Peripartum implications of caffein intake in pregnancy: Is there cause for concern?
Implicaciones en el parto del uso de cafeína durante el embarazo: ¿existe una causa para preocuparse?
K.M. Kuczkowski
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kmkuczkowski@gmail.com
Correspondencia: Department of Anesthesiology Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine 4800 Alberta Avenue El Paso, Texas, United States of America
Correspondencia: Department of Anesthesiology Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine 4800 Alberta Avenue El Paso, Texas, United States of America
Associate Professor of Anesthesiology and Obstetrics and Gynecology. Vice-Chair for Academic Affairs, Department of Anesthesiology. Chief, Obstetric Anesthesia Services. Director, Fellowship in Obstetric Anesthesia. Departments of Anesthesiology and Obstetrics and Gynecology. Texas Tech University Health Sciences Center at El Paso. El Paso, Texas, United States of America.
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(DUC): dosis única, líneas continuas. (aclt): dosis acumulativas, líneas fragmentadas. (FEM): femenino. (MAS): masculino. (MIX): mixto.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Steinberg" "autores" => array:1 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Steinberg" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935609704761?idApp=UINPBA00004N" "url" => "/00349356/0000005600000010/v1_201305151407/S0034935609704761/v1_201305151407/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "Peripartum implications of caffein intake in pregnancy: Is there cause for concern?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "612" "paginaFinal" => "615" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "K.M. Kuczkowski" "autores" => array:1 [ 0 => array:4 [ "nombre" => "K.M." "apellidos" => "Kuczkowski" "email" => array:1 [ 0 => "kmkuczkowski@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Associate Professor of Anesthesiology and Obstetrics and Gynecology. Vice-Chair for Academic Affairs, Department of Anesthesiology. Chief, Obstetric Anesthesia Services. Director, Fellowship in Obstetric Anesthesia. Departments of Anesthesiology and Obstetrics and Gynecology. Texas Tech University Health Sciences Center at El Paso. El Paso, Texas, United States of America." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Department of Anesthesiology Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine 4800 Alberta Avenue El Paso, Texas, United States of America" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Implicaciones en el parto del uso de cafeína durante el embarazo: ¿existe una causa para preocuparse?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">1.</span><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Social drug use in pregnancy: defining the problem</span></p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">2.</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Caffeine in pregnancy: is there cause for concern?</span></p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">3.</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conclusion</span></p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">1. Social drug use in pregnancy: defining the problem</span><p id="par0025" class="elsevierStylePara elsevierViewall">The illicit drug abuse in pregnancy has received significant attention over the past three decades<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a>. Howe-ver, far too little attention has been given to the consequences of the use of “social drugs” such as caffeine, ethanol and tobacco, which are by far the most commonly abused substances during pregnancy and significantly contribute to the perinatal complications. In addition, while the deleterious effects of cocaine, amphetamines or hallucinogens on the mother and the fetus are more pronounced and easier to detect, the addiction to caffeine, ethanol and tobacco is usually subtle and more difficult to diagnose<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a>. As a <a name="p612"></a>result these forms of chemical dependency may continue undetected in pregnancy significantly impacting pregnancy outcome and peripartum management of these patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Caffeine is probably the most frequently ingested pharmacologically active substance in the world<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. 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. This article reviews the consequences of the social caffeine use in pregnancy and offers recommendation for peripatum management of these potentially complicated pregnancies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">2. Caffeine in pregnancy: is there cause for concern?