Relationship between maternal pre-pregnancy obesity and smokeless tobacco use and pre-term delivery and low birthweight among Palauan women

Background: Palau, like most other Pacific island nations is heavily burdened by obesity and tobacco use. Although both factors are known to be associated with adverse birth outcomes, little work has been done to examine these relationships in the Pacific. Methods: We conducted a retrospective cohort study on pregnant Palauan women and their infants from 2007-2013 (N=1171) using prenatal and delivery hospital records. Multivariate logistic regression assessed relationships between maternal pre-pregnancy obesity and smokeless tobacco use and pre-term delivery and low birthweight. Results: Overall, 76% of women reported chewing tobacco with betel nut during pregnancy, and 30% were obese prior to pregnancy. 106 infants (9%) born pre-term (<37 weeks), and 42 full-term (>=37 weeks) infants (4%) born low birthweight (<2500g). The odds of pre-term delivery were higher for women who were obese (BMI>=30) prior to pregnancy (aOR=1.6; 95%CI: 1.1-2.5) than women who were non-obese prior to pregnancy. The odds of delivering a full-term low birthweight infant were higher for women who chewed tobacco with betel nut during pregnancy (aOR=2.4; 95%CI: 1.0-6.0) than women with no tobacco or betel nut use during pregnancy. All models controlled for maternal age, parity, education, and marital status. Conclusion: Pre-pregnancy obesity was associated with increased risk of pre-term delivery; tobacco with betel nut chewing during pregnancy was associated with increased risk of low birthweight among full-term infants. These risk factors are highly prevalent among pregnant Palauan women, interventions should target these behaviors among young women in order to reduce adverse birth outcomes.