Adverse Pregnancy Outcomes Among Women Who Chew Khat in Meru County, February 2023 – March 2023

Abstract

BACKGROUND Khat (Catha edulis) is a green leafy plant that contains psychoactive alkaloids such as norpseudoephedrine also called cathine and alpha aminopropiophenone also known as cathinone. The prevalence of khat chewing, even during pregnancy, has been on the rise, particularly in khat-growing regions. Several studies have pointed to the fact that there is an association between khat chewing and reduction in the uteroplacental blood circulation as well as a rise in the blood pressure of uteroplacental vessels by up to 25% with an associated reduction in myoendometrial blood flow by up to 31%. These placental changes together with the poor nutrition observed in khat chewers are believed to lead to adverse pregnancy outcomes. In addition, due to its lipid solubility, cathinone is postulated to pass through the placental barrier leading to an accumulation in the fetus’ blood eliciting suspicion of its teratogenic effect. STUDY OBJECTIVE To determine the risk of adverse pregnancy outcomes among pregnant women who chew khat compared to pregnant women who do not chew khat in Meru County, 2023. METHODOLOGY This was a retrospective cohort study investigating the effect of khat chewing on pregnancy. The study was conducted in labour wards and post-natal wards of Nyambene District Hospital and Meru County Teaching and Referral Hospital. We recruited mothers who had delivered within 24 hours at GA between 28-40+6 . The exposed group (n=150) were women who had a positive history of chewing khat during pregnancy. The unexposed group (n=300) were women who did not chew khat during pregnancy. Fetal, immediate neonatal and maternal parameters were recorded and analyzed. A data abstraction tool was used to collect data from the patients and patients’ files. Sociodemographic characteristics were compared between the exposed and the unexposed. Relative Risk, as well as 95% confidence interval, were calculated. Known confounders were adjusted for. All statistical tests were considered significant where p<0.05. RESULTS Compared to mothers who never chewed khat, those who chewed khat during pregnancy had 4.95 times the odds of adverse fetal and early neonatal outcomes and 2.59 times the odds of adverse maternal outcomes. Among khat chewing women, there was a significant increase in the risk of preterm birth and labour (AOR 4.44, 95% CI 3.31 – 10.92, p 0.001), low birth weight (AOR 2.95, 95% CI 1.19-7.57, p 0.02), admission to NBU (AOR 1.13, 95% CI 0.28 – 4.10, p 0.01) and PPH (AOR 12.85, 95% CI 2.17 – 244.02, p 0.02). There was a 1.6 time increase risk of PROM though this was not statistically significant. The study did not show anu significant association between khat chewing and stillbirth, low APGAR score, congenital malformation and anaemia. CONCLUSION The study revealed an increased risk of perinatal outcomes when khat is chewed regularly during pregnancy. We recommended that a widespread campaign be undertaken, particularly in khat growing areas like Meru, to sensitize the community on khat's negative effects on health and pregnancy in particular. We also recommend that healthcare workers be sensitized on the same and asked to take history of khat chewing during ante-natal visits and inform those who chew khat on the negative effects of khat on the pregnancy.