Journal of Reproductive Health, 11 (2), 2020: 163-177

DOI: 10.22435 / kespro.v11i2.3799.163-177

THE EFFECT OF PREGNANT MOTHER ANEMIA ON LOW BORN WEIGHT:

META ANALYSIS STUDY OF SOME COUNTRIES, 2015 TO 2019

The effect of anemia among pregnant women to low birth weight babies:
A meta-analysis in various countries from 2015 to 2019

Aditianti *, Sri Poedji Hastoety Djaiman

Functional Implementing Unit - Stunting Prevention Innovation Research

and Development Center for Public Health Efforts Health Research and
Development Agency, Ministry of Health of the Republic of Indonesia

*
E-mail: aditianti@yahoo.com

Manuscripts for 9 September 2020; review 21 September 2020; approved to be published December 29, 2020

Abstract

Background: The prevalence of low birth weight (LBW) in Indonesia shows a decrease, but the risk factor for
anemia in pregnant women has increased sharply and this has an impact on increasing the prevalence of LBW.
Objective: This study aimed to determine the risk of anemia in pregnant women to the prevalence of LBW in
several countries.
Methods: This study was a meta-analysis using PRISMA. Eleven of the 122,000 studies met criteria for the
analysis. Presentation of the data used a forest plot with a random effect statistical model.
Results: The combined odds ratio (OR) showed that the effect of anemia in pregnant women on LBW was 1.49 times
higher than that of non-anemia mothers (95% CI: 1.26-4.60; p <0.001). The variance was 53.7%. The results of the funnel
plots from 11 studies were not evenly distributed so that the information obtained was homogeneous, focusing more on
the middle value.
Conclusion: There was an effect of anemia in pregnant women with the prevalence of LBW. Detection of anemia in
pregnant women needs to be done as early as possible by involving the role of health workers and cadres. Outreach
activities for young women at schools and Posyandu must be carried out regularly and continuously.

Keywords: Anemia, LBW, Pregnancy

Abstract

Background: The prevalence of low birth weight (LBW) in Indonesia shows a decrease, but the risk factor for anemia in
pregnant women has increased sharply and this has an impact on the increase in the incidence of LBW.
Destination: This study aims to determine the risk of anemia for pregnant women to the incidence of LBW in several
countries.
Method: This study is a meta-analysis using PRISMA. Eleven of the 122,000 studies met the criteria for
analysis. Presentation of data using a forest plot with a statistical model random effect.
Result: Big odds ratio ( OR) combined showed that the effect of anemic pregnant women on LBW was 1.49 times higher than that
of non-anemia mothers (95% CI: 1.26-4.60; p <0.001). The amount of the variant is 53.7 percent. The results of the funnel plots of
the 11 studies are not evenly distributed so that the information obtained is homogeneous, focusing more on the middle value.

Conclusion: There is an effect of anemia in pregnant women with the incidence of LBW. Detection of anemia in pregnant
women needs to be done as early as possible by involving the role of health workers and cadres. Outreach for young
women in schools and posyandu must be carried out regularly and continuously

