Maternal and Child Health Journal

, Volume 20, Issue 8, pp 1696–1703 | Cite as

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women

  • Katherine E. Berger
  • James Masterson
  • Joy Mascardo
  • Jayvee Grapa
  • Inger Appanaitis
  • Everlynn Temengil
  • Berry Moon Watson
  • Haley L. Cash


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 health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.


Betel nut Chewing tobacco Obesity Pregnancy Adverse birth outcomes Low birth weight Preterm birth Palau 



We thank the staff at the Palau Ministry of Health Office of Health, Policy, Research, and Development, as well as the Family Health Unit for their support. Additionally, we would like to thank the Public Health Program at Oregon Health and Science University for their partnership with the Palau Ministry of Health. We would also like to thank all of the local staff who collected these data. Finally, we are grateful to the women and children of Palau. Funding was obtained from Health Resources and Services grant B04 MC. All authors operated independently of this grant. The funding body did not play a role in the study design, writing of the manuscript, or the decision to submit the manuscript for publication.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Katherine E. Berger
    • 1
  • James Masterson
    • 2
  • Joy Mascardo
    • 3
    • 4
  • Jayvee Grapa
    • 3
    • 4
  • Inger Appanaitis
    • 3
    • 4
  • Everlynn Temengil
    • 3
    • 5
  • Berry Moon Watson
    • 3
  • Haley L. Cash
    • 3
    • 4
  1. 1.School of MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.Office of Public Health StudiesUniversity of HawaiiHonoluluUSA
  3. 3.Department of Public HealthMinistry of HealthKororRepublic of Palau
  4. 4.Office of Health Policy, Research and DevelopmentMinistry of HealthKororRepublic of Palau
  5. 5.Division of Behavioral HealthMinistry of HealthKororRepublic of Palau

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