In the UK, 1 in every 250 pregnancies ends in stillbirth** (when a baby dies after 24 weeks gestation). Research has identified various things that can raise the risk of stillbirth, from a mother’s age and ethnicity to consumption of cigarettes and alcohol, but this study aimed to clarify the mixed evidence on caffeine – a key issue in a country where 80% of the population drinks coffee and the average person consumes 211.5 litres of (often highly caffeinated) soft drinks a year***.

Scientists from Tommy’s stillbirth research centre at the University of Manchester studied more than 1,000 mothers across 41 UK hospitals between 2014 and 2016. They combined information typically used to measure stillbirth risk with an interviewer-led questionnaire about mothers’ consumption of various caffeinated drinks, as well as other risk factors like alcohol and cigarettes that have confused previous studies, to see if and when stillbirth may have been linked to caffeine****.

When caffeine crosses the placenta, babies can’t process it like adults, and it can endanger their lives. Current NHS guidance is to keep daily caffeine intake below 200mg when pregnant, while the World Health Organization (WHO) cites 300mg as the safe limit. This new study reports a 27% increase in stillbirth risk for each 100mg consumed, suggesting that safe limits in these guidelines need to be reconsidered.

The Tommy’s team found an increasing relationship between caffeine consumption and stillbirth risk – and although most (54.5%) participants cut down on caffeine while pregnant, 1 in 20 actually consumed more during pregnancy, showing a lack of awareness about the caffeine content of certain drinks and/or the risks associated with high intake.

Energy drinks had the most impact, leading to 1.85x higher stillbirth risk, followed by instant coffee (1.34x) and cola (1.23x). Researchers noted that it wasn’t possible to separate the impact of caffeine from that of sugar in cola and chemicals like taurine in energy drinks, so more detailed investigation is needed.

The main source of pregnant women’s caffeine consumption was tea, but the study found this did not pose a significant risk as its caffeine levels are quite low (around 75mg per 350ml). Filtered or decaffeinated coffee, chai, green tea and hot chocolate were also shown to have no association with stillbirth.

91直播 author Prof Alexander Heazell, Tommy's research centre director and professor of obstetrics at the University of Manchester, commented: “Caffeine has been in our diets for a long time, and, as with many things we like to eat and drink, large amounts can be harmful – especially during pregnancy. It’s a relatively small risk, so people shouldn’t be worried about the occasional cup of coffee, but it’s a risk this research suggests many aren’t aware of.

“Anyone planning to have a baby needs to know that consuming caffeine during pregnancy can raise the risk of stillbirth and other pregnancy complications, so it’s important to cut down as much as you can; the national guidelines should be the limit, not the goal, and the more you can cut down beyond that the better. Breaking habits can be hard, but little things like switching to decaf and swapping fizzy drinks for fruit juice or squash can really help reduce the risk. If you’re worried or confused, talk to your doctor or midwife, or use tools like Tommy’s caffeine calculator.”

A 2018 poll by Tommy's found that 61% of women would consume less caffeine after being made aware of how much is ‘hidden’ in certain soft drinks, and the charity has free online resources to help mums-to-be understand and reduce their pregnancy risks, including a caffeine calculator and healthy pregnancy tool.

Charlotte Stirling-Reed, registered nutritionist and mum to three-year-old Raffy and four-month-old Ada, said: “Caffeine intake can be really confusing, even as someone with a background in nutrition; it can be hard to work out the amounts consumed, and many people just aren’t aware of how much caffeine is in some of their favourite foods and drinks.

“All mums want the best for their baby during pregnancy and beyond, so anything that can be done to help break down the guidance and give practical tips on why and how to cut down is really important. Tommy’s research and practical tools are really key to supporting as many families as possible.”

The UK’s stillbirth rate is 24th out of 49 high-income countries*, and while a Government aim to halve stillbirth rates by 2025 has resulted in promising initiatives like the NHS Care Bundle, campaigners are calling for more concerted efforts to educate parents and professionals about the risks.

Tommy’s chief executive Jane Brewin explained: “Eight babies are stillborn every day in the UK**, and the reasons often have nothing to do with diet and lifestyle – but we know there are some things we can do to reduce the risk of this tragedy, so communicating these latest research findings as widely as possible is a vital part of our mission to save babies’ lives.

“This study found that midwives and internet resources had the most impact on pregnant women’s caffeine consumption, so we need to make better use of their influence to support mothers throughout their pregnancy journey. Risk is a complex concept to communicate, so healthcare professionals may need training to help them get these messages across.”

