Abstract Aim: To identify the association between spontaneous abortion (SAB) and coffee consumption.
Abstract
Aim: To identify the association between spontaneous abortion (SAB) and coffee consumption in Maternity and Child Hospital in Makkah, Saudi Arabia
Research Question: Is there an impact of caffeine consumption on the rate of spontaneous abortion in Makkah, Saudi Arabia?
Objectives:
– Define the effect of caffeine on spontaneous abortion.
– Asses if there is increasing rate of abortion
– The aim of this study was to further explore the relationship between caffeine consumption and the occurrence of spontaneous abortion
Methods: Quantitative descriptive explorative research study and cluster sampling of 600 from 2000 women according to Uma Sekaran Research Method for Business (4th Ed, 2010), aged between 25-45 years from Maternity and children hospital in Makkah.
Conclusion: We talked about the nature of the relation and presented the studies that talked about that.
Keywords: pregnancy loss, spontaneous abortion, caffeine, miscarriage, abortion
Introduction
Pregnancy is one of the stages Passed by both mother and child. Mothers may want to maintain the health of their fetus and avoid all that may endanger the life of the fetus. One of the biggest problems that mothers may fear is the risk of Abortion. An abortion (miscarriage) is defined as a termination or loss of pregnancy before 20 weeks of gestation (as calculated from the date of the last menstrual period) or delivery of a fetus weighing less than 500g.And of its kind spontaneous abortion that occurs is also known as a miscarriage.(Ryan A. Pedigo Amanda Mularz, Steven Dalati,2016)
The number of abortions in Saudi Arabia is high in recent years. At Baljurashi General Hospital, Albaha Region, Saudi Arabia the number of abortions from March, 2016 to March, 2017 was 300/2935 = 10% (Alghamdi et al., 2018). (Department of Health, June 2015 ) As a result, mortality and abortion rates may increase, increasing the economic burden on the Government.
Risk factors for miscarriage include an older parent, previous miscarriage, exposure to tobacco smoke, caffeine, obesity, diabetes, thyroid problems, and drug or alcohol use. (Oliver, A; Overton, C (May 2014)) especially in pregnancy because it is considered a sensitive period, caffeine is well documented that caffeine is the world’s most widely consumed drug with its main source found in coffee. (ACADEMIC JOURNALS, 2018). In 2008, two studies on the effects of caffeine related to miscarriage showed significantly different outcomes. In one study released by the (American Journal of Obstetrics and Gynecology,2018), it was found that women who consume 200mg or more of caffeine daily are twice as likely to have a miscarriage as those who do not consume any caffeine. (American Journal of Obstetrics and Gynecology,2018). The lower the caffeine consumption, it would be better. Some experts say more than 150 mg of caffeine a day is prepare too much while others say more than 300 mg a day is prepare too much. (American Pregnancy Association,2018).
Caffeine cn (15.08 hour half-life) compared with non-pregnant women (4.71 hour half-life).(Woldu, J Preg Child Health 2017).Caffeine originates in more than 60 plants, occurs naturally in various food products and beverages consumed during pregnancy ,(including coffee, tea, chocolate, colas), and is added to some soft drinks and most “energy” drinks. Caffeine is also found in some prescription and over-the-counter medications, such as cold and flu remedies, allergy and headache treatments. Increasingly, caffeine is now present as an additive in snack foods, and dietary supplements. (Vicki Nisenblat, MDRobert J Norman, MD,2019)
T the problem miscarriage around the women’s is very concern issue. One of the most important cause is caffeine s. The relationship between caffeine and abortion directly is not clear, Thus, the aim of this study was to is there Impacts of Caffeine on Spontaneous Abortion in Makkah, Saudi Arabia, because the lack of adequate and clear studies in Saudi Arabia. The hypothesis of the study predicts a strong relationship between consumption of caffeine and abortion, that is, if increased consumption of caffeine may lead to increase the chances of abortion.
