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Caffeine and SIDS

Risk Factor or Not?

Translation to the Polish language, courtesy of Alice Slaba (February 2015)

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Translation to the French language, courtesy of Rutherd Barn (June 2019)

(1/28/98)

Dear Friends,

The following article hit the news this morning. We have received many e-mail messages asking for more information. The public has been on an information roller coaster, the result of an explosion of medical reports, each heralding a 'breakthrough in SIDS research. We need to help people separate myth from fact and risk factor from cause. We are currently gathering more information about this specific research and will keep you updated.

Please keep the following in mind:

- When it comes to media coverage of SIDS, we often feel a sense of frustration in being confronted with misleading headlines, announcements of so-called breakthroughs and statements taken out of context.

- Please read the article, "Mass Media's" Role in SIDS Education, at <http://sids-network.org/media.htm>.

- This article does not claim that caffeine cause SIDS.

- The article statement that "... the New Zealand study is the first to suggest a link to SIDS" appears to be false. A "caffeine AND sids" search of the National Library of Medicine's MEDLINE service at <http://www.nlm.nih.gov/> reveals an entry from early 1997 that suggests a similar link (Nurse Pract 1997 Feb;22(2):66-67 "Melatonin: media hype or therapeutic breakthrough?" by Kendler BS).

Heavy caffeine intake in pregnancy and sudden infant death syndrome

R P K Ford,a P J Schluter,a E A Mitchell,b B J Taylor,c R Scragg,d A W Stewart,e the New Zealand Cot Death Study Group

a Community Paediatric Unit, Christchurch, b Department of Paediatrics, University of Auckland, c Department of Paediatrics, University of Otago, d Department of Epidemiology, University of Auckland, e Department of Biostatistics, University of Auckland

Correspondence to: Dr R P K Ford, Community Paediatric Unit, Community Child and Family Service, PO Box 25-265, Christchurch, New Zealand.

AIMS: To examine the association between maternal caffeine consumption during pregnancy and the risk of sudden infant death syndrome (SIDS).
METHODS: A nationwide case-control study surveying parents of 393 SIDS victims and parents of 1592 control infants. Caffeine consumption in each of the first and third trimesters was estimated by questionnaire. Heavy caffeine intake was defined as 400 mg/day or more (equivalent to four or more cups of coffee per day).
RESULTS: Infants whose mothers had heavy caffeine consumption throughout their pregnancy had a significantly increased risk for SIDS (odds ratio 1.65; 95% confidence interval 1.15 to 2.35) after adjusting for likely confounding factors.
CONCLUSION: Caffeine intake has been associated with fetal harm and now SIDS. Reducing heavy caffeine intake during pregnancy could be another way to lessen the risk of SIDS. This needs confirmation by others.

Key messages

· Heavy maternal caffeine consumption throughout pregnancy was significantly associated with an increased relative risk for SIDS (OR 1.65) after adjustment for confounders

· Caffeine consumption of 400 mg/day (equivalent to four or more cups of coffee per day) was defined to be heavy

· Caffeine consumption is a modifiable behavior

· Reducing heavy caffeine intake during pregnancy may decrease the risk of SIDS

We are currently gathering more information about this specific research and will keep you updated.

Thanks!

Chuck Mihalko
Executive Manager
SIDS Network

Date: Wed, 28 Jan 1998

Sounds preliminary but plausible. However, I think it's very premature for them to suggest that this effect is due to blunting of respiratory drive, etc. Reports of the effects of caffeine on respiratory control are conflicting. It has been reported that caffeine depresses the ventilatory response to hypoxia (acute). On the other hand, it has also been reported that in piglets caffeine abolishes the late VE decline (phase 2) of the so-called 'biphasic' VE response to hypoxia. Somebody reported that the excitatory effects of caffeine on VE were mediated by the carotid bodies in lambs... somebody else said that caffeine has no effect on carotid body discharge in cats, etc etc. The literature is a bit of a mess. I'm not aware of a paper looking specifically at the effects of prenatal caffeine exposure on postnatal development of O2 sensitivity (or CO2, or any other aspect of respiratory control maturation).

