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Rohweder R, de Oliveira Schmalfuss T, Dos Santos Borniger D, Ferreira CZ, Zanardini MK, Lopes GPTF, Barbosa CP, Moreira TD, Schuler-Faccini L, Sanseverino MTV, da Silva AA, Abeche AM, Vianna FSL, Fraga LR. Caffeine intake during pregnancy and adverse outcomes: An integrative review. Reprod Toxicol 2024; 123:108518. [PMID: 38042437 DOI: 10.1016/j.reprotox.2023.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
Caffeine intake during pregnancy is common. Caffeine crosses the placenta, raising concerns about its possible deleterious effects on the developing embryo/fetus. Studies on this subject show conflicting results, and still there is no consensus on the recommended dose of caffeine during pregnancy. We performed an integrative review with studies from six databases, using broad MESH terms to allow the identification of publications that addressed the outcomes of caffeine use during pregnancy, with no date limit for publications, in English and Portuguese language. The research returned 16,192 articles. After removing duplicates, screening by title, abstract and full-text, we evaluated 257 and included 59 articles. We found association between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. The effects were often dose dependent. No association with prematurity has been demonstrated, but one study showed a small reduction in gestational age with increasing doses of caffeine intake. Defining a safe dose for caffeine intake during pregnancy is a challenging task due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed. In some studies, exposures below the recommended level of caffeine intake during pregnancy (200 mg/day), as suggested by the guidelines, were associated with pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. Well-designed studies with reliable quantification of caffeine intake are needed to assess the safety of low doses during pregnancy.
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Affiliation(s)
- Ricardo Rohweder
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thanyse de Oliveira Schmalfuss
- Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil
| | - Diessy Dos Santos Borniger
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Zanfir Ferreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcos Kobren Zanardini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Paulon Torrano Ferreira Lopes
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Pocharski Barbosa
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Taiane Dornelles Moreira
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lavinia Schuler-Faccini
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Monitoramento de Defeitos Congênitos do Hospital de Clínicas de Porto Alegre (PMDC-HCPA), Porto Alegre, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas - Universidade do Vale do Taquari - UNIVATES, Lajeado, Brazil; Universidade do Vale do Rio dos Sinos - UNISINOS, São Leopoldo, Brazil
| | - Alberto Mantovani Abeche
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Sales Luiz Vianna
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- Sistema Nacional de Informação sobre Agentes Teratogênicos (SIAT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Medicina - Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Mérida-Ortega Á, Pérez-Saldivar ML, Espinoza-Hernández LE, Dorantes-Acosta EM, Torres-Nava JR, Solís-Labastida KA, Paredes-Aguilera R, Velázquez-Aviña MM, Espinosa-Elizondo RM, Miranda-Madrazo MR, González-Ávila AI, Rodríguez-Villalobos LR, Dosta-Herrera JJ, Mondragón-García JA, Castañeda-Echevarría A, López-Caballero MG, Martínez-Silva SI, Rivera-González J, Hernández-Pineda NA, Flores-Botello J, Pérez-Gómez JA, Rodríguez-Vázquez MA, Torres-Valle D, Olvera-Durán JÁ, Martínez-Ríos A, García‐Cortés LR, Almeida-Hernández C, Flores-Lujano J, Núñez-Enríquez JC, Mata-Rocha M, Rosas-Vargas H, Duarte-Rodríguez DA, Jiménez-Morales S, Mejía-Arangure JM, López-Carrillo L. A protective maternal nutrient concomitant intake associated with acute leukemia might be modified by sex, in children under 2 years. Front Oncol 2023; 13:1239147. [PMID: 37746300 PMCID: PMC10514356 DOI: 10.3389/fonc.2023.1239147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Maternal dietary consumption during pregnancy has been inconclusively associated with acute leukemia (AL) in infants, probably because epidemiological evidence has emerged mainly from the analysis of one-by-one nutrient, which is not a real-life scenario. Our objective was to evaluate the association between AL in Mexican children under 2 years of age and their mothers' nutrients concomitant intake during pregnancy, as well as to explore whether there are differences between girls and boys. Methods We conducted a study of 110 cases of AL and 252 hospital-based controls in the Mexico City Metropolitan area from 2010 to 2019. We obtained information on maternal intake of 32 nutrients by a food frequency questionnaire and used weighted quantile sum regression to identify nutrient concomitant intakes. Results We found a concomitant intake of nutrients negatively associated with AL (OR 0.17; CI95% 0.03,0.88) only among girls; and we did not find a nutrient concomitant intake positively associated with AL. Discussion This is the first study that suggests nutrients that have been individually associated with AL are not necessarily the same in the presence of other nutrients (concomitant intake); as well as that maternal diet might reduce AL risk only in girls.
