Association between betel nut consumption and folate deficiency among pregnant women in Matlab, Bangladesh

Abstract: Background:  Betel nut (BN) or Areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alcaloid arecoline in betel nut has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes.  It is also reportedly associated with nutritional deficiencies including lower folate status among men and women. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, the fetus and the placenta.  Folate deficiency during pregnancy is a major public health concern as it is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, delayed maturation of the nervous system, growth retardation and megaloblastic anemia. Aim: To evaluate the association between betel nut use and folate status among pregnant women in Matlab, Bangladesh. Design: A secondary analysis of data from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial.  A sub sample of pregnant women aged 14-50 years and living in the study area Matlab with available serum folate measurements (N= 730) was included in this study. Outcome variable was folate level and folate deficiency and the independent variable was betel nut consumption.  Logistic regression analysis and analyses of covariance (ANCOVA) were done. Results were adjusted for potential confounders. Results: Two-thirds (63%) of the women consumed betel nut and 17% had folate deficiency. Women who consumed betel nut combined with  chewing  tobacco were 2.57 times more likely to have folate deficiency (OR = 2.57; 95% CI = 1.23-5.36; p =0.012;) and  betel nut consumption 2-3 times/day was significantly associated with folate deficiency among users (OR = 2.51; 95% CI = 1.07–5.92; p =0.035). Mean serum folate levels were significantly lower among betel nut users as compared to non-users. Conclusion: Betel nut consumption combined with chewing tobacco is associated with lower serum folate level or folate deficiency among pregnant women in Matlab in Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes. There is a need of more knowledge regarding betel nut use and other combined substances to distinguish their individual effects on folate deficiency.