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


METHODS
We 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.


RESULTS
83.3% [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).


CONCLUSIONS
AN 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.


BACKGROUND
ClinicalTrials.gov NCT01136850 (06 April 2010).
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. marai.kaius@gmail.com.
Maria
M
Ome-Kaius
Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Post Office Royal Hospital, Parkville, Melbourne, VIC 3050, Australia. hwunger@doctors.org.uk.
Holger W
HW
Unger
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. marai.kaius@gmail.com.
Dupain
D
Singirok
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. wangnapi.regina@yahoo.com.
Regina A
RA
Wangnapi
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. shanieh@unimelb.edu.au.
Sarah
S
Hanieh
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. alex.umbers@gmail.com.
Alexandra J
AJ
Umbers
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. marai.kaius@gmail.com.
Julie
J
Elizah
Papua New Guinea Institute of Medical Research (PNG IMR), PO BOX 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. pmaxsiba@gmail.com.
Peter
P
Siba
Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, 3052, Parkville, Australia. mueller@wehi.edu.au.|Barcelona Centre for International Health Research (CRESIB), Rosselo 132, 08036, Barcelona, Spain. mueller@wehi.edu.au.
Ivo
I
Mueller
Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Post Office Royal Hospital, Parkville, Melbourne, VIC 3050, Australia. sroger@unimelb.edu.au.
Stephen J
SJ
Rogerson
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology*; D001114:Areca; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult