{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T01:50:38Z","timestamp":1777513838429,"version":"3.51.4"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,13]],"date-time":"2024-01-13T00:00:00Z","timestamp":1705104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,13]],"date-time":"2024-01-13T00:00:00Z","timestamp":1705104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007941","name":"Addis Ababa University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007941","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021567","name":"Debre Markos University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021567","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Restriction in the growth of the fetus is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Documented existing scientific evidence have shown the effects of maternal drugs use, alcohol drinking, tobacco smoking, cocaine use and heroin use on fetal growth restriction. However, data is lacking on the effects of khat chewing during pregnancy on fetal growth status and newborn size at birth. Therefore, the aim of the present study was to measure the effect of chewing khat during pregnancy on fetal growth and size at birth in eastern Ethiopia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>A cohort study was conducted in selected health institutions in eastern Ethiopia. All pregnant women fulfilled the eligibility criteria in the selected health institutions was the source population. The calculated sample size of exposed and unexposed groups included in the study, in total, was 344. Data collection was performed prospectively by interviewers administered questionnaires, and anthropometric, clinical and ultrasound measurements. Data was analyzed using SPSS version 27 and STATA version 16 software. The survival analysis (cox proportional hazards model) and generalized linear model (GLM) for the binomial family analysis were performed to estimate the crude and adjusted relative risk and attributable risk (AR) with corresponding 95% CI of chewing khat on fetal growth restriction. The mediation effect has been examined through Generalized Structural Equation Modeling (GSEM) analysis using the Stata \u2018gsem\u2019 command. Statistically significant association was declared at <jats:italic>p<\/jats:italic>-value less than 5%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In the present study, the incidence of fetal growth restriction (FGR) among the study cohorts was 95 (29.7%); of this, 81 (85.3%) were among khat chewer cohorts. The relative risk of fetal growth restriction among khat chewer cohort mothers was significantly higher (aRR\u2009=\u20094.32; 95%CI 2.62\u20137.12). Moreover, the incidence of small for gestational age at birth among the present study cohorts was 100 (31.3%); 84 (84%) were from khat chewer cohorts\u2019 deliveries. More importantly, in the present study, 98.95% of the ultrasound-identified fetuses with FGR were found to be SGA at birth. Hence, in the current study, FGR was highly associated with SGA at birth. In additional analysis, the regression coefficient of khat chewing during pregnancy on fetal growth restriction has been decreased in size from path o, \u03b2\u2009=\u20090.43, p\u2009&lt;\u20090.001 to path o\u2019, \u03b2\u2009=\u20090.32, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, after adjusting for gestational hypertension and maternal anemia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In sum, the present study showed khat chewing during pregnancy is not simply affected the mothers, but it also affected the unborn fetuses. Therefore, the health workers as well as the local community and religious leaders should give high emphasis on provision of health education regarding the damage of chewing khat by pregnant mothers, with especial focus of the effects on their fetuses.