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Chronic use of ST has direct health implications on the mother, as reported by Subramoney and Gupta (2008) from their population-based cohort study of 918 pregnant women in Mumbai, India, and found that ST use resulted in significantly reduced mean hemoglobin (Hb) levels (10.00 g/dl) compared with nonusers (10.46 g/dl, p 1000 ml) was found in pituri chewers compared with 22% of smokers and 36% of the non-users (Ratsch et al., 2021)

This is far more nicotine than even heavier smokers often need from an alternative, and while they do not deliver the harmful chemicals of tobacco smoke, they risk worsening the underlying addiction to nicotine

They want to avoid confusion between similar-looking variants

PMCID: PMC4007115