BMJ  2003;326:1269 (7 June), doi:10.1136/bmj.326.7401.1269

Letter

Consumption of coffee during pregnancy

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—In a prospective study we found that coffee drinking during pregnancy was associated with an increased risk of stillbirth, but not with death in infancy.¹ Our results on stillbirth seemed to indicate a threshold effect around four to seven cups per day, but the risk estimate in women with the highest intake of coffee was based on only 11 stillbirths and we therefore had no possibility to explore further the relation between coffee and stillbirth in women drinking eight or more cups of coffee per day. Ludwig claims that a dose dependent association is the gold standard for establishing a causal relation. This is not correct. A monotonic, unidirectional dose-response curve is neither necessary nor sufficient for establishing a causal relation.²

Our result may represent a causal relationship or be due to other factors associated with coffee drinking and stillbirth. Sindos et al are particularly concerned about the . . . [Full text of this article]

kiwi@perinatal.dk Perinatal Epidemiological Research Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, DK-8200 Aarhus, Denmark

Department of Obstetrics and Gynaecology, Aarhus University Hospital

Department of Paediatrics, Aarhus University Hospital

Department of Epidemiology and Social Medicine, University of Aarhus, DK-8000 Aarhus C, Denmark

Danish Epidemiology Science Centre, University of Aarhus

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