title: Is areca innocent? The effect of areca (betel) nut chewing in a population of pregnant women on the Thai-Myanmar border.
abstract: Eight manuscripts have specifically examined the effects of areca (betel) nut use in pregnant women, seven of which have documented adverse effects on birth weight, newborn neurological status, gender ratio and pregnancy outcomes such as anaemia and miscarriage following areca nut use during pregnancy. A retrospective cohort analysis of migrant and refugee pregnant women attending antenatal clinics along the Thai-Myanmar border (July 1997 to November 2006) was conducted to examine the adverse effects of areca nut use routinely recorded on enrolment. Of 7685 women, 2284 (29.7%) never used areca or smoked (cheroots), 2484 (32.3%) only used areca, 438 (5.7%) only smoked cheroots and 2479 (32.3%) used both areca and cheroots. Pieces of ripe areca nut in a leaf with lime, without tobacco, were used particularly among older multigravid women. Adverse pregnancy effects were not observed in areca nut users compared with non-users. Smoking, but not areca nut use, had a dose-related effect on miscarriage. Areca nut use in conjunction with smoking reduced the adverse effects of smoking on birth weight, further supporting a lack of effect of areca nut. Areca (betel) nut-related adverse pregnancy outcomes were not observed in this population, whereas smoking was clearly harmful. Differences from previous reports may result from the amount or types of areca nut, or quid content, consumed between countries. Smoking, but not areca nut, reduction is likely to improve pregnancy outcomes on the Thai-Myanmar border.
authors.affiliation: Shoklo Malaria Research Unit, 68/30 Baan Tung Road, P.O. Box 46, Mae Sot, Tak 63110, Thailand.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Chue
authors.forename: Verena I
authors.initials: VI
authors.lastname: Carrara
authors.forename: Moo Kho
authors.initials: MK
authors.lastname: Paw
authors.forename: Mupawjay
authors.initials: M
authors.lastname: Pimanpanarak
authors.forename: Jacher
authors.initials: J
authors.lastname: Wiladphaingern
authors.forename: Michele
authors.initials: M
authors.lastname: van Vugt
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: François
authors.initials: F
authors.lastname: Nosten
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
references.citation: IARC Monogr Eval Carcinog Risks Hum. 2004;85:1-334
references.pmid: 15635762
references.citation: Aust N Z J Obstet Gynaecol. 1982 Feb;22(1):22-4
references.pmid: 6954939
references.citation: Public Health. 1999 Jul;113(4):189-92
references.pmid: 10483082
references.citation: J Pediatr. 1970 Jul;77(1):1-10
references.pmid: 5430794
references.citation: Arch Dis Child Fetal Neonatal Ed. 2005 May;90(3):F276-7
references.pmid: 15846024
references.citation: Drug Alcohol Depend. 2009 Nov 1;105(1-2):126-31
references.pmid: 19665325
references.citation: Ann Trop Paediatr. 2000 Dec;20(4):323-36
references.pmid: 11219171
references.citation: Trans R Soc Trop Med Hyg. 2003 Mar-Apr;97(2):251-5
references.pmid: 14584386
references.citation: Carcinogenesis. 2000 Jul;21(7):1365-70
references.pmid: 10874015
references.citation: P N G Med J. 1988 Dec;31(4):229-33
references.pmid: 3269687
references.citation: Asian Pac J Cancer Prev. 2011;12(9):2149-56
references.pmid: 22296348
references.citation: Indian Pediatr. 1983 Feb;20(2):105-11
references.pmid: 6862608
references.citation: Am J Epidemiol. 2001 Sep 1;154(5):459-65
references.pmid: 11532788
references.citation: Soc Sci Med. 1982;16(1):99-106
references.pmid: 7201676
references.citation: J Toxicol Environ Health A. 2001 Nov 23;64(6):465-72
references.pmid: 11732697
references.citation: Ultrasound Obstet Gynecol. 2009 Oct;34(4):395-403
references.pmid: 19790099
references.citation: J Can Dent Assoc. 2004 Apr;70(4):244-8
references.pmid: 15120019
references.citation: J R Soc Interface. 2012 Mar 7;9(68):503-10
references.pmid: 21849388
references.citation: Lancet. 1998 Nov 7;352(9139):1521-2
references.pmid: 9820305
references.citation: Trans R Soc Trop Med Hyg. 1991 Jul-Aug;85(4):424-9
references.pmid: 1836685
references.citation: J Biomed Sci. 2001 May-Jun;8(3):229-36
references.pmid: 11385294
references.citation: Indian J Pharmacol. 2010 Oct;42(5):306-11
references.pmid: 21206624
references.citation: Addict Biol. 2002 Jan;7(1):99-102
references.pmid: 11900628
references.citation: Ann Acad Med Singap. 2004 Jul;33(4 Suppl):31-6
references.pmid: 15389304
references.citation: J Oral Pathol Med. 1995 Jul;24(6):241-3
references.pmid: 7562658
references.citation: Drug Alcohol Depend. 2008 May 1;95(1-2):134-9
references.pmid: 18282667