Significance of the study:
Abortion leads to the loss of fetuses and high fetal mortality rate (Alghamdi et al., 2018) even without the desire of the mother or without a health factor such as spontaneous abortion, which is one of the most common abortions, and the rate of spontaneous abortion in Saudi Arabia is increasing (Alghamdi et al., 2018), and one of the most important reasons that may contribute to spontaneous abortion is wrong consumption of caffeine, especially by pregnant women.
Expected outcome:
This study will be discovered if there is significant association between caffeine and abortion.
We will discover the causes from abortion.
Make recommendations and advice to women to leave this provide preventive methods for women how have caffeine consumption habits.
Anticipated Socio-Economic Benefits:
The anticipated Socio-Economic Benefits could be the following:
1- Increase the awareness about the risk of caffeine that associated with spontaneous abortion. Thus could
reduce the abortion rate and mortality rate.
2- Women’s awareness about risk of caffeine may lead to reduce number spontaneous abortion in Makkah
Saudi Arabia. Consequently, reduce the government expenditures on the surgical abortion.
Research Methodology: The methodology will be a quantitative descriptive explorative research study. The objective of this research is to identify and explore of caffeine consumption associated with spontaneous abortion in women in Makkah.
-Sample:
Type and Size: A cluster sampling of 600 from 2000 women according to Uma Sekaran Research Method for Business(4th Ed, 2010), aged between 25-45 years.
Selection of Participants:
The sample will be recruited from Maternity and children hospital in Makkah
Access to Sample:
The sample will be accessed through attendance of women with abortion at Maternity and children hospital
Inclusion Criteria:
The sample will include women who fit the following criteria: women who had experience of spontaneous abortion. Aged between 25 and 45. accept to be part of study. Well women any disease Well women any complication Speak Arabic and English
Exclusion Criteria: Unwell Women any disease Unwell Women any complication Women less 25 and above 45 Women who doesn’t speak Arabic or English Women who had experience of spontaneous abortion
Data collection:
After three months in 3 august 2019, the researchers will go to the maternity hospital in Makkah after receiving the ethical approval from the hospital and Um Al-Qura university they will go to the head nurse of post-natal department. We will send to him the objective, consent form and questionnaire and assure him that we will provide complete privacy to the participants in the research, it will be unnamed and once filled out the questionnaire they will be sure to join us in the research.
Plot study:
The pilot study will conduct to test the clarity and applicability of tools. will carried on 10 mothers They will chose randomly form, women who had experience of spontaneous abortion and aged between 25 and 45, send the survey through a WhatsApp
Ethical approval:
Ethical approval will be sought from the Ethics Committee of the Department of Research, Faculty of Nursing, Umm Al-Qura University, Makkah. In addition, you will be granted permission to conduct the study from the Ministry of Health in Saudi Arabia.
Risk/Benefit Assessment: It minimizes the risk and maximize the benefits.
Informed Consent: Informed consent will be obtained from each participant in the study. A standard, pre-evaluated questionnaire is administered by the interviewer. According to the guidelines of the research ethics committee at the Faculty of Nursing at Umm Al Qura University.When obtaining the informed consent of the participants. The participants’ approval will be obtained in writing (Umm Al-Qura University protocol and guidelines, the research ethics committee at the Faculty of Nursing).
Privacy and confidentiality: Ensure the absolute privacy and confidentiality of any personal information recorded in the research work. In addition, all information will be deselected by removing items. Which can be used to identify participants. A code will be assigned to the information and no participant will be mentioned in the search documents.
Assessing participants’ fragility: The participants’ consent form will be finalized for ethics approval for a project involving humanitarian participants and will be submitted to the Ethics Committee. Participants may refuse to participate and withdraw their consent at any time of study.
Private participants are people who have a decreasing ability to give informed consent and are therefore at risk of exploitation. This includes children, persons with developmental disabilities, disordered elderly, individuals with mental illness, persons with a subordinate relationship who can not grant free consent. This group must be treated with the same ethical standards as all other groups and require greater protection because of its inability to give informed consent.
Security Data Search: The information will be stored in a secure location and all electronic information will be stored in the disk. The data collected during the study will be stored in a safe area.
