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Strengths of this study include a large cohort size, detailed information on chewing habits and participant characteristics, and a comprehensive assessment of the effect of AN use on a number of adverse pregnancy outcomes and maternal anaemia.
Similarly, adjusted multivariate analyses did not demonstrate an effect of AN use on LBW or mean birthweight (Table 3).
This research also identified an association between AN use and miscarriage, stillbirth, preterm delivery (PTD, <37 gestational weeks) and increased male-to-female ratio [ 16, 21, 22].
This raises concerns about its potentially detrimental effects on embryogenesis and fetal growth, and hence AN use could represent an important target for public health interventions to reduce the burden of low birthweight (LBW, birthweight <2500 g) and infant mortality [ 18, 19].
The study area was previously reported to have a high prevalence of AN use [ 15], malaria and anaemia [ 30, 31], and LBW [ 15].
There was an interaction between gravidity and AN use on anaemia at delivery (P = 0.027): the negative impact of chewing on anaemia appeared more profound amongst multigravidae (chewers: 78.1 % [523/670] vs. non-chewers: 59.5 % [78/131], P < 0.001) compared to primigravidae (chewers: 72.2 % [465/644] vs. non-chewers: 67.5 % [104/154], P =0.25).> -wrap-foot> Note: Data are n.
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