{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:31:48Z","timestamp":1782189108242,"version":"3.54.5"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/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":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Little is known about the fetal and pregnancy effects of khat chewing during pregnancy. The aim of the current study was to determine the impact of chewing khat during pregnancy on selected pregnancy outcomes in Ethiopia, 2022: A Cohort Study with a Generalized Structural Equation Modeling Analysis Approach.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An institution-based prospective cohort study was employed in selected hospitals in eastern Ethiopia. Pregnant women who visited the selected hospitals in the study area during the study period that fulfilled the eligibility criteria were included until a sample size (344) was fulfilled. The main outcomes studied in the present study were preterm birth and low birth weight. Data were collected through anthropometric and clinical measurements, and interviewers administered questionnaires. The survival analysis and generalized linear model analysis were performed to estimate the crude and adjusted relative risk and attributable risk. The Generalized Structural Equation Modeling (GSEM) analysis was performed using the Statistical software for data science (Stata) \u2018GSEM\u2019 command to examine the mediation effect.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The risk of occurrence of preterm birth was significantly higher among khat chewers [adjusted relative risk (aRR) = 2.19; 95%CI 1.21\u20133.96]. In further analysis after adjusting for gestational hypertension and cesarean delivery, the regression coefficient of khat chewing during pregnancy on preterm birth has been decreased in size from path n, \u03b2 = 0.37, <jats:italic>p<\/jats:italic>&lt;0.001 to path n\u2019, \u03b2 = 0.15, <jats:italic>p<\/jats:italic>&lt;0.005. The risk of occurrence of low birth weight among khat chewers was significantly higher (aRR = 4.17; 95%CI 2.11\u20138.25). In further analysis after adjusting for gestational hypertension, cesarean delivery, preterm birth and maternal anemia, the regression coefficient of khat chewing during pregnancy on low birth weight has been decreased in size from path q, \u03b2 = 0.4, <jats:italic>p<\/jats:italic>&lt;0.001 to path q\u2019, \u03b2 = 0.2, <jats:italic>p<\/jats:italic>&lt;0.001.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Overall, the present study revealed that khat chewing is not only a worry of the current population but also a public health concern of the generation affecting unborn fetuses.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0308681","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T17:33:40Z","timestamp":1723224820000},"page":"e0308681","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of chewing 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