title: The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.
abstract: The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.
authors.affiliation: School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. bergerk@ohsu.edu.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Berger
authors.affiliation: Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Honolulu, HI, 96822, USA.
authors.forename: James
authors.initials: J
authors.lastname: Masterson
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.|Office of Health Policy, Research and Development, Ministry of Health, Koror, Republic of Palau.
authors.forename: Joy
authors.initials: J
authors.lastname: Mascardo
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.|Office of Health Policy, Research and Development, Ministry of Health, Koror, Republic of Palau.
authors.forename: Jayvee
authors.initials: J
authors.lastname: Grapa
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.|Office of Health Policy, Research and Development, Ministry of Health, Koror, Republic of Palau.
authors.forename: Inger
authors.initials: I
authors.lastname: Appanaitis
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.|Division of Behavioral Health, Ministry of Health, Koror, Republic of Palau.
authors.forename: Everlynn
authors.initials: E
authors.lastname: Temengil
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.
authors.forename: Berry Moon
authors.initials: BM
authors.lastname: Watson
authors.affiliation: Department of Public Health, Ministry of Health, Koror, Republic of Palau.|Office of Health Policy, Research and Development, Ministry of Health, Koror, Republic of Palau.
authors.forename: Haley L
authors.initials: HL
authors.lastname: Cash
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000208:ethnology; D001114:Areca / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008409:Mastication; D009765:Obesity; D019029:Palau / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult; D062789:Tobacco Products
keywords: Adverse birth outcomes; Betel nut; Chewing tobacco; Low birth weight; Obesity; Palau; Pregnancy; Preterm birth