Other effects of caffeine during pregnancy seem complicated and some effects are only significant in mothers who smoke, for example. There may be complicated interactions. Caffeine consumption during pregnancy may affect *sleep* in the offspring and have other neurological effects that would be relevant to SIDS.

On the other hand, it is true that reducing caffeine consumption is a relatively easy behavior to modify.

John L. Carroll, M.D.
The Johns Hopkins Children's Center
Pediatric Pulmonary Division, Park 316
600 North Wolfe Street
Baltimore, Maryland 21287-2533

Date: Wed, 28 Jan 1998

This is a very good, but preliminary study that is the first to suggest that heavy coffee (>4 cups/Day) is associated with an increased risk of SIDS. The authors including Ed Mitchell, a very respected and capable SIDS epidemiologist, caution that confirmation of their results is needed. Their evidence which makes this finding reasonable, including the known consequences of lower birth weights in humans and adenosine receptor abnormalities occurring after chronic caffeine ingestion in animals. It would seem prudent to limit coffee consumption during pregnancy, not just to PERHAPS reduce the SIDS risk, but also to reduce other potential complications such as low birth weight, which is associated with other complications.

Henry Krous
hkrous@health.ucsd.edu
Children's Hospital - San Diego

Media Advisory From The SIDS Alliance about caffeine and SIDS (1/29/98)

(6/11/96)

A pediatrician and SIDS mom I spoke with recently had her subsequent infant (different father) tested and found a breathing problem which was treated with caffeine. He is now a thriving 16 month old. What do you think of caffeine or some other stimulant for SIDS-prone babies (assuming we could identify them ahead of time).

Dr. Carl Hunt of Medical College of Ohio, Toledo looked at this years ago. Caffeine does not prevent SIDS. It is a neurostimulant that works well for apnea of prematurely, a common breathing problem in preterms and easily diagnosed by "testing" (pneumogram or event recording). Many of our preterm infants are treated with caffeine for apnea of prematurely and sent home on caffeine (>200 in last 4 years). Caffeine will also normalize breathing patterns in full term infants with apnea as reported by Drs. Kelly and Shannon from Boston.

I hope this helps.

JDDeCristofaro, MD
University Medical Center
Stony Brook, NY
Infant Apnea Program

March 1999

Caffeine and alcohol as risk factors for sudden infant death syndrome

B Alma, G Wennergrena, G Norveniusa, R Skjærvenb, N Øyenb, K Helweg-Larsenc, H Lagercrantzd, L M Irgensb, on behalf of the Nordic Epidemiological SIDS Study

a Department of Paediatrics, Sahlgrenska University Hospital/Östra, S-416 85 Göteborg, Sweden, b The Medical Birth Registry of Norway, N-5021 Bergen, Norway, c The Danish Institute for Clinical Epidemiology, 2100 Copenhagen, Denmark, d Department of Paediatrics, Karolinska Hospital, S-17176 Stockholm, Sweden

Correspondence to: Dr Alm.

OBJECTIVE; To assess whether alcohol and caffeine are independent risk factors for sudden infant death syndrome (SIDS).
MATERIALS AND METHODS; Analyses based on data from the Nordic epidemiological SIDS study, a case control study in which all parents of SIDS victims in the Nordic countries from 1 September 1992 to 31 August 1995 were invited to participate with parents of four controls, matched for sex and age at death. Odds ratios (ORs) were calculated by conditional logistic regression analysis.
RESULTS; The crude ORs for caffeine consumption > 800 mg/24 hours both during and after pregnancy were significantly raised: 3.9 (95% confidence interval (CI), 1.9 to 8.1) and 3.1 (95% CI, 1.5 to 6.3), respectively. However, after adjustment for maternal smoking in 1st trimester, maternal age, education and parity, no significant effect of caffeine during or after pregnancy remained. For maternal or paternal alcohol use, no significant risk increase was found after adjusting for social variables, except for heavy postnatal intake of alcohol by the mother, where the risk was significantly increased.
CONCLUSIONS; Caffeine during or after pregnancy was not found to be an independent risk factor for SIDS after adjustment for maternal age, education, parity, and smoking during pregnancy. Heavy postnatal but not prenatal intake of alcohol by the mother increased the risk.

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