The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women
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The Effects of Chewing Betel Nut with Tobacco and Prepregnancy Obesity on Adverse Birth Outcomes Among Palauan Women Katherine E. Berger1 • James Masterson2 • Joy Mascardo3,4 • Jayvee Grapa3,4 Inger Appanaitis3,4 • Everlynn Temengil3,5 • Berry Moon Watson3 • Haley L. Cash3,4
•
Ó Springer Science+Business Media New York 2016
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 & Katherine E. Berger [email protected] 1
2
School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Honolulu, HI 96822, USA
3
Department of Public Health, Ministry of Health, Koror, Republic of Palau
4
Office of Health Policy, Research and Development, Ministry of Health, Koror, Republic of Palau
5
Division of Behavioral Health, Ministry of Health, Koror, Republic of Palau
health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking. Keywords Betel nut Chewing tobacco Obesity Pregnancy Adverse birth outcomes Low birth weight Preterm birth Palau
Significance What is already known on this subject? Betel nut with simultaneous tobacco chewing is a common practice throughout Asia and the Pacific region. Chewing tobacco while pregnant may cause adverse birth outcomes. Obesity during pregnancy has been associated with preterm delivery. Adverse birth outcomes lead to long term health complications. What this study adds? Obesity and chewing betel nut with tobacco are both highly prevalent in the Republic of Palau. Women who reported chewing betel nut with tobacco showed an increased risk for having low birth weight among full-term infants. Our findings corroborate previous studies that show obese mothers are at a higher risk for preterm delivery.
Introduction The Republic of Palau is a small island nation of approximately 17,500
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