Systematic review of areca (betel nut) use and adverse pregnancy outcomes

Abstract

Background Betel nut is the fourth most commonly abused substance worldwide and has been associated with significant adverse health outcomes. Little is known about its effects on the fetus. Objective To perform a systematic review of studies investigating prenatal betel nut use and adverse perinatal outcomes. Search strategy Pubmed, Embase, and Cochrane databases were searched from inception until July 2018 using the terms areca, betel nut, pregnancy, pregnancy complications, and infection. Selection criteria Eligible studies included case–control, cohort, and randomized control studies involving pregnant women. Data collection and analysis Where appropriate, bivariate meta‐analysis was performed, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Main results In total, 28 studies were screened and eight studies (including 15 270 women) were included in the review and meta‐analysis. Preterm birth, low birthweight, and anemia were most commonly investigated. Meta‐analysis revealed a significant association between betel nut use and low birthweight, with a pooled OR of 1.75 (95% CI, 1.35–2.27). Conclusions The review identified only eight eligible studies, all based in the Asia–Pacific region. There was a significant association between low birthweight and betel nut exposure in pregnancy. Further prospective studies are needed to confirm this association.

Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: A scoping review

“… 49 Studies from Southeast Asia have also reported betel nut chewing during pregnancy as having an impact on birth weight, fetal length and preterm birth. 15 , 29 , 68 The magnitude of the effects of betel nut chewing on birth outcomes remains unclear. Reductions in birth weight from betel nut use appear to be at least as large as those reported for smoking during pregnancy.…”

“…Betel nut use is practised in PNG, Solomon Islands, Palau and the Marshall Islands. 29 Studies have reported that betel nut use is associated with oral cancers in the region and elsewhere. 29 , 30 Studies in LMIC countries outside the Pacific Island region (South East Asia) have also shown betel nut use to be adversely associated with adverse birth outcomes.…”

“… 29 Studies have reported that betel nut use is associated with oral cancers in the region and elsewhere. 29 , 30 Studies in LMIC countries outside the Pacific Island region (South East Asia) have also shown betel nut use to be adversely associated with adverse birth outcomes. 29 Kava, a traditional drink made from Piper methysticum, is another unique exposure to many Pacific Islanders, including those from Fiji, Vanuatu and Samoa.…”

“… 29 , 30 Studies in LMIC countries outside the Pacific Island region (South East Asia) have also shown betel nut use to be adversely associated with adverse birth outcomes. 29 Kava, a traditional drink made from Piper methysticum, is another unique exposure to many Pacific Islanders, including those from Fiji, Vanuatu and Samoa. 31 There is a dearth of studies on kava use and its impact on birth outcomes, 32 and to date, there has been no systematic assessment of the burden of, and risk factors for adverse birth outcomes in the Pacific Island region.…”

Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: a scoping review protocol

“…There is some indication that levels of alcohol consumption and tobacco and substance use (including betel or areca nut) may be among the highest globally. [19][20][21][22][23] The aim of this scoping review is to synthesise available results from studies on the prevalence and risk factors of adverse birth outcomes in the Pacific Island region.…”