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Affiliation(s)
- Ángel Mérida-Ortega
- Center of Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
| | - María Luisa Pérez-Saldivar
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo-XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| | - Laura E. Espinoza-Hernández
- Servicio de Hematología Pediátrica, Hospital General “Gaudencio González Garza”, CMN “La Raza”, IMSS, Mexico City, Mexico
| | - Elisa M. Dorantes-Acosta
- Departamento de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaria de Salud (SSA), Mexico City, Mexico
| | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | | | | | | | | | - M. Raquel Miranda-Madrazo
- Servicio de Hematología Pediátrica, CMN”20 de Noviembre”, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Ana Itamar González-Ávila
- Servicio de Hematología Pediátrica, HGR No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” IMSS, Mexico City, Mexico
| | | | - Juan José Dosta-Herrera
- Servicio de Cirugía Pediátrica, Hospital General “Gaudencio González Garza”, CMN “La Raza”, IMSS, Mexico City, Mexico
| | - Javier A. Mondragón-García
- Servicio de Cirugía Pediátrica, Hospital General Regional (HGR) No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” IMSS, Mexico City, Mexico
| | | | | | | | - Juan Rivera-González
- Hospital General Dr. “Gustavo Baz Prada”, Instituto de Salud del Estado de México (ISEM), State of Mexico, Mexico
| | | | - Jesús Flores-Botello
- Coordinación Clínica y Pediatría, Hospital General “La Perla” ISEM, Nezahualcóyotl, State of Mexico, Mexico
| | - Jessica Arleet Pérez-Gómez
- Coordinación Clínica y Pediatría, HGR No. 72 “Dr. Vicente Santos Guajardo”, IMSS, Tlalnepantla de Baz, State of Mexico, Mexico
| | | | - Delfino Torres-Valle
- Coordinación Clínica y Pediatría del Hospital General de Zona 71, IMSS, Chalco de Díaz Covarrubias, State of Mexico, Mexico
| | | | | | - Luis R. García‐Cortés
- Delegación Regional Estado de México Oriente, IMSS, Naucalpan de Juárez, State of Mexico, Mexico
| | | | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo-XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo-XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| | - Minerva Mata-Rocha
- Laboratorio de Biología Molecular de las Leucemias, Unidad de Investigación en Genética Humana, UMAE, Hospital de Pediatría, CMN “Siglo XXI”, IMSS, Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Laboratorio de Genética, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo-XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo-XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Innovación y Medicina de Precisión, Núcleo A, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
| | - Juan Manuel Mejía-Arangure
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México City, Mexico
| | - Lizbeth López-Carrillo
- Center of Population Health Research, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
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Blanco-Lopez J, Iguacel I, Pisanu S, Almeida CCB, Steliarova-Foucher E, Sierens C, Gunter MJ, Ladas EJ, Barr RD, Van Herck K, Huybrechts I. Role of Maternal Diet in the Risk of Childhood Acute Leukemia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5428. [PMID: 37048042 PMCID: PMC10093835 DOI: 10.3390/ijerph20075428] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/23/2023] [Accepted: 04/05/2023] [Indexed: 06/19/2023]
Abstract
Many studies have investigated the etiology of acute leukemia, one of the most common types of cancer in children; however, there is a lack of clarity regarding preventable risk factors. This systematic review and meta-analysis aimed to summarize the current evidence regarding the role of maternal dietary factors in the development of childhood leukemia. All epidemiological studies published until July 2022 that evaluated maternal dietary risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science) without limits of publication year or language. A total of 38 studies (1 prospective cohort study, 34 case-control studies and 3 studies with pooled analysis) were included. The published risk estimates were combined into a meta-analysis, using the Generic Inverse Variance method. The maternal consumption of fruits (two or more daily servings vs. less) was inversely associated with acute lymphoblastic leukemia (odds ratio = 0.71; 95% CI, 0.59-0.86), whereas maternal coffee intake (higher than two cups per day vs. no consumption) was associated with an increased risk of acute lymphoblastic leukemia (odds ratio = 1.45; 95% CI, 1.12-1.89). Despite these findings, more high-quality research from cohort studies and the identification of causal factors are needed to develop evidence-based and cost-effective prevention strategies applicable at the population level. Review Registration: PROSPERO registration no. CRD42019128937.
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Affiliation(s)
| | - Isabel Iguacel
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Silvia Pisanu
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, 09124 Cagliari, Italy
| | | | | | - Ciska Sierens
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Marc J. Gunter
- Faculty of Medicine, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Elena J. Ladas
- Division of Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ronald D. Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, ON L8S 4L7, Canada
| | - Koen Van Herck
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Inge Huybrechts
- International Agency for Research on Cancer, 69007 Lyon, France
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