</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pharmacology, epidemiology and pathophysiology</span><p id="par0035" class="elsevierStylePara elsevierViewall">Caffeine is a methylxanthine found in a variety of products such as tea, coffee, cola and cocoa. Most Americans consume caffeine daily in one of its many forms<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. A cup of coffee, for example, contains 29 to 176<span class="elsevierStyleHsp" style=""></span>mg of caffeine depending on its strength. It has been reported that approximately 80% of women drink caffeine-containing beverages daily<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Coffee is a complex mixture of chemicals that provides significant amounts of chlorogenic acid and caffeine<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. 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 high 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/day providing 300–400<span class="elsevierStyleHsp" style=""></span>mg/day 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/day providing no more than 300<span class="elsevierStyleHsp" style=""></span>mg/d of caffeine to exclude any increased probability of spontaneous abortion or impaired fetal growth<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">There is wide inter-individual variation in caffeine metabolism, primarily due to variations in CYP1A2 enzyme activity<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Considerable evidence exists that maternal caffeine metabolism is influenced by a variety of endogenous and exogenous factors. There is substantial evidence that measurement of maternal, fetal, and neonatal caffeine metabolites may allow for a more precise measure of fetal caffeine exposure<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis and clinical presentation</span><p id="par0050" class="elsevierStylePara elsevierViewall">Studies on the effects of caffeine on human health, while numerous, have produced inconsistent results. One of the most uncertain and controversial effects is on pregnancy outcome. The major challenge is the accurate assessment of caffeine intake. Boylan et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> attempted to explore different methods of assessing caffeine exposure in pregnant women. Twenty-four healthy pregnant women completed both a detailed questionnaire, the caffeine assessment tool (CAT) designed specifically to assess caffeine intake and a prospective 3 day food and drink diary. The women also provided nine saliva samples over two consecutive days for estimation of caffeine and a metabolite (paraxanthine). Caffeine intakes from the CAT and diary showed adequate agreement (intra-class correlation coefficient of 0.5). For saliva caffeine and paraxanthine measures, the between-sample variation (within the same woman) was greater than between-woman and between-day variation. However, there was still adequate agreement between these measures and the CAT. The authors concluded that the CAT is a valuable tool that is now being used in a large prospective study investigating caffeine's role in pregnancy outcome<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical research indicates that withdrawal symptoms can occur when daily consumption of caffeine is abruptly interrupted<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. The caffeine physical dependence syndrome may lead to peripartum complications such as headache, nausea, vomiting and muscular aches. Most commonly, however, abrupt discontinuation of regular daily caffeine intake will lead to anxiety, mild to moderate headache and muscle aches<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Interactions with pregnancy</span><p id="par0060" class="elsevierStylePara elsevierViewall">Caffeine is readily absorbed from the mucosa of the gastrointestinal tract. It crosses the human placenta rapidly reaching concentration in the fetus similar to maternal plasma levels<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Caffeine has been implicated as a cause of spontaneous abortion, intrauterine <a name="p613"></a>growth restriction (IUGR), low birth weight (LBW) and preterm delivery.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Boylan el al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> conducted a prospective longitudinal observational study designed to examine the association of maternal caffeine intake with fetal growth restriction. The study included 2,635 low risk pregnant women recruited between 8–12 weeks of pregnancy. Investigations Quantification of total caffeine intake from 4 weeks before conception and throughout pregnancy was undertaken with a validated caffeine assessment tool. Caffeine half life (proxy for clearance) was determined by measuring caffeine in saliva after a caffeine challenge. Fetal growth restriction, as defined by customized birth weight centile, adjusted for alcohol intake and salivary cotinine concentrations.