Systematic literature review
A study conducted by Chen. et al (2016), which adopted categorical and dose–response meta-analysis of prospective design established that those mothers who take higher caffeine have high chances of aborting 1·72 (1·40, 2·13; I 2=0·0 %) than those who do not take. They revealed that the higher the amount of caffeine taken, the higher the chances of abortion. The study was however based on secondary data analysis. The studies selected were obtained from MEDLINE and SCOPUS databases. A similar study was conducted by Lyngsø et al (2017), who had a goal to determine the association between caffeine and spontaneous abortion. They explored literature from MEDLINE and Embase, with no time and language restrictions. Based on pooled results, it was found that intake of more than 300 mg caffeine/day increases the risk of women developing spontaneous abortion. The risk become even worse if the consumption is further increased. at (2014) the Lassi et al. use a systematic review and at the end results it was when the maternal intake caffeine higher than 300 mg/d the risk of miscarriage it’s increases about 31% and Several studies have shown that there is no significant risk of caffeine consumption frequently during pregnancy. Greenwood. et al (2014) use systematic review and dose–response meta-analysis , 53 studies (26 cohort and 27 case–control) and the result : a small but quantifiable association was observed between caffeine intake during pregnancy and incidence of miscarriage ,there is also a similar sized association between caffeine intake during pregnancy and small for gestational age. There was no evidence of an association between caffeine intake and preterm delivery. Morales-Suarez-Varela et al 22 December( 2017) using cohort study using the Danish National Birth Cohort (DNBC) The general practitioners in research (100418 pregnancies), study included (90 086 pregnant women) result: Women who nor drank coffee were used as the reference group. Drinking more than 3 cups per day of coffee was associated with the highest risk of fetal death .A low coffee intake may reduce the risk of fetal death, while a high coffee intake increases the risk. Li Ji et (2015) A total of 26 studies were included (Fig. 1, Supplementary Material S1): 13 were case-control studies [18–30] and 13 were cohort studies [31–43]. Twenty studies [18–27,31–40]were of caffeine and eight studies [28–30,36,39,41–43]were of coffee consumption. Among the studies about caffeine consumption, seven were conducted in Europe [21–24, 27,34,40], 11 in North/South America [18,19,25,31–33,35–39], and two in Asia [20,26]. Among the studies about coffee consumption, four were conducted in Europe [28,30,42,43], three in North/South America [36,39,41], and one in Asia [29]. Caffeine consumption during pregnancy was significantly associated with increased risk of pregnancy loss in both cohort and case-control studies. Heterogeneity was mainly from three studies [24,27,34], but the reasons were unclear. It might have been caused by varying characteristics—e.g. age, ethnic origin, sample size, adjusted estimates. Taking into account the heterogeneity among studies, a two-stage random effects dose–response meta-analysis was performed to compute the trend from the correlated log or estimates across levels of caffeine and coffee consumption. Morgan et al (2010) the researchers found consumption of caffeine at the range between 300 mg/d or less not have a high risk for abortion but if the daily intake of caffeine higher than 300mg/d maybe they have a risk for abortion.
Utilizing a case-control study design, Klebanoff and Keim (2015) attempted to determine the association between mother’s caffeine’s primary metabolite (paraxanthine) and child’s IQ. The mothers who participated in the study was part of Collaborative Perinatal Project. They found out that there is no significant relationship of serum paraxanthine level with childhood IQ or problem behaviors. Also, Peck et al (2010) found in Review of literature (Hassan, M.A., Killick, S.R., 2004. Negative lifestyle is associated with a significant reduction in fecundity. Fertil. Steril. 81, 384–392) This retrospective study enrolled (2112 pregnant) women from prenatal clinics in the United Kingdom Although described as a prospective study, these cross-sectional data were collected from a population of 500 healthy. The results of this study do not support an association between spontaneous abortion and caffeine intake before or during pregnancy. A study conducted by Pollack, et al (2011), which adopted in prospective cohort study analysis of prospective longitudinal measurement of caffeine intake during sensitive windows of human development. , The study cohort was restricted to women who reported in 1991 that they may be planning pregnancies in the next five years. In 1996, 2,637 women were re-contacted, of which 244 (9%) reported planning pregnancies in the next six months from which 113 (46%) women were enrolled. Fourteen women were already pregnant and were subsequently excluded from further participation, the study analyzed daily caffeine consumption while attempting pregnancy through 12 menstrual cycles at risk for pregnancy and found that caffeine consumption did not increase the risk (RR=0.98; 95% confidence interval (CI) 0.96-0.99) or hazard (HR=0.97; 95% CI 0.95-1.00) of miscarriage. Alomar (2017) The results showed that: 61.9% of women consumed coffee, 34% consumed tea, and 4.1% consumed soft drinks during pregnancy. 43% of women who consumed caffeine during pregnancy had at least one spontaneous abortion, 10.3% suffered from stillbirth .
