Mahdiah1*,
Atika Salma Rahmadani2
1 Lecturer in the Nutrition Department, Health
Polytechnic, Ministry of Health, Indonesia
2 Students from the Nutrition Department, Health
Polytechnic, Ministry of Health, Indonesia
*email: 1[email protected], 2[email protected]
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Keywords |
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ABSTRACT |
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Age of pregnant women, parity, ANC visits, folic acid intake |
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Anemia is a nutritional problem with a high
prevalence. Anemia often occurs in teenagers, women of childbearing age, and
pregnant women. This study aims to determine the relationship between
maternal characteristics and folic acid intake with the incidence of anemia
in pregnant women. The design of this study is cross sectional. The
population is all pregnant women in the second and third trimesters in three
villages in the Percut Sei Tuan sub-district. The sampling in this research
was porpusive sampling. Data collection was carried out through interviews
using questionnaires and food recall tables as research instruments. Data
processing through editing, entering and tabulating. Data analysis used the
Chi Square test with Ci 95%. The results of the study showed that 87.8% of
mothers in the good age group did not experience anemia and 12.1% of mothers
in the unfavorable age group experienced anemia. 90.2% of mothers in the good
parity group were not anemic and 9.8% of mothers in the poor parity group
were anemic. 90.2% of mothers with good ANC group experienced anemia and 9.8%
of mothers with poor ANC group did not experience anemia. 9.8% of pregnant
women in the good folic acid intake group were not anemic and 48.8% of
pregnant women in the not good folic acid intake group were anemic. There is
a relationship between parity, ANC visits and folic acid intake in pregnant
women in Percut Sei Tuan District. And there is no relationship between maternal
age and the incidence of anemia in Percut Sei Tuan District. |
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Anemia
is a nutritional problem with a high prevalence. Anemia often occurs in
teenagers, women of childbearing age, and pregnant women. For pregnant women, the pregnancy period is a
period that really determines the quality of human resources (HR) in the future
because the child's growth and development is very much determined by the
condition of the fetus and womb. Anemia in pregnant women is a condition where a
mother experiences iron deficiency in her blood (Rismawati & Rohmatin, 2018).
Anemia is a nutritional
problem in public health, especially in pregnant women. Pregnant women are said
to have anemia if the hemoglobin level is less than 11.0 g/dl for the first and
third trimesters and less than 10.5 g/adl for the second trimester (Asmin et al., 2021). Anemia often occurs in
pregnancy because pregnancy requires additional nutrients and changes occur in
the blood and bone marrow. A lot of blood in pregnancy is commonly called
hydremia or hypervolemia. However, the increase in blood cells is less than the
increase in plasma can cause blood thinning. This is because during pregnancy
there is an increase in plasma volume in a greater proportion compared to the
increase in erythrocytes (Millah, 2019).
Apart from that, the cause of
anemia in pregnant women is a lack of nutrients that play a role in the
formation of hemoglobin, one of which is folic acid. This is because consuming
folic acid can help improve the Hb levels of pregnant women where folic acid
helps in the formation of red blood cells (Tarigan et al., 2021).
According to the World Health Organization (WHO)
2018 globally, the prevalence of anemia in pregnant women throughout the world
is 36.5 %. The prevalence of anemia
in pregnant women is estimated at 47.8% in Asia, 45.8% in Africa, 23.5% in
Europe and 18.9% in America. In Indonesia itself, according to the Ministry of
Health of the Republic of Indonesia, the prevalence rate of anemia in pregnant
women in Indonesia in 2018 was 48.9%. This figure shows an increase compared to
2013, namely 37.1%. This figure is still far from the national target, namely
28% (Hidayah Pramesty Dewi, 2021).
Several factors that can cause
anemia in pregnancy are age, pregnancy spacing, parity, protein intake, iron
intake, LILA, maternal knowledge, Antenatal Care visits, and consumption of Fe
tablets (Windari et al., 2018).
Age is a risk factor that can
cause anemia in pregnant women. Because a mother's age is related to the female
reproductive organs. A good age to get pregnant is 20-35 years old. At the age
of <20 years, mothers are still emotionally and mentally unstable, resulting
in a lack of attention to meeting nutritional needs during pregnancy (Gusnidarsih, 2020). Women aged <20 years are
at risk of anemia because at this age malnutrition often occurs. This happens
because at the age of teenagers they desire an ideal body, therefore they go on
a strict diet without prioritizing nutritional balance so they experience poor
nutritional status when entering pregnancy (Rahmaniah, 2019). Age > 35 years in
pregnant women is associated with decline and decrease in body resistance as
well as a decline in biological organs which causes hemoglobin production to
decrease so that pregnant women are susceptible to anemia, this is caused by
fertilization which affects the decrease in iron reserves in the body. When
entering your first pregnancy at the age of over 35 years you will also
experience the risk of complications in childbirth and the start of
reproductive organ functions (Septiyaningsih & Yunadi, 2021).