The new study was published today in the European Journal of Obstetrics and Gynaecology. To find out more about Tommy’s stillbirth prevention work, go to tommys.org/research. For information and advice on pregnancy health, visit tommys.org/your-pregnancy-1-2-3, or you can measure your caffeine intake at tommys.org/caffeine-calculator.

*

**

***

**** The Midlands and North of England Stillbirth 91直播 (MiNESS) was a case control study of 1,024 pregnancies across 41 UK maternity units from 2014-16, comparing 291 non-anomalous singleton stillbirths at/before 28 weeks gestation with no congenital anomaly to 733 ongoing pregnancies. Researchers combined information on factors associated with stillbirth and typically used to measure risk with responses to an interviewer-administered questionnaire on maternal behaviours, including consumption of a variety of caffeinated drinks and soft drinks (instant coffee, filter coffee, decaf coffee, tea, chai, green tea, hot chocolate, energy drinks, cola). Anecdotally, older women often drink more caffeine, and those who drink more caffeine are more likely to smoke and drink alcohol; these factors are also associated with stillbirth and existing research evidence has been unable to separate the risks. This study used multivariable analysis to adjust for co-existing demographic and behavioural factors (age, ethnicity, BMI, smoking, alcohol, education, supplements, sleep habits, gestation and weight at birth) to determine if/when stillbirth was linked to caffeine.

www.tommys.org/pregnancy-information/im-pregnant/pregnancy-news-and-blogs/many-pregnant-women-are-over-consuming-caffeine

*

Mothers who experience psychological stress and domestic abuse are more likely to have stillborn babies – but attending more antenatal care appointments than UK guidelines currently dictate can reduce that risk, according to a new study from Tommy’s 91直播 Research Centre at The University of Manchester.

In the UK, 1 in every 250 pregnancies ends in stillbirth - when a baby dies after 24 weeks gestation. This rate is estimated to almost double in the most deprived parts of the nation compared to the most affluent areas but research has struggled to explain the difference as studies aren’t always able to adjust for other risk factors linked to deprivation, such as cigarette smoking, education, housing, ethnicity, migrant status and social stress.

Scientists from Tommy’s Maternal and Fetal Health Research Centre at the University of Manchester studied more than 1,000 births across 41 UK hospitals between 2014 and 2016. They combined information typically used to measure stillbirth risk with an interviewer-led questionnaire about mothers’ behaviour and social characteristics, taking into account other factors like smoking that have muddied the waters in previous research***, to see if and when stillbirth may have been avoidable.

The research team found that women from the most deprived socio-economic group were at almost triple the risk of stillbirth than those at the other end of the scale (2.96x higher risk - 6.09% vs 1.44%). Interestingly, this was a sudden change in the most deprived group rather than a gradual rise across the spectrum. Unemployed mothers were similarly more likely to have stillborn babies (2.85x higher risk - 6.12% vs 1.32%).

High levels of perceived stress were shown to double the risk of stillbirth (3.57% vs 1.17%) independent of other social factors and pregnancy complications that can put pressure on mothers. London mum Louise Joines, 36, gave birth to stillborn son Gabriel in December 2017 after a physically healthy but psychologically stressful pregnancy; she had a busy job as a deputy head teacher and 2 children at home with no support from the baby’s father. Despite asking to see a mental health specialist during the pregnancy, Louise was not referred and wonders now if that help could have saved her baby.

Louise said: “I found out I was expecting Gabriel just as I ended a strained relationship with his dad, so it was a very stressful pregnancy from the start. I told my midwife about my situation but sadly nothing came of it, so that’s a big ‘what if’ – a friend who had mental health care during pregnancy wasn’t allowed to go past 40 weeks, and Gabriel was born at 41 weeks, so perhaps if I’d been given the right support he would be alive today. We need better systems to protect pregnant mothers, and I hope that sharing Gabriel’s legacy will help to prevent other families losing a baby.”

The new study also found links between stillbirth and abusive relationships. Women who declined to answer a question about domestic abuse were over 4x more likely to experience stillbirth (6.70% vs 2.61%) – but those who answered yes did not have a higher risk, possibly because their willingness to disclose this information to researchers meant they’d also done so to other external parties who could then intervene to protect mother and baby.

26-year-old Lucy Wakeling from Worthing gave birth to stillborn daughter Hope in July 2018 after an extremely stressful pregnancy, intensified by emotional abuse from her ex-partner who didn’t want the baby and ended the relationship when she was 7 weeks pregnant. Lucy said: “He was so unpredictable, one minute wanting to be involved and the next threatening to ‘take the baby away as soon as you’ve finished breastfeeding’, saying my bump was small and accusing me of not looking after myself when I’d lost my appetite from stress.

