title: Consequences of smoking and caffeine consumption during pregnancy in women with type 1 diabetes.
abstract: OBJECTIVE
  To test the hypothesis that, in women with type 1 diabetes, prenatal smoking and caffeine consumption during pregnancy are associated with an increased risk of adverse maternal and perinatal outcomes.
  
  
  METHODS
  A secondary analysis of data on pregnant women with type 1 diabetes from an interdisciplinary program of Diabetes in Pregnancy. Women were interviewed monthly, by a trained non-medical member of the research team, using a standardized questionnaire, to ascertain daily smoking habits and caffeine consumption.
  
  
  RESULTS
  Smoking and caffeine information were available on 191 pregnancies, 168 progressing beyond 20 weeks of gestation. Early pregnancy smoking (OR 3.3, 95% CI 1.2, 8.7) and caffeine consumption (OR 4.5, 95% CI 1.2, 16.8) were associated with increased risk of spontaneous abortion when controlling for age, years since diagnosis of diabetes, previous spontaneous abortion, nephropathy and retinopathy. Smoking throughout pregnancy was significantly associated with decreased birth weight and prolonged neonatal hospital stay. Smoking throughout pregnancy (OR 0.2, 95% 0.1, 1.0) and caffeine consumption after 20 weeks (OR 0.3, 95% CI 0.1, 1.0) were associated with reduced risk of pre-eclampsia.
  
  
  CONCLUSIONS
  Caffeine consumption during early pregnancy, regardless of glycemic control, increases the risk of spontaneous abortion. Smoking throughout pregnancy and caffeine consumption are associated with reduced risk of pre-eclampsia.
authors.affiliation: Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0056, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Khoury
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.forename: C R
authors.initials: CR
authors.lastname: Buncher
authors.forename: H
authors.initials: H
authors.lastname: Kalkwarf
authors.forename: S
authors.initials: S
authors.lastname: McElvy
authors.forename: P R
authors.initials: PR
authors.lastname: Khoury
authors.forename: B
authors.initials: B
authors.lastname: Sibai
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001724:Birth Weight / Q000187:drug effects; D002110:Caffeine / Q000506:poisoning*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000150:complications*; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires
chemical_list: D002110:Caffeine