Parity is a mother who has
more than three children. Parity is one of the factors that causes anemia
during pregnancy. This is because being pregnant too often can deplete the
mother's body's nutritional reserves (Amini et al., 2018) . The amount of iron lost is
estimated at 250 mg every time a woman gives birth (Octaviana & Indrasari, 2021).
Frequency of Antenatal Care
(ANC) is a factor that can influence the incidence of anemia in pregnant women.
This is because ANC is one way to prevent anemia. Maternal ANC visits during
pregnancy are 1 time in the first trimester, 1 time in the second trimester,
and 2 times in the third trimester (Dolang, 2020) Early anemia screening,
counseling and administration of Fe tablets are obtained from ANC care. Routine
ANC examinations can help reduce maternal and infant morbidity and mortality (Dolang, 2020).
This research is quantitative with a cross sectional method. This research was conducted in the areas of
Cinta Damai Village, Percut Village, and Tanjung Selamat Village, Percut Sei
Tuan District, which was carried out in May 2023. The selection of these areas
was based on the results of a research survey, where in these three villages
there were pregnant women with anemia status.
The population of this study was all pregnant women in
the second and third trimesters in three villages of Percut Sei Tuan District,
totaling 103 people. The sampling technique for this research was purposive sampling, which means there
were 41 pregnant women with certain criteria
��������������� Data processing
in this research went through several stages including editing, entering and
tabulating. This research analysis was carried out to explain the relationship
between two variables, namely the independent variable and the dependent
variable. To analyze folic acid intake, the Nutrisurvey computer program was
used. Then the data was analyzed using the
Statistical Package for Social Science (SPSS) computer program. The
analysis in this study used the chi-square
statistical test and the Odds Ratio at a significance level of 95%. To
prove the hypothesis, the p-value is <0.05 ( H0 is rejected) and it is
concluded that there is a significant relationship between the independent
variable and the dependent variable.
EC:
01.1570/KEPK/Poltekkes Ministry of Health Medan 2023
Table 1
Table of Age Distribution of Pregnant Women in
Percut Village, Cinta Damai Village,
�and
Tanjung Village Happy 2022
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Research variable |
Number (n) |
Percentage (%) |
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Mother's Age < 20 years 20-35 years >35 years |
2 36 3 |
4.9 87.8 7.3 |
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Parity 1-3 ≥4 |
37 4 |
90.2 9.8 |
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ANC visit ≥ 4 < 4 |
37 4 |
90.2 9.8 |
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Folic Acid Intake Good Currently Not enough Deficit |
4 16 1 20 |
9.8 39.0 2.4 48.8 |
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Total |
41 |
100 |
Based on Table 1
above, it shows that there are 2 pregnant women aged > 20 years (4.9%), 36
pregnant women aged 20-35 years (87.8%), and 3 pregnant women aged > 35
years. people (7.3%). Parity in the good category was 37 people (90.2%) and
parity in the not good category was 4 people (9.8%). ANC visits in the good
category were 37 people (90.2%) and parity in the not good category were 4
people (9.8%). Folic acid intake in the good category was 4 people (9.8%). The
folic acid intake in the moderate category was 16 people (39.0%), the folic
acid intake in the deficient category was 1 person (2.4%), and the folic acid
intake in the deficit category was 20 people (48.8%).
Table 2
Relationship between
Maternal Characteristics and Folic Acid Intake With The Incidence of Anemia in
Pregnant Women
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Independent Variable |
Anemic Status |
Total |
% |
P - value |
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Anemia (n) |
% |
Not Anemic (n) |
% |
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1 |
Mother's Age Good Not good |
7 1 |
87.5 12.5 |
28 5 |
84.4 15.5 |
35 6 |
85.3 14.6 |
0.669 |
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2 |
Parity Good Not good |
5 3 |
62.5 37.5 |
32 1 |
96.9 3.0 |
37 4 |
90.2 9.8 |
0.019 |
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3 |
ANC visit Good Not good |
5 3 |
62.5 37.5 |
32 1 |
96.9 3.0 |
37 4 |
90.2 9.7 |
0.019 |
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4. |
Folic Acid Intake Good Not good |
1 7 |
12.5 87.5 |
18 15 |
54.5 45.4 |
19 22 |
46.3 53.7 |
0.037 |
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Total |
8 |
100 |
33 |
99.9 |
41 |
100 |
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Discussion
The research results show that there is no relationship
between maternal age and the incidence of anemia in pregnant women in Percut
Village, Cinta Damai Village, and Tanjung Selamat Village, Percut Sei Tuan
District 2022. The statistical test results show a p value of 0.669 ( > 0.05 ) . Based on the research results, the majority of respondents in
the 20-35 year category were 36 people with 28 respondents not experiencing
anemia, and 7 respondents experiencing anemia aged <20 years and >35
years. This is in line with research (Purwaningtyas & Prameswari, 2017) that there is no relationship between age and anemia in
pregnant women ( p value 1,000).