“At 25 weeks pregnant I cut contact with him, until I invited him to the baby’s funeral, where he told me this wouldn’t have happened if I’d just had the abortion he wanted. It’s taken me a really long time to come to terms with such a heart-breaking loss, but the doctors said it shouldn’t happen again – so although I struggle to imagine it, I look forward to the day I can hold my baby, alive and healthy. I want to raise awareness by sharing Hope’s story in case it can help and protect others.”

Researchers noted that increased antenatal care could give strong protection against stillbirth, with 72% lower risk for mothers who went to more appointments than national guidelines dictate. Cardiff mum Sophie Tugwell had check-ups every other day for almost a month after a routine scan showed her baby was very small, and credits this extra care with the safe arrival of her now seven-month-old son. Sophie explained: “If the hospital hadn’t kept such a close eye on us, I might have never had the chance to come home with a baby.”

Currently, the UK’s stillbirth rate is 24th out of 49 high-income countries****, and researchers say the significant variation within and between developed countries suggests more could be done to prevent these babies’ deaths. A Government aim to halve stillbirth rates by 2025 has resulted in promising initiatives like the NHS Care Bundle – but in light of this new study, campaigners are calling for stillbirth prevention strategies to join up maternity care with other support systems in order to protect mothers and babies.

Tommy’s chief executive Jane Brewin commented: “1 in 250 UK pregnancies end in stillbirth, and while attending antenatal appointments can reduce the risk, this research shows that stillbirth is not a problem we can solve with healthcare alone. The complex relationships identified here between stillbirth and social stresses make it clear that the Government’s prevention strategy must extend beyond the NHS to tackle these deeper underlying issues within society.”

91直播 author Prof Alex Heazell, Tommy's Research Centre Director and obstetrics professor at the University of Manchester, added: “We know people are more likely to disclose issues such as stress and domestic abuse to a professional if they have a good relationship with them and believe that person can help. Maternity care providers should be supported and trained to have open conversations, and connect patients with any other services they need, so that we can start to reduce the risks for these women and their babies.”

The new study was published today in the British Journal of Obstetrics & Gynecology. For more information about this major ongoing research into stillbirth risk, visit tommys.org.

Women who develop diabetes in pregnancy but are not diagnosed are much more likely to experience stillbirth than women without the condition, according to new research.

The study, led by the University of Leeds and the University of Manchester, found that the risk of stillbirth was over four-times higher in women who developed signs of gestational diabetes but were not diagnosed.

However, with appropriate screening and diagnosis that increased risk of stillbirth disappeared.

Funded by the charities Action Medical Research, Cure Kids, Sands and Tommy’s, the study compared the symptoms and care of 291 women who experienced a stillbirth to 733 similar women who did not experience a stillbirth across 41 maternity units in England.

Researchers found that across all women with high blood sugar, measured after a period of fasting, they had on average twice the risk of stillbirth than women without the condition.

The increased risk was likely to be caused by the missed diagnoses and lack of subsequent care experienced by many of the women, although the results show an association only, and cannot provide certainty about cause and effect.

The new research was published in BJOG: An International Journal of Obstetrics and Gynaecology.

Dr Tomasina Stacey, who led the study at the University of Leeds and now works at the University of Huddersfield, said: "There's good news and there's bad news. The good news is that women with gestational diabetes have no increase in stillbirth risk if national guidelines are followed for screening, diagnosis and management. The bad news is that the guidelines are not always followed and some women therefore experience avoidably higher risk."

According to recent figures, approximately 5% of women in the UK experience gestational diabetes during pregnancy.

The National Institute for Care Excellence (NICE) recommends that all women at a higher risk of gestational diabetes should receive blood screening for the condition: this includes women with a raised body mass index (a BMI of over 30), or from South Asian or Black Caribbean ethnic groups.

Only 74.3% of the participating women with a raised BMI and 74.7% of the participating women from South Asian or Black Caribbean ethnic groups received screening.

On average, women at higher risk of gestational diabetes who were not screened according to the NICE guidelines also experienced higher risks of stillbirth.

Co-author Professor Alexander Heazell, from the University of Manchester and Clinical Director of Tommy’s Stillbirth Research Centre, said: “It's not clear why some women missed out on being screened or diagnosed for gestational diabetes, but this needs to be improved.

“Gestational diabetes can cause serious complications in pregnancy. It's important that we detect every woman with symptoms so she can receive the appropriate care and support.”

