Finds study despite reports of negative impact on pregnancy outcomes

To understand low birth weight (LBW) and preterm birth, and explore the impact of betel quid (doma) chewing on pregnancy outcomes, a team conducted a study in Bhutan in 2015.

However, the study could not settle on clear evidence of association between LBW or preterm birth and betel quid chewing during pregnancy.

It has been found, though, that betel quid chewing is associated with increased odds of anemia.

An International UN volunteer public health programme officer with the World Health Organisation in Mongolia, Yuka Karasawa, said despite improvements in under-five mortality rates globally, less progress has been made for neonatal mortality rates.

“Prematurity and LBW are both strongly associated with neonatal mortality and morbidity. Weight at birth and gestational age have been used as indicators for newborn survival,” she said. “Betel quid chewing is the fourth common addictive substance in the world after tobacco, alcohol, and caffeine.”

She said that in Bhutan, chewing betel quid is cultural and is consumed by both men and women. About 61.5 percent of women in Bhutan were found to be betel quid chewers in 2010.

“Although several studies report the negative impact of betel quid chewing on pregnancy outcomes, the evidence is inconclusive,” she said.

The study was conducted as part of the global agenda to address preterm birth as a public health priority and to provide evidence to inform efforts to reduce neonatal morbidity and mortality in Bhutan.

Of the estimated causes of 2.7 million neonatal deaths in 194 countries from 2000 to 2015, preterm birth is the leading cause of neonatal death at 35 percent every year.

“Premature babies are at risk because of loss of body heat, inability to take enough nutrition, breathing difficulties and infections,” Yuka Karasawa said. “There are opportunities to reduce under-five mortalities by focusing on neonatal mortality and reducing preterm birth to achieve sustainable development goals target 3.2.”

Chewing betel quid stimulates the central nervous system and makes one feel warm, sweat, salivate, cardio-accelerate, and increase alertness.

According to the International Agency for Research on Cancer, 2004, chewing betel quid could cause cancer.

A multi-centre case-control design was used for the study. Information was collected using a semi-structured questionnaire from February 2015 to the beginning of March last year at the three-referral hospitals in Bhutan.

Yuka Karasawa said a trained interviewer enlisted study participants during their post-delivery stay before discharge from each hospital. A casual directed acyclic graph approach was used for building logistic regression models.

The referral hospitals had a total of 5,472 mothers of singleton live births from February 2015 to February 2016, of which 468 were eligible cases and 5,000 were eligible controls. Four did not have information on their child’s birth weight and gestational age.

Of the 669 participants, 55 percent of case mothers and 52 percent of the control mothers chewed betel quid during pregnancy. About 22 percent each of both case and control mothers used commercial betel products like Rajnigandha and Wiz during pregnancy.

Mothers of a singleton live-born whose birth weight was less than 2,500 grams and/or gestational age less than 37 completed weeks by last menstrual period participated as case mothers in the study.

Mothers of a singleton live-born whose birth weight was 2,500 or more grams and gestational age were equal to or more than 37 weeks were considered control mothers. Both case and control mothers are aged 17 and above.

It was also found that a total of 60 percent of the case mothers and 57 percent of the control mothers chewed either betel quid or packaged betel products during pregnancy.

Dechen Tshomo