Effects of Occupational Tobacco Exposure on Mother and Foetus in Beedi Rollers

Abstract

Background and objectives: Beedi rolling is a popular household occupation amongst the economically poor female population of coastal Karnataka districts. This study aimed to identify the effects of occupational tobacco exposure on the beedi rolling pregnant mother and her neonate. The objectives were to study the maternal outcomes with respect to hypertension in pregnancy, anemia, abruptio-placenta, preterm labor and the neonatal outcomes such as low birth weight, low appearance, pulse grimace, activity, respiration (APGAR) and clinical assessment of nutrition status (CANS) score. Methods: This prospective cohort study was conducted in a tertiary care hospital in Mangaluru from February 2014 to June 2015. A sample size of 500 was calculated with a 95% confidence level and 85% power. Cohort groups of 250 each were randomized as beedi rollers and non-beedi rollers based on the history of exposure and were prospectively followed till delivery. Results: The study results showed overall complications of 37.6 % among the beedi rollers which was clinically and statistically significant. Among the beedi rollers, 22.4% mothers had hypertension in pregnancy, of which 13.4%, had gestational hypertension, 8.2% pre-eclampsia, 0.4% had eclampsia, 27.6% were anaemic, and 9.6% had fetal growth restriction. There was no increase in the incidence of preterm labor, abrubtio-placenta. Our study also showed an increased risk of low birth weight (29.4%), but no significant difference in APGAR scores and CANS score among both groups. Based on the ROC curve we found, rolling 425 beedis can be taken as a safe limit during pregnancy with a sensitivity of 73.4% and specificity of 53.2% and 22 weeks period of gestation can be taken as safe limit up to which beedis can be rolled during pregnancy with a sensitivity of 61.7% and specificity of 64.1%. Clinical significance: In this study, dreadful complications can be attributed to beedi rolling. Majority of it can be prevented by health education and simple preventive measures such as using masks and gloves while rolling beedis for which further studies are warranted.