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Caffeine consumption throughout pregnancy was associated with an increased risk of fetal growth restriction (odds ratios 1.2 (95% CI 0.9 to 1.6) for 100–199<span class="elsevierStyleHsp" style=""></span>mg/day, 1.5 (1.1 to 2.1) for 200–299<span class="elsevierStyleHsp" style=""></span>mg/day, and 1.4 (1.0 to 2.0) for <span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg/day compared with <span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg/day; test for trend P<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Mean caffeine consumption decreased in the first trimester and increased in the third. The association between caffeine and fetal growth restriction was stronger in women with a faster compared to a slower caffeine clearance (test for interaction, P<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06). The authors concluded that caffeine consumption during pregnancy was associated with an increased risk of fetal growth restriction and this association continued throughout pregnancy. Sensible advice would be to reduce caffeine intake before conception and throughout pregnancy.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Bech et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> conducted randomized double blind controlled trial designed to estimate the effect of reducing caffeine intake during pregnancy on birth weight and length of gestation. The study included 1,207 pregnant women drinking at least three cups of coffee (caffeinated or decaffeinated instant coffee) a day, recruited before 20 weeks' gestation. Data on birth weight were obtained for 1150 live born singletons and on length of gestation for 1153 live born singletons. No significant differences were found for mean birth weight or mean length of gestation between women in the decaffeinated coffee group (whose mean caffeine intake was 182<span class="elsevierStyleHsp" style=""></span>mg lower than that of the other group) and women in the caffeinated coffee group. After adjustment for length of gestation, parity, prepregnancy body mass index, and smoking at entry to the study the mean birth weight of babies born to women in the decaffeinated group was 16 g (95% confidence interval –40 to 73) higher than those born to women in the caffeinated group. The adjusted difference (decaffeinated group-caffeinated group) of length of gestation was –1.31 days (–2.87 to 0.25). The authors concluded that a moderate reduction in caffeine intake in the second half of pregnancy has no effect on birth weight or length of gestation<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">At least three cases of acute fetal arrhythmias secondary to excessive maternal intake of caffeine have been reported<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>. Fernandez et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> found a small but statistically significant increase in the risk of spontaneous abortion and LBW infants in women consuming more than 150<span class="elsevierStyleHsp" style=""></span>mg of caffeine daily. Caffeine induced disturbances in the development of central nervous system such as neural tube closure in animal models (mouse) have been reported<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Weng et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> conducted a population-based prospective cohort study designed to examine whether the risk of miscarriage is associated with caffeine consumption during pregnancy after controlling for pregnancy-related symptoms. An increasing dose of daily caffeine intake during pregnancy was associated with an increased risk of miscarriage, compared with no caffeine intake, with an adjusted hazard ratio (aHR) of 1.42 (95% confidence interval 0.93 to 2.15) for caffeine intake of less than 200<span class="elsevierStyleHsp" style=""></span>mg/day, and aHR of 2.23 (1.34 to 3.69) for intake of 200 or more mg/day, respectively. Nausea or vomiting during pregnancy did not materially affect this observed association, nor did the change in intake pattern of caffeine during pregnancy. In addition, the magnitude of the association appeared to be stronger among women without a history of miscarriage (aHR 2.33, 1.48 to 3.67) than that among women with such a history (aHR 0.81, 0.34 to 1.94). The authors concluded that high doses of caffeine intake during pregnancy increase the risk of miscarriage, independent of pregnancy-related symptoms<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The physiologic effects and common use of caffeine during pregnancy call for examination of maternal caffeine consumption and risk of birth defects. Epidemiologic studies have so far yielded mixed results. Browne et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> studied consumption of caffeinated coffee, tea, soda, and chocolate to estimate total caffeine intake and separately