Keywords: Anemia, LBW, Pregnancy

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

PRELIMINARY babies born with normal weight. 9

Low birth weight (LBW) is still a health
problem for mothers and children in
developing countries and is an indicator to
predict infant mortality, stunting, and
disease in adulthood. 1 World Health
Organization ( WHO) defines LBW as babies
born weighing ≤2,500 grams. 2 In
developing and developed countries,
babies with low birth weight (<2,500
grams) are one of the main factors that
can affect neonatal mortality, mortality. post-neonatal
as well as
morbidity in children. 3 According to WHO
Neonatal mortality is 20 times more due to
LBW than normal weight infants. 4 United
Nations Children's Fund ( UNICEF) stated
that LBW is the highest predictor of infant
mortality, especially in the first month
since the child is born. 5
According to UNICEF, the prevalence of LBW
globally reaches almost 15 percent. More
than half of the babies with LBW were born
in West Africa and Central Africa. In 2019 the
prevalence of LBW in Southeast Asia is 14.9
percent and the prevalence in Indonesia is
10 percent. 5 Based on data from Basic Health
Research (Riskesdas), the prevalence of LBW
in Indonesia shows a decreasing trend,
namely in 2010 it was 11.1 percent, in 2013
the prevalence was 10.2 percent, and in
2018 it again decreased to
6.2 percent. 6,7,8 However, this is not in line with
the global target which targets the prevalence
of LBW babies to experience a decline
2.7 percent per year up to year
2025. 2
Body weight is one indicator of a
newborn's health. Basically, babies with
low birth weight that is less than 2500
grams have a higher risk of experiencing
preterm birth, yellow birth, and have
lower scores for skin color, heart rate,
reflex, muscle tone, and respiration
(APGAR) compared to
According to WHO, babies with low birth
weight generally experience poor
long-term life processes. If you do not die
at the beginning of birth, LBW babies have
a risk of growing and developing more
slowly than babies born with normal
weight. 4 In the same article, it was also
stated that there were developmental
disorders and individuals with a history of
LBW had high risk factors for developing
hypertension, heart disease, and diabetes
after reaching the age of 40 years. 4
A study conducted by Mitao in 2015 in North
Tanzania stated that the factors related to the
incidence of LBW were maternal height, time of
visit antenatal care
(ANC) first, number of ANC visits, iron
supplementation, calcium supplements,
maternal education, all diseases during
pregnancy, and hypertension. 9Study which
conducted by Rajashree in 2015 in Karnataka, India
reported that there are multidimensional factors
that cause the birth of LBW babies, namely:
maternal age, literacy rate, birth spacing, daytime
rest during pregnancy, low maternal weight gain
during pregnancy, and blood hemoglobin (Hb)
levels. 10
Sutan in his 2014 study in Malaysia concluded
that LBW can be caused by internal factors of
the mother (nutritional status, age, parity, poor
pregnancy history, previous pregnancy).
give birth LBW, and
abortion / miscarriage) and maternal external
factors (economic status, poor ANC care, fetal
condition). 11 In 2016, the Kamariyah and
Musyarofah study conducted in Surabaya
reported that maternal nutrition before and
during pregnancy can affect the birth weight of
the baby, such as macro nutrient deficiency
(chronic lack of energy) as indicated by the
upper arm circumference indicator <23.5cm. 12 A
2016 study in India stated that anemia in
pregnant women is associated with an
increased risk of postpartum hemorrhage, low
birth weight and perinatal mortality. 13

____________________________
*
Author correspondence
( aditianti@yahoo.com )

© ISSN Health Research and Development Agency:

2354-8762 (electronic); ISSN: 2087-703X (print)

