Autor/a:
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Ome-Kaius, Maria; Unger, Holger Werner; Singirok, Dupain; Wangnapi, Regina A.; Hanieh, Sarah; Umbers, Alexandra J.; Elizah, Julie; Siba, Peter; Mueller, Ivo; Rogerson, Stephen John
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Abstract:
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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). |