On the other hand, a prospective longitudinal study involving 2,643 pregnant women conducted by Greenwood et al (2010) establish a strong relationship between caffeine intake in the first trimester and miscarriage and stillbirth. Odds ratio for those consuming increased significantly.
In another prospective longitudinal study conducted between 1996 and 2002 by Howards et al (2012) to determine the association on prescription of caffeine (200 mg) with spontaneous abortion (SAB) in the Danish National Birth Cohort, it was established that high level of caffeine administered preconceptionally does not increase the risk of abortion. This is because they found that the odds ratio does not change significantly. Gaskins et al (2018) conducted a study with similar goal using similar study design. However, they evaluated a relatively more women (15,590 pregnancies from 11,072 women). The study duration lasted for 8 years. The findings revealed that preconception intake of caffeine is positively correlated with the spontaneous abortion. Specifically, they established that women consuming more than 400 mg/day had 1.11 (95 % CI 0.98, 1.25) times the risk of SAB compared women consuming less than 50 mg of caffeine per day.
Adel et al (2015) analyzed 60 women hospitalized for spontaneous abortion in UAE and compared it with 180 women with normal delivery. They evaluated several factors such as exercise, sleep patterns, diet, tobacco use, and the consumption of soft drinks. The findings revealed that there is no association between the consumption of soft drinks and spontaneous abortion. The limitation of the study is that it was conducted within limited location and hence it is not valid to generalize the results.
Using prospective cohort study, Hahn et al (2015) analyzed the consumption of caffeine among the 5132 Danish women planning pregnancy by asking them to report their caffeine consumption before conception and during early pregnancy. They then analyzed the hazard ratios. They found out that those women whose consumption was relatively higher had higher hazard ratio than those whose consumption was low.
By reviewing existing studies, Woldu (2017) attempted to resolves the myths related to caffeine and pregnancy. They focused on the mechanism of toxicity, threshold for toxicity and the benefits of from prenatal caffeine exposure. They failed to establish the causal association on the effect of caffeine on pregnancy. However, they concluded that it is prudent to avoid the consumption of caffeine until when enough data is available.
Błaszczyk-Bebenek et al (2018) conducted a study to evaluate the caffeine consumption among pregnant women from Poland. A total of 140 women were evaluated. They used Questionnaire of Eating Behavior (QEB) and dairy products frequency questionnaire (ADOS-Ca). They found out that pregnant women tend to consume Black tea and instant and ground coffee. They also revealed that pregnant women tend to have lower activity of the CYP1A2 isozyme and this lowers metabolism of caffeine making them vulnerable.
Summary Table
Author’s Name and Year
Title
Study design
Findings
Chen. et al (2016)
Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose–response meta-analysis of prospective studies
Categorical and dose–response meta-analysis of prospective design
Increases the risk of abortion
Greenwood. et al (2014)
Caffeine intake during pregnancy and adverse birth outcomes: a systematic review and dose–response meta-analysis
A systematic review and dose–response meta-analysis
A small but quantifiable association
Lyngsø et al (2017)
Association between coffee or caffeine consumption and fecundity and fertility: a systematic review and dose–response meta-analysis
Systematic review and dose-response meta-analysis including data from case-control and cohort studies
Increases the risk of abortion
Klebanoff and Keim (2015)
Maternal Caffeine Intake During Pregnancy and Child Cognition and Behavior at 4 and 7 Years of Age
Case-control study design
Do not increase the risk of abortion
Greenwood et al (2010)
Caffeine intake during pregnancy, late miscarriage and stillbirth
A prospective longitudinal study
Increases the risk of abortion
Howards et al (2012)
Spontaneous Abortion and a Diet Drug Containing Caffeine and Ephedrine: A Study within the Danish National Birth Cohort
Prospective longitudinal study
Does not increase the risk of abortion when administered preconceptionally
Gaskins et al (2018)
Pre‑pregnancy caffeine and caffeinated beverage intake and risk of spontaneous abortion
Prospective longitudinal study
Increases the risk of abortion
Adel et al (2015)
Determinants of Spontaneous Abortion: A Hospital Based Case-Control Study in Ajman, UAE.
