Available online at www.sciencedirect.com Drug and Alcohol Dependence 95 (2008) 134–139 The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan Mei-Sang Yang a , Chien-Hung Lee b , Shun-Jen Chang c , Tieh-Chi Chung d , Eing-Mei Tsai e , Allen Min-Jen Ko f , Ying-Chin Ko g,∗ a College of Nursing, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan b Faculty of Public Health, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan c Department of Public Health, School of Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan d Department of Health Business Administration, Meiho Institute of Technology, No. 23 Pingguang Road, Neipu, Pingtung 242, Taiwan e Department of Obstetrics and Gynecology, School of Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan f St. Vincent’s Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Sydney, Australia g Faculty of Medicine, School of Medicine, Kaohsiung Medical University; Division of Environmental Health and Occupational Medicine, National Health Research Institutes. No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan, ROC Received 25 July 2007; received in revised form 19 December 2007; accepted 3 January 2008 Available online 20 February 2008 Abstract In considering documented developmental toxicity and teratogenicity found in earlier research, maternal betel quid chewing may very well be linked to a higher risk of adverse birth outcomes. The aim of this study was to investigate the significance of betel quid chewing, together with the use of cigarettes or alcohol, either independently or combined, on birth-related outcomes. A total of 1264 aboriginal women who had just given birth in 10 hospitals in Southern and Eastern Taiwan were recruited. Information on their maternal and newborn characteristics was obtained from medical charts and by performing personal interviews using a validated questionnaire. Maternal areca nut chewing during pregnancy was found to be significantly associated with both birth weight loss (-89.54 g) and birth length reduction (-0.43 cm). A significantly lower male newborn rate (aOR=0.62) was observed among aboriginal women with a habit of betel quid chewing during pregnancy. The use of this substance conveyed a 2.40- and 3.67-fold independent risk of low birth weight and full-term low birth weight, respectively. An enhanced risk (aOR = 3.26–5.99) of low birth weight was observed among women concomitantly using betel quid, cigarette and alcohol during gestation. Our findings suggest that betel quid chewing during pregnancy has a substantial effect on a number of birth outcomes, including sex ratio at birth, lower birth weight and reduced birth length. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Areca nut; Offspring sex ratio; Adverse birth outcomes 1. Introduction Betel quid is a substance that has long been widespread in Southeast Asia and in migrant communities originating from these regions (Gupta and Warnakulasuriya, 2002). It is the fourth most commonly used drug in the world after tobacco, alcohol and caffeine (Winstock, 2002). In Taiwan, among aboriginal people, 46.5% of men and 38.0% of women were reported to be current betel quid users; on the other hand, the prevalence of ∗ Corresponding author. Tel.: +886 7 3114418; fax: +886 7 3162725. E-mail address: ycko@nhri.org.tw (Y.-C. Ko). the use of this substance was 9.8% in men and 1.6% in women in general population (Ko et al., 1992). Additionally, a previ- ous study found that 23.7% of aboriginal women chewed betel quid during pregnancy, as compared to 0.78% of non-aboriginal women in Taiwan (Lua et al., 1995). The most popular ingredients in betel quid in Taiwan are betel (also named areca) nut, slaked lime and a piece of unripe fruit from the species Piper betel. Betel quid itself has been commer- cialized in Taiwan, and can be easily purchased from various stands located in the community. According to the report from Ko et al., lesser educated older men, blue collar workers, smok- ers and drinkers were at a higher risk of chewing betel quid (Ko et al., 1992). Although tobacco is an important additive in 0376-8716/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2008.01.003