PIP: 43 determinants of low birth weight were analyzed from 895 published papers in the English and French literature from 1970-1984 The assessment was limited to singleton births of women living at sea level with no chronic illness; rare factors and complications of pregnancy were excluded The 43 factors were categorized as genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposure and antenatal care The existence and magnitude of a causal effect on birth weight, gestational age, prematurity and intrauterine growth retardation were determined by a set of methodological standards In developed countries, the most important factor was cigarette smoking, followed by nutrition and pre-pregnancy weight In developing countries the major determinants were racial origin, nutrition, low pre-pregnancy weight, short maternal stature, and malaria Pre-pregnancy weight, prior premature birth or miscarriage, diethylstilbestrol exposure and smoking were major determinants of gestational duration, but the majority of prematurity was unexplained in both developed and developing countries There is a need for future research on the effect of maternal work, prenatal care, and certain vitamin and mineral deficiencies on intrauterine growth, and the effect of genital tract infection, prenatal care, maternal employment, stress and anxiety on prematurity

Determinants of low birth weight: Methodological assessment and meta-analysis

Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).

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Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

Caffeine is probably the most frequently ingested pharmacologically active substance in the world. It is found in common beverages (coffee, tea, soft drinks), in products containing cocoa or chocolate, and in medications. Because of its wide consumption at different levels by most segments of the population, the public and the scientific community have expressed interest in the potential for caffeine to produce adverse effects on human health. The possibility that caffeine ingestion adversely affects human health was investigated based on reviews of (primarily) published human studies obtained through a comprehensive literature search. Based on the data reviewed, it is concluded that for the healthy adult population, moderate daily caffeine intake at a dose level up to 400 mg day(-1) (equivalent to 6 mg kg(-1) body weight day(-1) in a 65-kg person) is not associated with adverse effects such as general toxicity, cardiovascular effects, effects on bone status and calcium balance (with consumption of adequate calcium), changes in adult behaviour, increased incidence of cancer and effects on male fertility. The data also show that reproductive-aged women and children are 'at risk' subgroups who may require specific advice on moderating their caffeine intake. Based on available evidence, it is suggested that reproductive-aged women should consume </=300 mg caffeine per day (equivalent to 4.6 mg kg(-1) bw day(-1) for a 65-kg person) while children should consume </=2.5 mg kg(-1) bw day(-1).

Effects of caffeine on human health.

Coffee is a complex mixture of chemicals that provides significant amounts of chlorogenic acid and caffeine. Unfiltered coffee is a significant source of cafestol and kahweol, which are diterpenes that have been implicated in the cholesterolraising effects of coffee. The results of epidemiological research suggest that coffee consumption may help prevent several chronic diseases, including type 2 diabetes mellitus, Parkinson’s disease and liver disease (cirrhosis and hepatocellular carcinoma). Most prospective cohort studies have not found coffee consumption to be associated with significantly increased cardiovascular disease risk. However, coffee consumption is associated with increases in several cardiovascular disease risk factors, including blood pressure and plasma homocysteine. At present, there is little evidence that coffee consumption increases the risk of cancer. For adults consuming moderate amounts of coffee (3‐4 cups/d providing 300‐400 mg/d of caffeine), there is little evidence of health risks and some evidence of health benefits. However, some groups, including people with hypertension, children, adolescents, and the elderly, may be more vulnerable to the adverse effects of caffeine. In addition, currently available evidence suggests that it may be prudent for pregnant women to limit coffee consumption to 3 cups/d providing no more than 300 mg/d of caffeine to exclude any increased probability of spontaneous abortion or impaired fetal growth.

https://www.tandfonline.com/doi/pdf/10.1080/10408390500400009

Coffee and Health: A Review of Recent Human Research

Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994

We analyzed interview and medical-record data of 12,205 non-diabetic, non-asthmatic women to evaluate the relation between coffee consumption and adverse outcomes of pregnancy. Low birth weight and short gestation occurred more often among offspring of women who drank four or more cups of coffee a day and more often among the offspring of smokers. After controlling for smoking, other habits, demographic characteristics, and medical history by standardization and logistic regression, we found no relation between low birth weight or short gestation and heavy coffee consumption. Furthermore, there was no excess of malformations among coffee drinkers. These negative results suggest that coffee consumption has a minimal effect, if any, on the outcome of pregnancy.

No association between coffee consumption and adverse outcomes of pregnancy.

Interview and record review data from 12,023 singleton deliveries were analyzed to determine the relationships between neonatal hyperbilirubinemia (10 mg/dL or greater) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis. There was a statistically significant positive relationship between hyperbilirubinemia and low birth weight, Oriental race, premature rupture of membranes, breast-feeding, neonatal infection, use of the "pill" at time of conception, instrumental delivery, and history of first trimester bleeding. Maternal smoking and black race were negatively related to hyperbilirubinemia and statistically significant. In this study, other previously suspected etiologic factors such as epidural anesthesia, parity, use of oxytocin in labor, and white race were not associated with hyperbilirubinemia.

Epidemiology of neonatal hyperbilirubinemia.

Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).

Cigarettes, Coffee, and Preterm Premature Rupture of the Membranes

Pregnancy outcomes of 7,155 women who worked between one and nine months of pregnancy were compared with outcomes of 4,018 women who were not employed. There were no differences in rates of prematurity, Apgar score, birthweight, perinatal death rate, or malformation prevalence. Working women were divided into those who left employment during the first eight months and those who worked all nine months. The latter had a lower rate of adverse outcome than the other working group and the nonworking group. This indicates that working to term in the absence of contraindications does not impose an added risk on mother or infant. After control of confounding by parity and other relevant factors, an increased risk of prolonged gestational age was seen among primiparous working women. There was an increased risk of fetal distress among those women leaving work prior to nine months who were having their third or subsequent child. A small decrease in birth weight was seen among women who left work prior to term but not among those who worked all nine months. Overall the results are reassuring that working during pregnancy is not in itself a risk factor for adverse outcome.

Phillip G. Stubblefield

Papers

No association between coffee consumption and adverse outcomes of pregnancy.

Epidemiology of neonatal hyperbilirubinemia.

Cigarettes, Coffee, and Preterm Premature Rupture of the Membranes

Work and pregnancy.

Pain of first-trimester abortion: its quantification and relations with other variables.