COFFEE AND PREGNANCY McDermott S, Wareing M, Lavender T, Thomas S Background for Study Almost £730 million is spent on coffee each year An estimated 1.6 billion cups of coffee are consumed everyday On average, women consume approximately 1.5 cups of coffee a day 75% of women state that they consume coffee during their pregnancy Physiological Effects Benefits of coffee consumption Weight Loss Diabetes Cancer Parkinson’s disease Suicide Hepatic injury, cirrhosis and hepatocellular carcinoma Risks of coffee consumption Cardiovascular disease Increased homocysteine levels Stroke Pancreatic, bladder and ovarian cancer Osteoporosis and hip fracture Mineral deficiencies Coffee Consumption and Pregnancy Coffee consumption and the risk of: Miscarriage FGR/SGA Developmental problems Disease in later life Delays in conception and general poor pregnancy outcome Current Coffee Information Below 200mg a day/ 2 mugs of instant coffee a dayFood Standards Agency, UK 200mg per day throughout pregnancy- Food Safety Authority of Ireland Up to 300mg caffeine a day- Antenatal NICE guidelines, UK Do not drink more than 4 cups or glasses of caffeinecontaining drinks- Irish Nutrition and Dietetic Institute, Health Promotion Unit What are women’s and midwives’ views and opinions on coffee consumption? Methodology Pragmatic Paradigm Alternative Through to the more dominant paradigms combining research approaches we are offered the best opportunity for answering important research questions Protocol and Standard Operating Procedures Ethical Approval Granted Begin the Interviewing Process Interview Midwives21 in total Interview Women- 20 in total Complete Interviews Transcriptions Analysis and Initial Findings Analysis Framework analysis Immersing oneself in data (familiarization) Identifying and developing a thematic framework Indexing Charting and Mapping Interpretation Findings Variation in advice on coffee/caffeine consumption General advice is ≤ 2 cups of coffee a day ‘I would probably check what her normal caffeine intake was and then go from there because if she regularly drinks coffee from... [cafes]... that’s quite a lot stronger than normal coffee that’s something where she should be decreasing it quite a lot’ Midwife Rita ‘And I think it’s 6-8 cups of tea and 4-6 cups of coffee was recommended, yea, but don't know whether that’s changed’ Midwife Jenny Findings Variation in advice on coffee/caffeine consumption Midwives try to prioritise the advice they give; coffee consumption is quite low down on the list ‘I don't think it was something I would volunteer to bring up in other appointments because you only have 15 minutes and as the pregnancy is going on there are more concerns to talk about such as the upcoming labour or fetal movements or anything else. So it tends to not be at the forefront’ Midwife Amy ‘I think it’s balancing isn’t it because there’s things like smoking and drug taking and probably on the hierarchy of things it’s not as high up as other things’ Midwife Fiona Findings Variation in advice on coffee/caffeine consumption Midwives discussed personal experiences of pregnant women and coffee ‘I guess, one woman once… was asking about the drinks, probably one of the only times a woman asked me about her diet was that she said ‘I’ve been drinking these caffeinated fizzy drinks’ and I said ‘well how many do you drink?’ and she said ‘oh, a few a day’ and I said ‘well I really don't think you should have too much of those, you know too much caffeine is bad in pregnancy’. It happened to be that appointment that it took us a very long time to find her fetal heart and I was really concerned thinking that maybe, obviously having heard this research that too much caffeine is bad in pregnancy and then… taking a long time to find her baby’s heart beat, I was concerned that some damage had been done. In the end I did find it which was a huge reassurance’ Midwife Sarah Findings Variation in advice on coffee/caffeine consumption Women feel that they are overloaded with information ‘I teach antenatal care and women are bombarded with information at booking and a whole array of leaflets and I’m not quite sure how much is read or more worryingly how much of it is understood. So I think that anything that is given should then be backed up, at some stage, with a conversation’ Midwife Emma ‘But I haven’t read it all…… Because I haven’t got the time’ Catherine Findings Knowledge about coffee Miscarriage ‘raised blood pressure, linked with IUGR and miscarriages. And then preconception… infertility or less likely to get pregnant’ Midwife Rita ‘it never crossed my mind to tell them, plus, to be fair, when we booked them, they were about 12 or 13 weeks pregnant. The risk of miscarriage is decreased towards the end of the first trimester and they were approaching the second. You’ve thought someone else would have talked to them about it or would have had information from elsewhere because it’s kind of a bit late, is it by then’ Midwife Anna Findings Knowledge about coffee Need to decrease amount ‘having problems conceiving I wanted to… increase my chances of getting pregnant and I just found it really difficult knowing how much caffeine I had in any one drink. You know, you don’t have it written on the side of the cups in most cases so I wasn’t sure what was a safe amount to drink’ Samantha Findings Knowledge about coffee Side effects and general physiological/psychological effects ‘my knowledge of, I suppose of caffeine is probably limited, you know to the fact that it’s a stimulant, in varying amounts’ Midwife Emma ‘I’d imagine it’s not good for your heart, the heart rate of the child, I don’t know really but I think you know the less chemicals you put in your body the better really. I don’t think it’s necessarily going to harm your baby massively