This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/IJGO.12971 This article is protected by copyright. All rights reserved REVIEW ARTICLE Systematic review of areca (betel nut) use and adverse pregnancy outcomes Manarangi De Silva 1,2,* , Leeanne Panisi 3 , Fiona C. Brownfoot 1,2 , Anthea Lindquist 1,2 , Susan P. Walker 2 , Stephen Tong 1,2 , Roxanne Hastie 1,2 1 Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia 2 Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia 3 Department of Obstetrics and Gynecology, National Referral Hospital, Honiara, Solomon Islands * Correspondence Manarangi De Silva, Department of Obstetrics and Gynecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg 3084, Australia Email: rangi.desilva@unimelb.edu.au KEYWORDS Adverse outcomes; Areca; Betel nut; Pregnancy; Pregnancy complications SYNOPSIS A review of the evidence of adverse perinatal outcomes and areca use identified eight studies in the Asia–Pacific region showing an association with low birthweight. 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 Author Manuscript