Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

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

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

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

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.

Trial registration

ClinicalTrials.gov NCT01136850 (06 April 2010).
Literature
1.
Gupta PC, Ray CS. Epidemiology of betel quid usage. Ann Acad Med Singapore. 2004;33(4 Suppl):31–6.PubMed
2.
Gupta PC, Warnakulasuriya S. Global epidemiology of areca nut usage. Addict Biol. 2002;7(1):77–83.CrossRefPubMed
3.
Chu NS. Effects of Betel chewing on the central and autonomic nervous systems. J Biomed Sci. 2001;8(3):229–36.CrossRefPubMed
4.
5.
IARC/WHO. Betel-quid and areca-nut chewing and some areca-nut derived nitrosamines. IARC Monogr Eval Carcinog Risks Hum Suppl. 2004;85:1–334.
6.
Tsai YS, Lee KW, Huang JL, Liu YS, Juo SH, Kuo WR, et al. Arecoline, a major alkaloid of areca nut, inhibits p53, represses DNA repair, and triggers DNA damage response in human epithelial cells. Toxicology. 2008;249(2–3):230–7.CrossRefPubMed
7.
Deng JF, Ger J, Tsai WJ, Kao WF, Yang CC. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicology. 2001;39(4):355–60.
8.
Benjamin AL. Community screening for high blood pressure among adults in urban and rural Papua New Guinea. PNG Med J. 2006;49(3–4):137–46.
9.
Chu NS. Cardiovascular responses to betel chewing. J Formos Med Assoc. 1993;92(9):835–7.PubMed
10.
Benjamin AL. Community screening for diabetes in the National Capital District, Papua New Guinea: is betelnut chewing a risk factor for diabetes? PNG Med J. 2001;44(3–4):101–7.
11.
Tung TH, Chiu YH, Chen LS, Wu HM, Boucher BJ, Chen TH. A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Diabetologia. 2004;47(10):1776–81.CrossRefPubMed
12.
Thomas SJ, Harris R, Ness AR, Taulo J, Maclennan R, Howes N, et al. Betel quid not containing tobacco and oral leukoplakia: a report on a cross-sectional study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer. 2008;123(8):1871–6.CrossRefPubMed
13.
Pindborg JJ, Barmes D, Roed-Petersen B. Epidemiology and histology of oral leukoplakia and leukoedema among Papuans and New Guineans. Cancer. 1968;22(2):379–84.CrossRefPubMed
14.
Benjamin AL, Margis D. Betelnut chewing: a contributing factor to the poor glycaemic control in diabetic patients attending Port Moresby General Hospital. Papua New Guinea PNG Med J. 2005;48(3–4):174–82.
15.
Senn M, Baiwog F, Winmai J, Mueller I, Rogerson S, Senn N. Betel nut chewing during pregnancy, Madang province. Papua New Guinea Drug Alcohol Depend. 2009;105(1–2):126–31.CrossRefPubMed
16.
Yang MS, Lee CH, Chang SJ, Chung TC, Tsai EM, Ko AM, et al. The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan. Drug Alcohol Depend. 2008;95(1–2):134–9.CrossRefPubMed
17.
Chue AL, Carrara VI, Paw MK, Pimanpanarak M, Wiladphaingern J, van Vugt M, et al. Is areca innocent? The effect of areca (betel) nut chewing in a population of pregnant women on the Thai-Myanmar border. Int Health. 2012;4(3):204–9.CrossRefPubMed
18.
Klufio CA, Amoa AB, Augerea L, Wurr F. A case–control study of singleton low birthweight babies at the Port Moresby General Hospital. PNG Med J. 1997;40(3–4):136–45.
19.
de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52 Suppl 1:S5–15.PubMed
20.
de Costa C, Griew AR. Effects of betel chewing on pregnancy outcome. Aust N Z J Obstet Gynaecol. 1982;22(1):22–4.CrossRefPubMed
21.
Yang MJ, Chung TC, Yang MJ, Hsu TY, Ko YC. Betel quid chewing and risk of adverse birth outcomes among aborigines in eastern Taiwan. J Toxicology Environ Health A. 2001;64(6):465–72.CrossRef
22.
Yang MS, Chang FT, Chen SS, Lee CH, Ko YC. Betel quid chewing and risk of adverse pregnancy outcomes among aborigines in southern Taiwan. Public Health. 1999;113(4):189–92.CrossRefPubMed
23.
Taufa T. Betel-nut chewing and pregnancy. PNG Med J. 1988;31(4):229–33.
24.
