Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure

Abstract

IntroductionAs providing health education, optimizing nutrition, and managing risk factors can be effective for ensuring a healthy outcome for women and her yet un-conceived baby, external influences play a significant role as well. Alcohol, smoking, caffeine use and other similar lifestyle factors, have now become an integral part of the daily life of most men and women, who use/misuse one or more of these harmful substances regularly despite knowledge of their detrimental effects. The adverse health outcomes of these voluntary and involuntary exposures are of even greater concern in women of child bearing age where the exposure has the potential of inflicting harm to two generations. This paper is examining the available literature for the possible effects of caffeine consumption, smoking, alcohol or exposure to chemicals may have on the maternal, newborn and child health (MNCH).MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception usage of caffeine, tobacco, alcohol and other illicit drugs; and exposure to environmental chemicals and radiant on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsHeavy maternal preconception caffeine intake of >300mg/d significantly increase the risk of a subsequent fetal loss by 31% (95% CI: 8-58%). On the other hand, preconception alcohol consumption leads to non-significant 30% increase in spontaneous abortion (RR 1.30; 95% CI: 0.85-1.97). Preconception counselling can lead to a significant decrease in the consumption of alcohol during the first trimester (OR 1.79; 95% CI: 1.08-2.97). Periconception smoking, on the other hand, was found to be associated with an almost 3 times increased risk of congenital heart defects (OR 2.80; 95% CI 1.76-4.47). While the review found limited evidence of preconception environmental exposure on maternal, newborn and child health outcomes, occupational exposure in female radiation workers before conception showed an increased impact in risk of early miscarriages.ConclusionIdentification of substance abuse and environmental history during preconception period provides an opportunity to assist women in reducing major health risks and identify key determinants of healthy pregnancy. Studies have shown that the aversion and prevention of exposure feasibility can play an important role in improving the health of women and their families, however, the results should be interpreted with great caution as there were few studies in each section. Therefore, there is a need for more rigorous studies to test the hypotheses.

Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose–response meta-analysis of prospective studies

“…However, our results should be interpreted with caution in consideration of methodological limitations of the original studies and other potential issues such as residual confounding and publication bias that may have influenced our results. Most previous reviews on maternal caffeine intake and pregnancy loss included only a qualitative summary of the evidence (17,48,49) , used estimates that were not adjusted for potential confounders (50) or included only five studies on preconception caffeine intake (51) . A recent meta-analysis reported significant associations stronger than those observed in our meta-analysis between higher maternal caffeine intakes and higher risks of miscarriage (summary RR = 1·14 per 100 mg caffeine/d, 95 % CI 1·10, 1·19 in that study compared with 1·08, 95 % CI 1·04, 1·13 in our study) and stillbirth (summary RR = 1·19, 95 % CI 1·05, 1·35 in that study compared with 1·09, 95 % CI 1·02, 1·16 in our study) (18) .…”

Substance Use and Preconception Care: A Review of the Literature

“…The use of illicit drugs, such as cocaine, marijuana, and methamphetamines, is associated with pregnancy complications, such as placental abruption, low birth weight infants, an increased risk of infant mortality, and neonatal abstinence syndrome (6,(25)(26)(27)(28). Further, caffeine intake in women prior to pregnancy has not been conclusively shown to affect fertility; however, it may increase their risk for spontaneous abortion in the first trimester (29)(30)(31).…”

“…Alcohol exposure during pregnancy can cause maternal morbidity, neonatal birth defects, and developmental disabilities (6,22,27,(32)(33)(34). The most well-known detrimental outcome of alcohol use in pregnancy is fetal alcohol syndrome in the infant (35).…”

Identification of Behavioral Risk Factors During Pregnancy

“…A protective environment for the pregnancy evolution in order to reduce the fetus exposure risk as much as possible, will ensure its optimal development. Exposure to smoking, increased consumption of caffeine and alcohol during pregnancy, was commonly described as potentially threatening the woman and child health [8,9,10].…”