examined exposure to each caffeinated beverage. Smoking, alcohol, vasoactive medications, folic acid supplement use, and infant gender were evaluated for effect modification. Maternal interview reports for 4,196 cardiovascular malformation (CVM) case infants overall and 3,957 control infants were analyzed. The study did not identify any significant positive associations between maternal caffeine consumption and CVMs. For tetralogy of Fallot, nonsignificant elevations in risk were observed for moderate (but not high) caffeine intake overall and among nonsmokers (ORs of 1.3 to 1.5). Risk estimates for both smoking and consuming caffeine were less than the sum of the excess risks for each exposure. The authors observed an inverse trend between coffee intake and risk of atrial septal defect; however, this single <a name="p614"></a>significant pattern of association might have been a chance finding. In summary the study found no evidence for an appreciable teratogenic effect of caffeine with regard to CVMs<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Peripartum concerns</span><p id="par0095" class="elsevierStylePara elsevierViewall">Symptoms of caffeine withdrawal may occur during labor or in the parturient fasting before or after abdominal delivery. A significant relationship exists between daily caffeine intake prior to surgery and the incidence of postoperative headache<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. If regional anesthetic technique is selected, differentiation between post-dural puncture headache (PDPH) and caffeine withdrawal headache should be considered in all patients reporting postpartum headache.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">3. Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Caffeine is probably the most frequently ingested pharmacologically active substance in the world. Maternal use of caffeine in pregnancy continues to increase – worldwide. Nawrot et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> investigated the possibility that caffeine ingestion adversely affects human health. Based on the data reviewed, the authors concluded that for the healthy adult population, moderate daily caffeine intake at a dose level up to 400<span class="elsevierStyleHsp" style=""></span>mg day<span class="elsevierStyleSup">(−1)</span> (equivalent to 6<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">(−1)</span> body weight day<span class="elsevierStyleSup">(−1)</span> 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 behavior, increased incidence of cancer and effects on 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 <span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg caffeine per day (equivalent to 4.6<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">(−1)</span> bw day<span class="elsevierStyleSup">(−1)</span> for a 65–kg person) while children should consume <span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">(−1)</span> bw day<span class="elsevierStyleSup">(−1)6</span>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres173572" "titulo" => "Resumen" ] 1 => array:2 [ "identificador" => "xpalclavsec161868" "titulo" => "Palabras clave" ] 2 => array:2 [ "identificador" => "xres173573" "titulo" => "Summary" ] 3 => array:2 [ "identificador" => "xpalclavsec161869" "titulo" => "Key words" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "1. Social drug use in pregnancy: defining the problem" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "2. Caffeine in pregnancy: is there cause for concern?" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Pharmacology, epidemiology and pathophysiology" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis and clinical presentation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Interactions with pregnancy" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Peripartum concerns" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "3. Conclusion" ] 7 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2009-11-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec161868" "palabras" => array:6 [ 0 => "Embarazo" 1 => "Uso de drogas sociales" 2 => "Abuso de drogas" 3 => "Dependencia química" 4 => "Drogadicción" 5 => "Cafeína" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec161869" "palabras" => array:6 [ 0 => "Pregnancy" 1 => "Social drug use" 2 => "Drug abuse" 3 => "Chemical dependency" 4 => "Drug addiction" 5 => "Caffeine" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El uso materno de “drogas sociales” tales como cafeína, etanol y tabaco durante el embarazo se encuentra en aumento en todo el mundo. La cafeína es probablemente la sustancia farmacológicamente activa de uso más frecuente en todos los países. Se encuentra en bebidas comunes (café, té, refrescos), en productos que contienen cacao o chocolate, así como en medicaciones. Debido a su amplio consumo a