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-024-06243-2","type":"journal-article","created":{"date-parts":[[2024,1,13]],"date-time":"2024-01-13T07:01:58Z","timestamp":1705129318000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The effect of possible mediators on the association between chewing khat during pregnancy and fetal growth and newborn size at birth in Eastern Ethiopia"],"prefix":"10.1186","volume":"24","author":[{"given":"Amsalu Taye","family":"Wondemagegn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miressa","family":"Bekana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonas","family":"Bekuretsion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mekbeb","family":"Afework","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,1,13]]},"reference":[{"issue":"4","key":"6243_CR1","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.ajog.2013.02.007","volume":"208","author":"J Unterscheider","year":"2013","unstructured":"Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O\u2019Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO study. Am J Obstet Gynecol. 2013;208(4):290\u2013e291.","journal-title":"Am J Obstet Gynecol"},{"issue":"Suppl 2","key":"6243_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000053079","volume":"49","author":"HA Wollmann","year":"1998","unstructured":"Wollmann HA. Intrauterine growth restriction: definition and etiology. Hormone Res Paediatrics. 1998;49(Suppl 2):1\u20136.","journal-title":"Hormone Res Paediatrics"},{"key":"6243_CR3","doi-asserted-by":"crossref","unstructured":"Avagliano L, Garo C, Marconi AM. Placental amino acids transport in intrauterine growth restriction. Journal of pregnancy 2012, 2012.","DOI":"10.1155\/2012\/972562"},{"key":"6243_CR4","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.jnutbio.2018.06.003","volume":"59","author":"Y-Y Chen","year":"2018","unstructured":"Chen Y-Y, Gupta MB, Grattton R, Powell TL, Jansson T. Down-regulation of placental folate transporters in intrauterine growth restriction. J Nutr Biochem. 2018;59:136\u201341.","journal-title":"J Nutr Biochem"},{"key":"6243_CR5","unstructured":"Who E. Committee Physical Status: The Use And Interpretation Of Anthopometry: Report of a WHO Expert Committee. WHO Technical Report Series 1995, 854."},{"key":"6243_CR6","doi-asserted-by":"crossref","unstructured":"Baschat AA, Galan HL. Intrauterine growth restriction. Obstetrics: normal and problem pregnancies. edn.: Elsevier; 2016. pp. 737\u201369.","DOI":"10.1016\/B978-0-323-32108-2.00033-0"},{"issue":"03","key":"6243_CR7","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1097\/FM9.0000000000000161","volume":"4","author":"HD Kamphof","year":"2022","unstructured":"Kamphof HD, Posthuma S, Gordijn SJ, Ganzevoort W. Fetal growth restriction: mechanisms, epidemiology, and management. Maternal-Fetal Med. 2022;4(03):186\u201396.","journal-title":"Maternal-Fetal Med"},{"key":"6243_CR8","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1007\/s00404-017-4341-9","volume":"295","author":"LMM Nardozza","year":"2017","unstructured":"Nardozza LMM, Caetano ACR, Zamarian ACP, Mazzola JB, Silva CP, Mar\u00e7al VMG, Lobo TF, Peixoto AB. Araujo J\u00fanior E: fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295:1061\u201377.","journal-title":"Arch Gynecol Obstet"},{"issue":"3","key":"6243_CR9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1002\/uog.1806","volume":"25","author":"PG Lindqvist","year":"2005","unstructured":"Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005;25(3):258\u201364.","journal-title":"Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology"},{"key":"6243_CR10","unstructured":"Lee ACC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, Sania A, Rosen HE, Schmiegelow C, Adair LS. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets. bmj 2017, 358."},{"issue":"1","key":"6243_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13690-020-00475-2","volume":"78","author":"D Tesfa","year":"2020","unstructured":"Tesfa D, Tadege M, Digssie A, Abebaw S. Intrauterine growth restriction and its associated factors in South Gondar Zone hospitals, Northwest Ethiopia, 2019. Archives of Public Health. 2020;78(1):1\u20139.","journal-title":"Archives of Public Health"},{"key":"6243_CR12","doi-asserted-by":"crossref","unstructured":"Acharya GRK, Creasy R, Resnik JD, Iams CJ, Lockwood TR, Moore M, Greene, editors. Creasy & Resnik\u2019s Maternal-Fetal Medicine: Principles and Practice, 7th edn. Elsevier Saunders, Philadelphia, 2014. ISBN: 978-1-4557-1137-6. Hardback. \u20ac127.50. Acta Obstetricia et Gynecologica Scandinavica 2015, 94(3):338\u2013338.","DOI":"10.1111\/aogs.12555"},{"issue":"2","key":"6243_CR13","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/aogs.13702","volume":"99","author":"A Pels","year":"2020","unstructured":"Pels A, Beune IM, van Wassenaer-Leemhuis AG, Limpens J, Ganzevoort W. Early-onset fetal growth restriction: a systematic review on mortality and morbidity. Acta Obstet Gynecol Scand. 