Areca Nut Chewing as a Modifiable Risk Factor for Maternal Anemia, Prematurity and Fetal Low Birth Weight: A Cross Sectional Study in Teluk Wondama, West Papua

Yuda Putra Disastra,1 Muhammad Alamsyah Aziz,1 Windi Nurdiawan,1 Andi Kurniadi,1 Patricia M Tauran,2 Christian James Ibrahim2 1Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Clinical Pathology, Albert H Torey District Hospital, West Papua, IndonesiaCorrespondence: Yuda Putra Disastra, Email yuda21003@mail.unpad.ac.idIntroduction: Maternal anemia remains a major global public health problem, affecting over 40% of pregnancies and contributing to maternal morbidity, perinatal mortality and impaired child development. Areca nut (Areca Catechu) chewing is a common cultural practice in South and Southeast Asia including Papua, Indonesia, and has been hypothesized to exacerbate anemia, yet evidence in pregnancy is limited. This study aimed to investigate the association between areca nut chewing with maternal anemia, low birth weight and prematurity.Methods: A cross-sectional study was conducted among 263 pregnant women attending antenatal care at Dr. Albert H Torey District General Hospital, West Papua, Indonesia, between September 2024 and September 2025. Areca nut chewing was recorded during routine antenatal care and subsequently extracted from medical records. Maternal anemia was defined as hemoglobin < 11 g/dl, low birth weight as < 2500 gr and prematurity as delivery before 37 weeks. Associations were analyzed using Chi-square and multivariate logistic regression tests (ORs 95% CI, significant if p value < 0.05), adjusted for potential confounders.Results: The prevalence of maternal anemia occurred in 65.4% of participants, low birth weight in 43.3% and prematurity in 41.4%. Areca nut chewing was strongly associated with maternal anemia (OR = 11.4; 95% CI: 4.38– 29.65), low birth weight (OR = 10.89; 95% CI: 5.69– 20.84) and prematurity (OR = 10.67; 95% CI: 5.50– 20.68) (all p < 0.001).Conclusion: Areca nut chewing during pregnancy significantly increases the risk of maternal anemia, low birth weight and preterm birth. Highlighting the need for culturally sensitive preventive interventions.Keywords: areca catechu, fetal low birth weight, maternal anemia, prematurity, pregnancy