Mothers aged 20-35 years are a good age for pregnancy because there are very
few problems or complications during pregnancy and childbirth.
Mothers aged 20-35 years are psychologically ready so
they can control their emotions which will affect the growth and development of
the fetus. Mothers aged <20 years are emotionally unstable, making it
difficult to control the growth and development of the fetus. Apart from that,
mothers aged < 20 years are still growing and require more nutrients than
those aged 20-35 years. So the main causes of death in women aged 15-19 years
are complications of pregnancy, childbirth and complications of miscarriage (Leny, 2019) . Pregnancies that occur in mothers before their teens are fully developed
can also pose significant risks to the baby including injury during delivery,
low birth weight, and a lower chance of survival for the baby.
Likewise, for mothers aged > 35 years, mothers aged
> 35 years are at risk of developing anemia due to the influence of the
mother's immunity, making them susceptible to contracting disease during
pregnancy. Women aged > 35 years are more likely to experience miscarriage,
whether the fetus is normal or abnormal (Leny, 2019) .
At the age of 20-35 years the female reproductive organs
are healthy and safe for pregnancy. Biologically, those aged under 20-35 years
old have a mental state that is not yet optimal, with emotions that tend to be
unstable, so they easily experience shocks which result in a lack of consuming
nutrients. Then, those aged over 35 years are also susceptible to various
diseases at this age (Amini et al., 2018) .
The statistical test results
show that the p value is 0.019
(<0.05), meaning that parity influences the
incidence of anemia in pregnancy. The more frequently a woman becomes pregnant
and gives birth, the greater the risk of experiencing anemia because pregnancy
uses iron reserves in the body. Based on the research results, 32 mothers in
the good category did not experience anemia (96.9%) and 3 mothers in the not
good category experienced anemia (37.5%). This is in line with research by Teja et al., 2021, there is a relationship between parity and the incidence
of anemia in pregnant women ( p value 0.002).
Women who frequently experience pregnancy and childbirth are at risk of
developing anemia due to iron loss, this occurs due to the use of iron reserves
in the body.
Mothers with parity ≥4 times can increase the
frequency of complications in pregnancy and childbirth, such as increasing the
risk of fetal death in the womb and bleeding before and after birth, which can
be fatal. This is because women who have given birth frequently can result in
damage to the blood vessels and vascularization of the uterine wall due to
previous births, resulting in inadequate blood flow to the placenta which can
ultimately reduce its function and affect nutrition to the fetus (Leny, 2019 ) .
Statistical results show that the p value is 0.019 (<0.05), meaning
that there is a high risk of anemia in pregnancy in
pregnant women who do not regularly make ANC or antenatal care visits during
their pregnancy . According to (Nanda and
Rodiani, 2017) that pregnant women who do not regularly make ANC visits which
can increase the risk of pregnancy, one of which is anemia so that the
continuity of health checks during pregnancy can be seen from the first visit
(K1) to the K4 visit with visit times according to trimester of pregnancy.
Therefore, it is necessary to carry out ANC or antenatal care to provide an
overview of the condition of the pregnant woman, the fetus in the womb, and
general health.
The mother did not routinely perform ANC because she had
experienced a previous pregnancy so she already knew what to do during
pregnancy. In addition, mothers with many children feel embarrassed to visit
health services such as community health centers or clinics for ANC visits. ANC
visits are carried out to produce a healthy pregnancy through physical
examination, provision of iron supplements and education regarding the health
of pregnant women (akhirin et al., 2021) .
The results of the study showed that the p value was 0.037 (<0.05), meaning that the proportion of
folic acid consumption among pregnant women who did not consume folic acid was
greater than that of pregnant women who consumed folic acid. This is because
consuming folic acid is a behavior carried out by pregnant women to fulfill
their nutritional needs. This is in line with research. In line with research (Nugrahani, 2020) there is a relationship between folic acid intake and the
incidence of anemia with a p value of 0.001.
Folic acid is a main component in the formation of blood cells, as well as the
formation of DNA, so it is also needed for cell development and growth.
Food recall results show that the majority of respondents
do not often consume green vegetables, chicken liver and beef liver. This
causes some respondents to have poor folic acid intake, because green
vegetables, chicken liver and beef liver are sources of folic acid. As well as
the habit of eating bad food and frequently consuming snacks such as grilled
meatballs, waffers, chips, and so on, which causes pregnant women to feel full
quickly.