2020;99(2):153\u201366.","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"5","key":"6243_CR14","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1002\/uog.9008","volume":"37","author":"AA Baschat","year":"2011","unstructured":"Baschat AA. Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2011;37(5):501\u201314.","journal-title":"Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology"},{"issue":"1","key":"6243_CR15","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1080\/14767050500127674","volume":"18","author":"ME Kleijer","year":"2005","unstructured":"Kleijer ME, Dekker GA, Heard AR. Risk factors for intrauterine growth restriction in a socio-economically disadvantaged region. J Maternal-Fetal Neonatal Med. 2005;18(1):23\u201330.","journal-title":"J Maternal-Fetal Neonatal Med"},{"issue":"7","key":"6243_CR16","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.2105\/AJPH.84.7.1127","volume":"84","author":"E Lieberman","year":"1994","unstructured":"Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. Am J Public Health. 1994;84(7):1127\u201331.","journal-title":"Am J Public Health"},{"issue":"1","key":"6243_CR17","first-page":"27","volume":"31","author":"E Dendir","year":"2017","unstructured":"Dendir E, Deyessa N. Substance use and birth weight among mothers attending public hospitals: a case control study. Ethiop J Health Dev. 2017;31(1):27\u201335.","journal-title":"Ethiop J Health Dev"},{"key":"6243_CR18","doi-asserted-by":"crossref","unstructured":"Whittaker A, Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy By World Health Organization Geneva., Switzerland: WHO Press, 2014 ISBN: 9789241548731, 224 pp. Available free online http:\/\/www.who.int\/substance_abuse\/publications\/pregnancy_guidelines\/en. In.: Wiley Online Library; 2015.","DOI":"10.1111\/dar.12212"},{"issue":"11","key":"6243_CR19","doi-asserted-by":"publisher","first-page":"e0224606","DOI":"10.1371\/journal.pone.0224606","volume":"14","author":"ZG Gudata","year":"2019","unstructured":"Gudata ZG, Cochrane L, Imana G. An assessment of khat consumption habit and its linkage to household economies and work culture: the case of Harar city. PLoS ONE. 2019;14(11):e0224606.","journal-title":"PLoS ONE"},{"issue":"1","key":"6243_CR20","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.annepidem.2014.10.011","volume":"25","author":"LS Lundsberg","year":"2015","unstructured":"Lundsberg LS, Illuzzi JL, Belanger K, Triche EW, Bracken MB. Low-to-moderate prenatal alcohol consumption and the risk of selected birth outcomes: a prospective cohort study. Ann Epidemiol. 2015;25(1):46\u201354e43.","journal-title":"Ann Epidemiol"},{"issue":"2","key":"6243_CR21","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/j.1465-3362.2011.00374.x","volume":"31","author":"WC Kerr","year":"2012","unstructured":"Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug Alcohol Rev. 2012;31(2):200\u20135.","journal-title":"Drug Alcohol Rev"},{"issue":"3","key":"6243_CR22","doi-asserted-by":"publisher","first-page":"709","DOI":"10.2214\/ajr.164.3.7863900","volume":"164","author":"PM Doubilet","year":"1995","unstructured":"Doubilet PM, Benson CB. Sonographic evaluation of intrauterine growth retardation. AJR Am J Roentgenol. 1995;164(3):709\u201317.","journal-title":"AJR Am J Roentgenol"},{"key":"6243_CR23","unstructured":"The Ministry of Public Health and Population. Y: Environmental and Social Impact Assessment (ESIA). Health and Population Project Final Report. 2010."},{"issue":"1","key":"6243_CR24","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/0378-8741(88)90111-0","volume":"23","author":"T Jansson","year":"1988","unstructured":"Jansson T, Kristiansson B, Qirbi A. Effect of khat on uteroplacental blood flow in awake, chronically catheterized, late-pregnant guinea pigs. J Ethnopharmacol. 1988;23(1):19\u201326.","journal-title":"J Ethnopharmacol"},{"issue":"5\u20136","key":"6243_CR25","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/j.1474-8673.2004.00303.x","volume":"23","author":"AL Al-Motarreb","year":"2003","unstructured":"Al-Motarreb AL, Broadley KJ. Coronary and aortic vasoconstriction by cathinone, the active constituent of khat. Auton Autacoid Pharmacol. 