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

De Silva, Manarangi; Panisi, Leeanne; Brownfoot, Fiona C; Lindquist, Anthea; Walker, Susan P; Tong, Stephen; Hastie, Roxanne

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.