Systematic literature review
Do not Increases the risk of abortion
Hahn et al (2015)
Caffeine and caffeinated beverage consumption and risk of spontaneous abortion.
Prospective cohort study
Increases the risk of abortion
Woldu (2017)
The Effect of Caffeine on Pregnancy-Fact or Myth?
Systematic literature review
Likely to increase the risk of abortion
Błaszczyk-Bebenek et al (2018)
Evaluation of Caffeine Consumption among Pregnant Women from Southern Poland
A prospective longitudinal study
Causes abortion
Morgan et al (2010)
Is caffeine consumption safe during pregnancy?
Case-control and cohort studies.
Consumption of caffeine about 300 mg/d or less do not increased risk abortion
Pollack et al (2011)
Caffeine Consumption and Miscarriage: A Prospective Cohort Study
A prospective cohort study with longitudinal measurement
Light or moderate of caffeine consumption don’t increase risk of abortion.
Morales-Suarez-Varela et al (2017)
Potential combined effects of maternal smoking and
coffee intake on foetal death within the Danish
National Birth Cohort
Cohort study
Does not increase the risk of abortion when administered preconceptionally
Li Ji et al (2015)
A meta-analysis of risk of pregnancy loss and caffeine and coffee
consumption during pregnancy
A meta-analysis
There is association between caffeine consumption and risk of pregnancy
loss
Lassi et al (2014)
Preconception care: caffeine, smoking, alcohol,
drugs and other environmental chemical/
radiation exposure
A systematic review and meta-analysis
Caffeine intake of >300mg/d significantly increase the risk of a subsequent
fetal loss by 31% (95% CI: 8-58%).
Peck et al (2010)
A review of the epidemiologic evidence concerning the reproductive health effects of caffeine consumption: A 2000–2009 update
Review of literature
Study do not support an association between
spontaneous abortion and caffeine intake before or during pregnancy
Alomar (2017)
EVALUATION OF CAFFEINE CONSUMPTION AND EFFECT DURING PREGNANCY AMONG WOMEN IN THE UAE
A retrospective cross-sectional survey
Increases the risk of abortion
Time Table:
Action
Time (week) Meeting with other members and discuss the topic of Proposal. discuss the topic of Proposal with the supervisor.
From week 6 to 7 Selection of the final topic of Proposal. Abstract. Introduction. Purpose (significance of the study).
From week 7 to 8 Hypothesis. Methodology
From week 8 to 9 Method:
Setting.
Subjects.
Design.
Data collection.
From week 9 to 10 Sample size. Data analysis. Literature review
From week 10 to 11 Other procedures: Ethical consideration. Administrative design. Conclusion.
From week 11 to 12 Pilot study. Time table. Reference.
From week 12 to 13 Grammar Editing
From week 13 to 14
Conclusion
The results of the analysis showed that the caffeine intake, which significantly increased the likelihood of miscarriage, was greater than 300 mg per day, which was 1 times higher than the original study of 150 mg. It also suggested that with the increase in caffeine intake, the possibility of miscarriage would Increase. In summary, the results of this study suggest that daily consumption of caffeinated beverages by pregnant women may increase abortion, especially if a daily drink containing more than 300 mg of caffeine (about 3 cups of coffee) will increase the abortion rate. Therefore, it is recommended that pregnant women should reduce or stop drinking coffee or other caffeinated drinks (including tea, cola, cocoa, etc.) during pregnancy.