2003;23(5\u20136):319\u201326.","journal-title":"Auton Autacoid Pharmacol"},{"key":"6243_CR26","doi-asserted-by":"crossref","unstructured":"Redline RWJTP. The umbilical cord. 2011:114\u2013121.","DOI":"10.1002\/9781444393927.ch15"},{"key":"6243_CR27","doi-asserted-by":"crossref","unstructured":"Tantbirojn P, Saleemuddin A, Sirois K, Crum C, Boyd T, Tworoger S, Parast MJP. Gross abnormalities of the umbilical cord: related placental histology and clinical significance. 2009, 30(12):1083\u20138.","DOI":"10.1016\/j.placenta.2009.09.005"},{"key":"6243_CR28","doi-asserted-by":"crossref","unstructured":"Ebbing C, Kiserud T, Johnsen SL, Albrechtsen S. Rasmussen SJPo: prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies. 2013, 8(7):e70380.","DOI":"10.1371\/journal.pone.0070380"},{"issue":"1","key":"6243_CR29","first-page":"15","volume":"43","author":"D DiSalvo","year":"1998","unstructured":"DiSalvo D. The correlation between placental pathology and intraventricular hemorrhage in the preterm infant. Dev Epidemiol Netw Investigators Pediatr Res. 1998;43(1):15\u20139.","journal-title":"Dev Epidemiol Netw Investigators Pediatr Res"},{"issue":"7","key":"6243_CR30","doi-asserted-by":"publisher","first-page":"611","DOI":"10.3109\/00016348809004273","volume":"67","author":"M Nordenvall","year":"1988","unstructured":"Nordenvall M, Sandstedt B, Ulmsten U. Relationship between placental shape, cord insertion, lobes and gestational outcome. Acta Obstet Gynecol Scand. 1988;67(7):611\u20136.","journal-title":"Acta Obstet Gynecol Scand"},{"key":"6243_CR31","doi-asserted-by":"crossref","unstructured":"Brouillet S, Dufour A, Prot F, Feige J-J, Equy V, Alfaidy N, Gillois P, Hoffmann P. Influence of the umbilical cord insertion site on the optimal individual birth weight achievement. BioMed research international 2014, 2014.","DOI":"10.1155\/2014\/341251"},{"key":"6243_CR32","unstructured":"Strong TH Jr, Elliott JP, Radin TGJO. gynecology: non-coiled umbilical blood vessels: a new marker for the fetus at risk. 1993, 81(3):409\u201311."},{"key":"6243_CR33","doi-asserted-by":"crossref","unstructured":"Chitra T, Sushanth Y, Raghavan SJO. international g: Umbilical coiling index as a marker of perinatal outcome: an analytical study. 2012, 2012.","DOI":"10.1155\/2012\/213689"},{"key":"6243_CR34","doi-asserted-by":"crossref","unstructured":"Machin GA, Ackerman J, Gilbert-Barness EJP, Pathology D. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. 2000, 3(5):462\u201371.","DOI":"10.1007\/s100240010103"},{"key":"6243_CR35","doi-asserted-by":"crossref","unstructured":"Ezimokhai M, Rizk DE, Thomas, LJAjop. Maternal risk factors for abnormal vascular coiling of the umbilical cord. 2000, 17(08):441\u20136.","DOI":"10.1055\/s-2000-13452"},{"key":"6243_CR36","doi-asserted-by":"crossref","unstructured":"de Laat M, Franx A, van Alderen E, Nikkels P, Visser GJTJM-F, Medicine N. The umbilical coiling index, a review of the literature. 2005, 17(2):93\u2013100.","DOI":"10.1080\/jmf.17.2.93.100"}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-024-06243-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12884-024-06243-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-024-06243-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,13]],"date-time":"2024-01-13T07:04:56Z","timestamp":1705129496000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/s12884-024-06243-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,13]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["6243"],"URL":"https:\/\/doi.org\/10.1186\/s12884-024-06243-2","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,13]]},"assertion":[{"value":"5 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from Institutional Review Board of College of Health Sciences, Addis Ababa University. All the study methods were carried out in accordance with relevant guidelines and regulations that is Declaration of Helsinki. In addition, informed written consent was obtained from all subjects and\/or their legal guardian(s).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participant"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"63"}}