Monday, January 28, 2008

Just let me vent over my venti coffee

Warning: I get a little long winded here!

Is your daily cup of Joe increasing your chances of miscarriage? That's what a study, published last week in the American Journal of Obstetrics and Gynecology, suggests. According to the New York Times, the study -- which was based on 1,063 pregnant women in California -- suggests that pregnant women who consume more than 200 milligrams of caffeine a day may be doubling their risk of miscarriage.

I'm no professional, researcher or doctor, nor do I claim to know it all about pregnancy and miscarriage, but I'm just sick of all the reports and research that is always coming out about what to do and what not to do when you are pregnant. Don't we have enough to worry about? Aren't we stressed enough? Don't mothers of miscarried children have enough to consume them then to think that that extra cup of Joe they had on day 67 of their pregnancy might have caused their latest conceived child to die?

The study says there is 200 mg in about 10 ounces of coffee or 25 ounces of tea. A trip to Starbucks for a tall (10 ounces) coffee is going to have you consuming 260 mg of caffeine. If Dunkin' Donuts is your choice you can order up a 16 ounce cup of joe for 206 mg of caffeine. What if Diet Coke is your choice for caffeine? Well, you're looking at 45.6 mg of caffeine per 12 ounce can - go ahead and have 4 a day!

So, my question is this - how accurate were these women in reporting the amount of caffeine intake during their pregnancy? I can't even accurately calculate the calories in the bowl of cereal I had yesterday - was it 3/4 cup like the serving size is or was it more like 1 cup, maybe even 1 1/2 cups - did I measure it - no, so I don't know exactly how much I ate, right? Nutritionist have long observed that people underestimate how many calories they eat in a day. Have you ever measured out the exact serving size of something you eat? If you have then you were probably shocked to see that it was much less than you had been consuming in the past. So if we have been so wrong on our calorie consumption - is it possible that the same holds true for our caffeine consumption? Maybe the moms in the study forgot about the refill of coffee they had or the bar of chocolate they ate as a snack. Maybe one cafe's small is another's medium. And maybe it has nothing to do with reporting at all and everything to do with the way that it was prepared -- how strong, how long it took to brew, was it made through a coffee press or was it brewed, how hot was the water? Some things have a definite amount of caffeine - you can look at the side of a coke can and know exactly how much caffeine you would consume if you drank the whole can. But if I were to tell you that I had 1/2 cup of coffee this morning at home, then went to Dunkin' Donuts and had a medium 1/2 decaf 1/2 regular with milk and then ate a piece of dark chocolate, how the hell would you calculate that? (Keep in mind, I like a lot of milk in my coffee) Seems to me like there is a lot of room for error!

In addition, Dr. Li, one of the researchers for this study, answered a question that had been unresolved in previous studies. "Women who have morning sickness are less likely to miscarry than those who do not, possible because the same hormonal changes that cause nausea and vomiting contribute to a healthy pregnancy." As the Times reports, there might be some confusion in the cause and effect going on. "some researchers said morning sickness could lead to misleading results in caffeine studies. These researchers argued that because they feel ill, some women may consume less caffeine. That tendency may make it appear that they are less likely to miscarry because they avoid caffeine, when the real reason is actually that they started out with healthier pregnancies." If you're feeling nauseous, you might not crave your usual triple latte -- which would lower your reported caffeine intake, and which might mean that you mistakenly associate your healthy pregnancy with your lowered caffeine consumption rather than with hormonal shifts that made you crave less caffeine to begin with.

Let's put caffeine aside for just a minute. What about the increased risk of miscarriage for moms who have had a c-section, abortion or D&C in the past? All of these procedures can cause scar tissue to form in the uterus which CAN cause an increase risk of miscarriage. If a fertilized egg tries to implant in the uterus where this scar tissue has formed there may be a decrease of blood flow or the possibility that the egg just doesn't implant like it should to sustain a healthy pregnancy. Why aren't there more reports on this? Why aren't there warnings for c-section patients that if this procedure is performed then there is a chance there could be problems later with carrying a child? I know I wasn't told any of this information. I was told that I could labor all night and still end up with a c-section or just go ahead and consent to one now and I would be holding my baby in 30 minutes. I only find out after the fact that that tiny incision that was not medically necessary might cause me to have infertility problems later.

What about chromosomal abnormalities? This is the reason for more than 50% of all miscarriages. It's what caused my 1st miscarriage - called a blighted ovum. Could I have prevented this if I would have given up my coffee? Hardly!

And then, there's hormonal imbalances - another reason listed for miscarriages. This is probably what caused by second miscarriage. I had low progesterone levels - could this have been prevented if I had stopped drinking my diet coke? Nope!

So for anyone who missed the piece in the Times, here's the most important excerpt:
"Dr. Carolyn Westhoff, a professor of obstetrics and gynecology, and epidemiology, at Columbia University Medical Center, had reservations about the study, noting that miscarriage is difficult to study or explain. Dr. Westhoff said most miscarriages resulted from chromosomal abnormalities, and there was no evidence that caffeine could cause those problems.
"'Just interviewing women, over half of whom had already had their miscarriage, does not strike me as the best way to get at the real scientific question here,' she said. 'But it is an excellent way to scare women.'
"She said that smoking, chlamidial infections and increasing maternal age were stronger risk factors for miscarriage, and ones that women could do something about. 'Moderation in all things is still an excellent rule,' Dr. Westhoff said. 'I think we tend to go overboard on saying expose your body to zero anything when pregnant. The human race wouldn't have succeeded if the early pregnancy was so vulnerable to a little bit of anything. We're more robust than that.'"

This is my midwife's take too - everything in moderation.


Leenie said...

I think everyone missed the biggest part of the study--it was done in California--with a Starbucks every 100 feet--I agree--perhaps they weren't truthful w/ what they had. And only a 1000some people--come on---I think it would be a more convincing study if they had done it on more people.

Aimee said...

I drank coffee, tea, coke - you name it - while I was pregnant, and didn't have any problems. Like you said - how accurate are these studies, really?!? You have to do what you feel is best for you!

Megan said...

The problem is with these studies there are always loopholes....Did any of these women have pre-existing health conditions? I agree- moderation is the key!!

Anne said...

The study is crap. Did they do this in other countries, where coffee is consumed a bit more? (perhaps Columbia). What about countries that drink tea all day (England)? I think that any study done with just 1000 people can be skewed in any way. Did they see what happened to 1000 women who ate a certain amount of sugar per day???
Don't even worry.

Jen said...

Ha. I drank wine with Wyatt. Maybe that's where his penis came from. I sneezed on a Tuesday with Greta. Maybe that's why she still wets her pants.

My OB with Caro said, "Don't smoke or shoot heroin. All else in moderation." Loved her.

Mommy Brain said...

The study is junk science! In fact, almost all the studies widely reported by the media are junk science...but they do make nice headlines and sound bites!

I believe each child has been given a place and time in this world...a purpose, and a plan. We as mother's need to be cautious but the rest, as "polly-annaish" as this sounds is in God's hands