In 2015, the NICE raised the threshold for diagnosing gestational diabetes to a fasting plasma glucose concentration – where blood sugar is measured after fasting – of greater than 5.6mmol/L. In the United States the threshold is 5.1mmol/L, and there is considerable debate worldwide about the appropriate level for diagnosis.

The present study found little evidence to support one threshold over another, instead finding that the risk of stillbirth increased steadily with increasing glucose concentration.

Dr Stacey, who also works at Calderdale and Huddersfield NHS Foundation Trust, added: "There's no blood sugar level where the risk suddenly jumps. The choice of the right threshold for diagnosis is therefore more about pragmatism and finding the right balance of risk to resource, and avoiding over-medicalisation. Our study shows that the current NICE guidelines can be effective, but only if they are followed."

According to recent figures from MBBRACE-UK, around four in every thousand pregnancies in the UK result in stillbirth.

Commenting on the research, Mr Edward Morris, Vice President of Clinical Quality at the Royal College of Obstetricians and Gynaecologists, said: “Women with gestational diabetes are more likely to have a stillbirth, but with adequate monitoring, care and treatment, this risk can be managed so that women can maximise their chances of having a healthy pregnancy and birth.

“Maternity units should follow NICE clinical guidance to ensure women are diagnosed and supported to avoid complications and ensure the best possible outcomes.”

The study is unique for separating the harmful biological effects of raised glucose from the benefits of diagnosis, which typically leads to better care and management of the condition.

Co-author Dr Peter Tennant, from the University of Leeds and the Alan Turing Institute, explained why this is so important. He said: "There's a lot of debate about the true impact of gestational diabetes, and whether it's worth spending so much time and money on screening, diagnosis, and care for these mothers. But most women with diabetes currently receive good care, and this really seems to help.

“Only when you look at women who aren't appropriately screened or diagnosed, does the full impact of gestational diabetes become clear."

The research project came out of a Stillbirth Summit in 2011, and was created with the help of more than 550 parents and members of the public. It was designed by and for parents, to try to maximise the positive impact it could have on society.

The paper is titled ‘Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK’ and will be available online

More information on gestational diabetes - including symptoms, treatment, and management – can be found on the .

Further analysis suggested the intervention might prevent five stillbirths for every 10,000 babies born. The effects were too small to prove that the care package had been beneficial, however. The team say further research will be needed.

91直播 lead Professor Jane Norman, Director of the Edinburgh Tommy’s Centre at the University of Edinburgh, said: “The study was designed to detect an effect of 30 per cent or greater. The results suggest that if there is a beneficial effect, it is much smaller than this. It is not possible to say with certainty that the intervention has any effect on reducing rates of stillbirth.

“The research adds further evidence to suggest that being aware of baby movements may help to marginally reduce risks of stillbirth, but it is unlikely that this strategy alone will be reliable for monitoring the wellbeing of babies in the womb. Other interventions will likely be needed to reduce stillbirth rates worldwide.”

In the group that received the care package, more women were induced early and there were higher rates of caesarean section deliveries, the study found.

Researchers say an economic analysis of these data will help policy makers assess whether this approach might fit into a stillbirth reduction strategy.

Professor Alexander Heazell, co-investigator on the study, said: “There are a number of other ongoing fetal movement awareness studies. Results from the AFFIRM trial should be analysed in conjunction with those studies before recommendations can be made on wider implementation of this approach.”

An estimated 2.6 million babies are stillborn each year around the world. In the UK, around 1 in 200 pregnancies end in stillbirth, around 9 babies every day.

Up to a half of women whose pregnancy ends in stillbirth report reduced movements of their babies in the womb in the previous week.

Jane Brewin, Chief Executive of Tommy’s, said: “We know that reduced baby movements is associated with the placenta not working so well and the baby’s health being compromised. The advice for mums-to-be remains the same – if your baby’s movements change please consult your midwife or local maternity unit immediately.”

The study, published in The Lancet, was initiated and funded by the Scottish Government’s Chief Scientist Office. It was also funded by Tommy’s, the baby charity, and Sands, the Stillbirth and Neonatal Death Charity.

Dr Clea Harmer, Chief Executive at Sands (stillbirth and neonatal death charity), said: “Women’s awareness of their baby’s movements remains a key part of public health information during pregnancy. At least 1 in 3 of the parents Sands supports tells us that their baby’s movements had slowed down or changed in the womb before they died. Getting the message out that women need to report any concerns straightaway remains vital to routine antenatal care.”