diferentes niveles por la mayor parte de los segmentos de la población, la comunidad científica ha manifestado su interés en el potencial de la cafeína para producir efectos adversos en la salud humana. Las mujeres en edad reproductiva y las mujeres embarazadas son subgrupos de riesgo que pueden requerir consejos acerca de la moderación en la ingesta diaria de cafeína. Este artículo pone de manifiesto la implicación de la ingesta de cafeína durante el embarazo, revisa las últimas evidencias basadas en la información disponible sobre esta materia y ofrece recomendaciones (consejos prácticos) para anestesiólogos y ginecólogos-obstetras sobre los cuidados que hay que ofrecer en el transcurso del parto a estos embarazos potencialmente complicados.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maternal use of “social drugs” such as caffeine, ethanol and tobacco in pregnancy is on increase -worldwide. 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. Reproductive-aged and pregnant women are 'at risk' subgroups of the population who may require specific advice on moderating their daily caffeine intake. This article highlights the implications of caffeine intake in pregnancy, reviews the latest evidence-based information available on this subject, and offers recommendations (practical advice) for anesthesiologists and obstetrician-gynecologists proving peripartum care to these potentially complicated pregnancies.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bib0s0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of drug abuse on pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.M. Kuczkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/GCO.0b013e3282f1bf17" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Obstet Gynecol" "fecha" => "2007" "volumen" => "19" "numero" => "6" "paginaInicial" => "578" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18007137" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthetic implications of drug abuse in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.M. Kuczkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Anesth" "fecha" => "2003" "volumen" => "15" "paginaInicial" => "382" "paginaFinal" => "394" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14507568" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Labor analgesia for the drug abusing parturient: is there cause for concern?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.M. Kuczkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.OGX.0000082148.97981.30" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol Surv" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "599" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12972835" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.M. Gowda" 1 => "I.A. Khan" 2 => "N.J. Mehta" 3 => "B.C. Vasavada" 4 => "T.Y. 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Kuczkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Med J Malaysia" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "147" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14556345" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1474442208702151" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of caffeine on human health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Nawrot" 1 => "S. Jordan" 2 => "J. Eastwood" 3 => "J. Rotstein" 4 => "A. Hugenholtz" 5 => "H. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 1 | 3 | 4 |
| 2019 Abril | 0 | 3 | 3 |
| 2017 Julio | 11 | 1 | 12 |
| 2017 Junio | 9 | 14 | 23 |
| 2017 Mayo | 21 | 7 | 28 |
| 2017 Abril | 5 | 5 | 10 |
| 2017 Marzo | 14 | 2 | 16 |
| 2017 Febrero | 17 | 3 | 20 |
| 2017 Enero | 7 | 1 | 8 |
| 2016 Diciembre | 7 | 3 | 10 |
| 2016 Noviembre | 13 | 5 | 18 |
| 2016 Octubre | 25 | 6 | 31 |
| 2016 Septiembre | 28 | 5 | 33 |
| 2016 Agosto | 13 | 3 | 16 |
| 2016 Julio | 9 | 2 | 11 |
| 2016 Junio | 10 | 4 | 14 |
| 2016 Mayo | 17 | 9 | 26 |
| 2016 Abril | 16 | 10 | 26 |
| 2016 Marzo | 13 | 9 | 22 |
| 2016 Febrero | 7 | 4 | 11 |
| 2016 Enero | 23 | 12 | 35 |
| 2015 Diciembre | 7 | 3 | 10 |
| 2015 Noviembre | 9 | 6 | 15 |
| 2015 Octubre | 14 | 4 | 18 |
| 2015 Septiembre | 13 | 9 | 22 |
| 2015 Agosto | 7 | 5 | 12 |
| 2015 Julio | 8 | 5 | 13 |
| 2015 Junio | 4 | 2 | 6 |
| 2015 Mayo | 5 | 3 | 8 |
| 2015 Abril | 8 | 3 | 11 |
| 2015 Marzo | 8 | 4 | 12 |
| 2015 Febrero | 7 | 0 | 7 |
| 2015 Enero | 41 | 2 | 43 |
| 2014 Diciembre | 28 | 2 | 30 |
| 2014 Noviembre | 8 | 1 | 9 |
| 2014 Octubre | 11 | 0 | 11 |
| 2014 Septiembre | 7 | 2 | 9 |
| 2014 Agosto | 4 | 1 | 5 |
| 2014 Julio | 3 | 0 | 3 |
| 2014 Junio | 4 | 2 | 6 |
| 2014 Mayo | 6 | 1 | 7 |
| 2014 Abril | 10 | 2 | 12 |
| 2014 Marzo | 6 | 3 | 9 |
| 2014 Febrero | 6 | 0 | 6 |
| 2014 Enero | 4 | 2 | 6 |
| 2013 Diciembre | 6 | 3 | 9 |
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| 2013 Octubre | 4 | 1 | 5 |
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