membranes) and coffee intake. PROM is an event that occurs during pregnancy when the sac containing the developing baby and the amniotic fluid bursts or develops a hole prior to the start of labor. "The findings indicated that women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold increased risk of PROM compared to women who drank two cups or less per day; the risk paralleled increasing coffee consumption" (Luke, p.108).

__**What Obstetrician-Gynecologists know about the affects of caffeine?**__
When questioned most Obstetrician-Gynecologists (ob-gyn) indicated that they were not sure what they considered to be a "healthy daily intake" of caffeine for non-pregnant women. Additionally many ob-gyns were unaware that caffeine significantly slows metabolism as pregnancy progresses, and that as little as 100mg of caffeine per day can produce withdrawal symptoms upon abstinence (Anderson et al., 2009).

__Sources:__
Anderson, B., Juliano, L., and Schulkin, J. (2009). Caffeine's implications for women's health and survey of obstetrician- gynecologists' caffeine knowledge and assassment practices. //Journal of Women's Health 18//(9) p. 1457-1466. Diego, M., Field, T., Hernandez-Reif, M., Vera, Y., and Gonzales-Garcia, A. (2007). Caffeine use affects pregnancy outcome. //Journal of Child & Adolescent Substance Abuse 17//(2) p. 41-49

James, D. (2004). //Caffeine Nutrition and well-being A-Z//. New York: MacMillan Reference.

Luke, B. (1995). //Every Pregnant Woman's Guide to Preventing Premature Birth//. New York: Random House, Inc.