Population Attributable Fractions of Caffeine and Water Pipe on low birth weight: The Bandar-Abbas Population-based Cohort in suburban areas
Abstract Background: Low Birth Weight (LBW) poses a major health challenge in low-resource suburban communities. Despite relatively commonality, there is little evidence on the effects of water pipe and dietary caffeine on reproductive outcomes in the Middle-East region. The Bandar Abbas Pregnancy Cohort (BAPC), as a population-based prospective study, has been investigating the effects of lifestyle and environmental factors on maternal wellbeing and child growth and development in suburban communities in the south of Iran. This study used the BAPC data to estimate the attribution of LBW incidence to fully or partially removal of dietary caffeine intake and water pipe smoking during pregnancy.Methods: The present study used data on 861 live singleton pregnancies in the first two BAPC visits (response rate= 95.42%). Water pipe smoking (yes/no) was measured during pregnancy using a structured checklist recommended by the World Health Organization (WHO). Dietary caffeine intake was measured during pregnancy using a structured checklist and categorized into low for 0-99 mg/day, and high for>100 mg/day. LBW (yes/no) was determined using recorded birth weight in infant`s vaccination card. Exposure relative risks were calculated using Modified Poisson regression models. Population Attributable Fractions (PAFs) and Generalized Impact Fractions (GIFs) were calculated on relative risk scale. The prevalence of counter fact was set as 3% for water pipe smokers and 14.9% for intake of >100 mg/day caffeine.Results: The cumulative incidence of LBW was 16.1%. An estimated 19% (95%CI: 6, 30%) and 11% (95%CI: 8, 14%) of LBW were attributed to high intake of dietary caffeine and water pipe smoking, respectively. Reducing the intake of caffeine to less than 100 mg/day or prevalence of water pipe to 3% would prevent 10.7% (95%CI: 6.6, 25.3%) and 5.7% (95%CI: 5.0, 6.8%) of LBW incidence, respectively. Conclusions: Our findings have provided evidence on quantitative contributions of caffeine and water pipe on LBW using real-world data. Integration of this information into practical action plans to prevent LBW is the next step in our cohort project. Furthermore, to get an overarching picture and in-depth understanding of reproductive effects of caffeine and water pipe, exercising this study`s analytic approach in other contexts is encouraged.