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Some of its components, particularly tobacco-specific nitrosamines, are known carcinogens

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Long term consequences of prenatal exposure to gutkha were demonstrated in mice, where the adult male offspring exposed to a high fat diet developed histological evidence of non-alcoholic fatty liver disease in addition to significant alterations in hepatic fibrosis-related cytokines (interleukin (IL)-1b and IL-6) and in hepatic collagen mRNA expression levels compared to control (non-exposed) group (Doherty Lyons et al., 2020)

"What makes a cigar a cigar is that it has some tobacco in the paper