BMJ  2003;326:1268 (7 June), doi:10.1136/bmj.326.7401.1268-a

Letter

Consumption of coffee during pregnancy

Authors should adjust for history of drug abuse

EDITOR—We read with interest the article of Wisborg et al.¹ The authors support that high maternal coffee consumption during pregnancy is associated with an increased risk of stillbirth but not with infant death. They mention that women with a high intake of coffee are more likely to be smokers and to have a high intake of alcohol. They correctly adjusted their results for smoking and drinking habits. However, they do not provide any information about drug abuse among these women.

Consumption of eight or more cups of coffee is suggestive of addictive behaviour. The use of illegal drugs such as cocaine is associated with an increased incidence of parallel cigarette and alcohol use.^{2 3} The adverse effect of maternal use of heroin, cocaine, crack cocaine, and benzodiazepines in pregnancy has been adequately documented.^3–5 The use of cannabis may not be a major prognostic factor regarding the outcome of pregnancy but is an indicator of low socioeconomic status and use of other harmful drugs.²

The authors draw the profile of pregnant women who consume high amounts of coffee. They tend to be older, more often multiparous, more likely to be single, less likely to be students, and they had fewer years of education. Interestingly this description matches with the profile of drug users.^{3 4} For the above reasons we believe that the exclusion of the information of drug abuse from the study is a methodological error.

sindosgyn{at}hotmail.com

Department of Women's Health, Whittington Hospital, London N19 5NF

Women's Health Directorate, St Thomas' Hospital, London SE1 7EH

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Competing interests: None declared.

References

1. Wisborg K, Kesmodel U, Hammer Beck B, Hedegaard M, Brink T. Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life: prospective study. BMJ 2003;326: 420-2. (22 February.)[Abstract/Free Full Text]
2. Miller JM Jr, Boudreaux MC. A study of antenatal cocaine use—chaos in action. Am J Obstet Gynecol 1999; 180: 1427-31.[Medline]
3. Singer L, Arendt R, Song LY, Warshawsky E, Kliegman R. Direct and indirect interactions of cocaine with childbirth outcomes. Arch Pediatr Adolesc Med 1994;148: 959-64.[Abstract]
4. Martinez A, Larrabee K, Monga M. Cocaine is associated with intrauterine fetal death in women with suspected preterm labor. Am J Perinatol 1996;13: 163-6.[Medline]
5. McCarthy JE, Siney C, Shaw NJ, Ruben SM. Outcome predictors in pregnant opiate and polydrug users. Eur J Pediatr 1999;158: 748-9.[Medline]

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Relevant Article

Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life: prospective study

Kirsten Wisborg, Ulrik Kesmodel, Bodil Hammer Bech, Morten Hedegaard, and Tine Brink Henriksen
BMJ 2003 326: 420. [Abstract] [Full Text] [PDF]