Determining effects of areca (betel) nut chewing in a prospective cohort of pregnant women in Madang Province, Papua New Guinea.

Maria Ome-Kaius,Alexandra J Umbers,Julie Elizah,Regina A Wangnapi,Holger W Unger,Dupain Singirok,Stephen J Rogerson,Sarah Hanieh,Ivo Mueller,Peter Siba

doi:10.1186/s12884-015-0615-z

Abstract

BackgroundChewing areca nut (AN), also known as betel nut, is common in Asia and the South Pacific and the habit has been linked to a number of serious health problems including oral cancer. Use of AN in pregnancy has been associated with a reduction in mean birthweight in some studies, but this association and the relationship between AN chewing and other adverse pregnancy outcomes remain poorly understood.MethodsWe assessed the impact of AN chewing on adverse outcomes including stillbirth, low birthweight (LBW, <2,500 g) and anaemia at delivery (haemoglobin <11.0 g/dL) in a longitudinal cohort of 2,700 pregnant women residing in rural lowland Papua New Guinea (PNG) from November 2009 until February 2013. Chewing habits and participant characteristics were evaluated at first antenatal visit and women were followed until delivery.Results83.3 % [2249/2700] of pregnant women used AN, and most chewed on a daily basis (86.2 % [1939/2249]. Smoking and alcohol use was reported by 18.9 % (511/2700) and 5.0 % (135/2688) of women, respectively.AN use was not associated with pregnancy loss or congenital abnormalities amongst women with a known pregnancy outcome (n = 2215). Analysis of 1769 birthweights did not demonstrate an association between AN and LBW (chewers: 13.7 % [200/1459] vs. non-chewers: 14.5 % [45/310], P = 0.87) or reduced mean birthweight (2957 g vs. 2966 g; P = 0.76). Women using AN were more likely to be anaemic (haemoglobin <11 g/dL) at delivery (75.2 % [998/1314] vs. 63.9 % [182/285], adjusted odds ratio [95 % CI]: 1.67 [1.27, 2.20], P < 0.001). Chewers more commonly had male babies than non-chewers (46.1 % [670/1455] vs. 39.8 % [123/309], P = 0.045).ConclusionsAN chewing may contribute to anaemia. Although not associated with other adverse pregnancy outcome in this cohort gestational AN use should be discouraged, given the potential adverse effects on haemoglobin and well-established long-term health risk including oral cancer. Future research evaluating the potential association of AN use and anaemia may be warranted.Trial registrationClinicalTrials.gov NCT01136850 (06 April 2010).

Highlights

Chewing areca nut (AN), known as betel nut, is common in Asia and the South Pacific and the habit has been linked to a number of serious health problems including oral cancer
Interested women were screened for eligibility and were excluded if they had i) symphysis-pubis fundal height >26 cm, ii) haemoglobin (Hb)
Tobacco smoking and alcohol use was reported by 18.9 % (511/2700) and 5.0 % (135/2688) of women, respectively, and both were more common among AN users (Table 1)

Summary

Introduction

Chewing areca nut (AN), known as betel nut, is common in Asia and the South Pacific and the habit has been linked to a number of serious health problems including oral cancer. Use increases the risk of hypertension and arrhythmias [7, 8], possibly due to the effects of arecoline on the autonomic nervous system [3, 9], and has been linked to endocrine disease such as diabetes [10, 11]. These adverse effects have been demonstrated in a range of different geographical settings including Papua New Guinea (PNG) [8, 12], where widespread AN use has been reported [13,14,15]

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