Folic acid functions to form red blood cells and white
blood cells in the bone marrow. If the cells are formed abnormally or
abnormally, it will result in megaloblastic anemia which is caused by a lack of
folic acid intake in the body. Folic acid plays an important role in DNA
synthesis and cell growth. Folic acid deficiency can result in incomplete DNA
synthesis and red blood cells not being able to mature properly so that red
blood cells cannot carry oxygen for the body's health, resulting in anemia (Putri et al., 2019).
There is
a relationship between parity, ANC visits, and folic acid intake in pregnant
women in Percut Sei Tuan District in 2022. Before becoming pregnant, mothers need to receive counseling or counseling
about nutrition during pregnancy so that mothers and children are carried to a
normal weight and strive to achieve normal
weight before becoming pregnant. mothers with normal and healthy Hb conditions
The author has stated that in this article there is no or potential
conflict of interest from either the author or the agency in connection with
the research that has been conducted, both based on authorship and publication.
On this occasion,
the author would like to thank all parties who have contributed to the
implementation of the research.
Amini, A., Pamungkas, CE, & Harahap, APHP (2018). Maternal Age and
Parity as Risk Factors that Influence the Incidence of Anemia in Pregnant Women
in the Ampenan Community Health Center Work Area. Midwifery Journal: UM
Midwifery Journal. Mataram, 3 (2), 108.
https://doi.org/10.31764/mj.v3i2.506
Asmin, E., Salulinggi, A., Titaley, CR, & Bension,
J. (2021). The Relationship between Knowledge and Compliance of Pregnant Women
Consuming Blood Supplement Tablets with the Incidence of Anemia in South
Leitimur and Teluk Ambon Districts. Journal of Community Health Epidemiology,
6 (1), 229�236. https://doi.org/10.14710/jekk.v6i1.10180
Dolang, M. W. (2020). Relationship between adherence
to consuming Fe tablets and regularity of ANC visits with the incidence of
anemia in pregnant women. Muhammadiyah Nursing Journal, 5 (1),
179�184.
Gusnidarsih, V. (2020). The Relationship between Age
and Pregnancy Distance with the Incident of Clinical Anemia during Pregnancy. Journal
of Maternal and Child Care, 5 (1), 35�40.
https://doi.org/10.33867/jaia.v5i1.155
Hidayah Pramesty Dewi, M. (2021). Risk Factors That
Influence the Incidence of Anemia in Pregnant Women in the Nusawungu II Cilacap
Community Health Center Working Area. 10 (November), 9�25.
Millah, AS (2019). The Relationship between Fe Tablet
Consumption and the Incidence of Anemia in Pregnant Women in Baregbeg Village,
Baregbeg Health Center Working Area, Ciamis Regency, 2018. Galuh Nursing
Journal, 1 (1), 12. https://doi.org/10.25157/jkg.v1i1.1787
Octaviana, A., & Indrasari, N. (2021). Parity,
Age, and Birth Interval on the Incidence of Anemia in Pregnant Women. Mahalayati
Midwifery Journal, 7 (3), 510�517.
http://ejurnalmalahayati.ac.id/index.php/kebidanan
Rahmaniah. (2019). the relationship between maternal
age and parity and the incidence of anemia in pregnant women in the Totoli
Health Center work area in 2017. Journal of Health, Education and Literacy,
2 (1), 24�28. https://doi.org/10.31605/j-healt.v2i1.442
Rismawati, S., & Rohmatin, E. (2018). Analysis of
the causes of anemia in pregnant women. Information Media, 14 (1),
51�57. https://doi.org/10.37160/bmi.v14i1.168
Septiyaningsih, R., & Yunadi, FD (2021). ANALYSIS
OF FACTORS INFLUENCING THE INCIDENT OF ANEMIA IN PREGNANCY. Ar-Rum Salatiga
Health Scientific Journal, 6, 13�19.
http://www.e-journal.ar-rum.ac.id/index.php/JIKA/article/view/126/127
Tarigan, N., Sitompul, L., & Zahra, S. (2021).
Energy Intake, Protein, Iron, Folic Acid and Anemia Status of Pregnant Women in
the Petumbukan Community Health Center Working Area. Innovation Vehicles,
10 (1), 117�126.
Windari, L., Lisnawati, N., & Herutomo, T. (2018).
Factors That Influence the Incidence of Anemia in Pregnant Women in Jatiluhur
District, Purwakarta Regency. Journal of Holistic and Health Sciences, 2
(1), 44�48. https://doi.org/10.51873/jhhs.v2i1.24