Certain adverse associations with areca nut use in pregnancy (LBW9,10,12,13,17 and reduced male births13) may have resulted from the small sample size and data selection not controlling for parity,malaria or other substance use.However, the lack of significant adverse associations of areca nut in this cohort of pregnant women may be due to differences in the way the nut is prepared and consumed across Asia. The majority of Karen and Burmese pregnant women consume a low number of ripe nuts per day, use P. betel Linn. leaf and do not add tobacco, whilst
Papuans and Taiwanese use a higher number of unripe nuts
per day.