25.
Gupta PC, Subramoney S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai. India BMJ. 2004;328(7455):1538.CrossRefPubMed
26.
IARC/WHO. Betel-quid and areca-nut chewing. IARC Monogr Evaluation Carcinog Risks Humans. 1985;37:137–202.
27.
Scrimgeour EM, McCall MG, Smith DE, Masarei JR. Levels of serum cholesterol, triglyceride, HDL-cholesterol, apoproteins A-I and B, and plasma glucose, and prevalence of diastolic hypertension and cigarette smoking in Papua New Guinea highlanders. Pathology. 1989;21(1):46–50.CrossRefPubMed
28.
Benjamin AL, Margis D. Betelnut chewing: a contributing factor to the poor glycaemic control in diabetic patients attending Port Moresby General Hospital, Papua New Guinea. P N G Med J. 2005;48(3–4):174–82.PubMed
29.
Unger HW, Ome-Kaius M, Wangnapi RA, Umbers AJ, Hanieh S, Suen CS, et al. Sulphadoxine-pyrimethamine plus azithromycin for the prevention of low birthweight in Papua New Guinea: a randomised controlled trial. BMC Med. 2015;13(1):9.CrossRefPubMedPubMedCentral
30.
Brabin BJ, Ginny M, Sapau J, Galme K, Paino J. Consequences of maternal anaemia on outcome of pregnancy in a malaria endemic area in Papua New Guinea. Ann Trop Med Parasitol. 1990;84(1):11–24.PubMed
31.
Allen SJ, Raiko A, O’Donnell A, Alexander ND, Clegg JB. Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea. Arch Dis Child Fetal Neonatal Ed. 1998;79(2):F135–140.CrossRefPubMedPubMedCentral
32.
DOH. National Malaria Treatment Protocol. Port Moresby. Papua New Guinea: National Department of Health; 2009.
33.
RCOG. Preterm Prelabour Rupture of Membranes (Green-top Guideline No. 44). London: Royal College of Obstetricians and Gynaecologists; 2010.
34.
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organisation (WHO); 2011.
35.
Taufa T. Betel-nut chewing and pregnancy. P N G Med J. 1988;31(4):229–33.PubMed
36.
Loannidis J. Why Most Published Research Findings Are False. PLoS Med. 2005;2(8):e124.CrossRef
37.
Mueller I, Rogerson S, Mola GD, Reeder JC. A review of the current state of malaria among pregnant women in Papua New Guinea. PNG Med J. 2008;51(1–2):12–6.
38.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013;346:f3443.CrossRefPubMedPubMedCentral
39.
Strickland SS, Veena GV, Houghton PJ, Stanford SC, Kurpad AV. Areca nut, energy metabolism and hunger in Asian men. Ann Hum Biol. 2003;30(1):26–52.CrossRefPubMed
40.
Mahmood AA, Al-Bayaty FH, Salmah I, Nor Syuhada AB, Harita H, Mughrabi FF. Enhancement of gastric ulcer by Areca catechu nut in ethanol-induced gastric mucosal injuries in rats. J Medici Plants Res. 2011;5(12):2562–9.
41.
Fukuda M, Fukuda K, Shimizu T, Andersen CY, Byskov AG. Parental periconceptional smoking and male: female ratio of newborn infants. Lancet. 2002;359(9315):1407–8.CrossRefPubMed
Metadata
Title
Determining effects of areca (betel) nut chewing in a prospective cohort of pregnant women in Madang Province, Papua New Guinea
Authors
Maria Ome-Kaius
Holger W Unger
Dupain Singirok
Regina A Wangnapi
Sarah Hanieh
Alexandra J Umbers
Julie Elizah
Peter Siba
Ivo Mueller
Stephen J Rogerson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0615-z

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Case report

A successful pregnancy and parturition in a patient with anuria undergoing maintenance hemodialysis for 6 years: a case report of a 3-year-follow-up

Research article

Amniotic fluid embolism: an Australian-New Zealand population-based study

Research article

Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone

Research article

Progression from gestational diabetes to type 2 diabetes in one region of Scotland: an observational follow-up study

Research article

Changes in maternal hemoglobin during pregnancy and birth outcomes

Research article

Determinants of use of care provided by complementary and alternative health care practitioners to pregnant women in primary midwifery care: a prospective cohort study