but it depends on how much you drink, if you’re drinking 10 cups a day perhaps that, to me, sounds too much’ Sandra Findings Sources of midwifery information Continuing professional development ‘As soon as something changes and it becomes a big thing in the NICE guidance we change the way we do things, there has to be really gold standard research for changing practice otherwise it’s really just traditional care and advice that we’ve learnt over the years from being a student and we’ve heard it said over and over again and we repeat the same things over and over again and it might not be right but if the question hasn’t been asked and hasn’t been researched and we get guidance from bigger authorities who we take notice of then we don’t give it, we just carry on with the standard advice’ Midwife Mary Findings Sources of midwifery information Media ‘I ask the students ‘you are giving these out, by doing that, as a midwife, you are actually endorsing the information that’s inside. Do you know what you’re giving them?’ because in the bounty packs there’s a lot of advertising. So I actually get the students to actually look at the information that they’re actually giving and the other sources from the web and so on and so forth, to get them thinking of whether it’s evidence based……what I’m asking them to look at and consider’ Midwife Emma Findings Sources of midwifery information Renew/Review their information regularly ‘you’ve got your midwives from various ages and generations have been trained as well saying different things- I think if you had somebody 10 years older than me and 10 years younger than me, probably we’d be saying 3 different things’ Midwife Patricia Findings Sources of midwifery information Want more information as they feel information is lacking ‘I should probably know more than I do but I don't. I don't really understand the why it’s not a good idea- that’s what I don't really understand’ Midwife Claire Findings Sources of women's information Internet ‘We did… a lucky dip [in a pregnancy class] and one week one of the things was internet sites and we just used to advise the women that anybody can put anything on the internet…. use a trusted site, but that’s hard [for the women] to know if it is a trusted site’ Midwife Emily ‘I do like sign-posting women to Tommy’s, because it used to be a Tommy centre…. and then just any of the pregnancy websites really’ Midwife Anna Findings Sources of women's information ‘Apps’ ‘The youth of today, well they love their text messaging, their BBM, their facebook, twitter…somebody clever could do something for that age group’ Midwife Patricia ‘that first bit of information I actually got from an application, you know an app. It was pregnancy e, I don’t know if you’ve heard of them but it was an application that I downloaded….I sort of felt that everything I just read was probably sufficient, and in the application anyway, the pregnancy e one, everyday it sends you different things, suggestions and things, and so it reminds you, at least weekly about diet and caffeine and alcohol’ Lucy Findings Sources of women's information Media ‘And the caffeine, I don’t think it’s advertised enough, if you advertised it a little bit more they might take it on board’ Midwife Rita ‘campaigns on the television, campaigns in the paper, campaigns on the radio…. works while they’re campaigning and then 4 to 6 months down the line they’ve forgotten that campaign’ Midwife Patricia Findings Sources of women's information Forums ‘I think they could be good for communication. I’m not quite sure where they get all their evidence from, therefore it would make me question it, but I have looked at MumsNet ‘cause I’m interested in what women know, where they get their sources of information from and I think it's a good forum’ Midwife Emma ‘Baby centre, that website as well, I used that quite a lot during my pregnancy for different things. That actually was recommended by my GP…. he said that it was a really good website’ Midwife Ashley Findings Sources of women's information Women lack awareness of coffee/caffeine and are concerned ‘You sit in...[the antenatal clinic]... waiting area in antenatal and everybody has got a massive cup of Costa coffee with them, all heavily pregnant, so obviously they’re not aware’ Samantha ‘I was surprised that you see your midwife less, you know I think every pregnancy is different really and you can still be worried about how the baby is developing regardless of whether it’s your first or second’ Sandra Findings Desire for more information Specific leaflets ‘if it was on a leaflet it would have to be visual. And then you’ve got to think of languages, especially in Manchester, we’ve got a very diverse, multicultural population’ Midwife Emma ‘Probably it would be to give women a better information leaflet…. what tells them why they need to avoid…because a lot of the time they don’t understand’ Midwife Rita Findings Desire for more information Media ‘there’s always something new coming out on the TV and in the media isn’t there. So that will get people talking… and they’ll ask questions at their booking appointment if they’ve heard something anyway’ Midwife Kirsty Discussion The need and desire for more information Timing and Presentation of Information Benefits to the study: Influence care provision or encourage a more holistic approach to maternal and fetal health Encourage the provision of information for expectant women Improve women’s education on their pregnancy Future Work Further analysis What’s next? Thank you! A special thank you to: Dr Mark Wareing Professor Dame Tina Lavender Suzanne Thomas All the recruitment staff, health care professionals and midwives of St. Mary’s Hospital All the women in St. Mary’s who have participated in this study Any Questions?