164 Journal of Reproductive Health, 11 (2), 2020

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
The same thing was expressed by Tabrizi and
Barjesteh in a study in Iran in 2018, namely
that low blood Hb levels during pregnancy are
associated with low birth weight. Maternal
blood hemoglobin has a positive relationship
with measurement of weight, length, and head
circumference in newborns. 14 While
According to a prospective study of anemia
in pregnancy conducted by Kaur in 2015 in
India, the maternal hemoglobin level has a
positive association with measurements of
the weight, length and head circumference
of newborns. 15 Prevalence of anemia
on mother pregnant show
A significant increase in the last decade, the
results of the 2013 Riskesdas showed the
prevalence of anemia in pregnant women
was 37 percent and the 2018 Riskesdas
showed an increase to 48.9 percent. 8), (9)
Although LBW in infants has shown a decrease,
the prevalence of anemia in pregnant women
shows an increasing trend. The strong influence
between anemia of pregnant women on low birth
weight encourages the need for information on
how big the problem is in Indonesia
Figure 1. Flow chart PRISMA (Moher D. et.al, 2009) 17
Journal of Reproductive Health, 11 (2), 2020
as well as several other countries. This
analysis aims to determine the risk of
maternal anemia during pregnancy for
LBW babies in several countries.
METHOD
This article is prepared using a meta-analysis
method, namely a quantitative, formal,
epidemiological research design that is used to
systematically assess using previous research. 16 In
other words, meta-analysis is a quantitative
approach by combining several studies with the
same size of association, which aims to obtain a
combined size of association. This meta-analysis
study uses the method Preferred Reporting
Items for Systematic reviews and
MetaAnalyses ( PRISM). 17 This method is
used because it is systematic and makes it
easier to extract data. There are 4 phases
carried out, that is identification, screening,
eligibility, and fall within the criteria as
described in Figure 1.
165
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
This analysis does not differentiate between
sources of reference search sources ( database
reference) and language. Article search strategy
using keywords: maternal anemia, low birth
weight, upper 2014. Source database is google
scholar and pubmed. Once obtained
a number of articles, then checked to see the same
or multiple articles. If the same article is found, then
the article is excluded so that there is only one
article with the same title and content. The next step
is to conduct a feasibility study on whether the
article matches the inclusion criteria that have been
set, if it does not comply with the inclusion /
eligibility criteria that have been set, then the article
is excluded or not included in the next analysis. The
inclusion criteria used were multiple pregnancy;
association sizes are not the same; born with
congenital defects, and the baby is stillborn.
Meanwhile, the exclusion criteria for this study were
not lab research and articles related to animal
subjects. Reference searches were conducted from
January 2019 to December 2019.
Methods are used to maintain reference
quality quorum by method checklist.
There are 5 indicator that used
depending on the subsections, namely (1) the
abstract includes: objectives, data sources, review
methods, results, conclusions; (2) introduction
includes: magnitude of the problem, rationalization,
expectations; (3) methodology includes reference
search, reference selection, reference validity
testing, abstraction
data, characteristics research,
qualitative data; (4) the results include an overview
of the analysis flow, study characteristics,
quantitative analysis data; (5) discussion includes
conclusions from key findings. References that do
not meet the quality are not included in the analysis.
The results of the meta-analysis are presented in forest plot,
namely the distribution description effect
size of all the research results analyzed. The
statistical model used refers to its width
confidence interval ( CI), if the combined CI
cuts all the CIs of the analyzed study
results, the statistical model used is fixed
effect model, however, if the combined CIs
do not cut all the CIs from the analyzed
study results then it will be used
random effect model. For look
The homogeneity or heterogeneity of the research which is the
source of the analysis is seen from the value I 2. When
166 Journal of Reproductive Health, 11 (2), 2020
I 2 below 50 percent, all research results are
considered homogeneous. Conversely, if I 2 above
50 percent, all research results are considered
heterogeneous.
The results of the meta-analysis are presented in forest plot,
each study was shown the same effect, taken by size
point estimate and convidence interval 95 percent
which corresponds to the size of the association.
Reference bias test is carried out using funnel plot,
that is to see the distribution from effect size study
by comparing between the research precision plots ( standard
error) with effect size
all studies analyzed. The data is said to be
biased when the value effect size not spread
symmetrically in a triangle funnel plot. Data
analysis using software Stata version 12.0
RESULTS
Based on keywords "Maternal anemia and
low birth weight upper 2014 ", Obtained
122,000 articles for further selection based on the
year of publication. By choosing a publication
year ranging from 2014 to 2019, 17,600 articles
were obtained. Further tracing was carried out by
selecting articles that matched the substance of
the analysis, from 17,600 which were in
accordance with the topic of analysis, there were
82 articles that were relevant. Of the 82 articles,
eight of them were duplicated so that they were
excluded from the article collection, henceforth
done filtering again
based on the inclusion criteria (single birth,
normal birth, and the child is still alive),
excluded the exclusion criteria (studies related to
experimental animals and clinical studies), which
ended with the acquisition of 38 articles.
Of the 38 articles, there were 15 articles that
were included in the meta-analysis because
they had the same size of association, the size
of the association used was value. odd ratio
(OR). Most of the articles have no data outcome
on exposure so it is not possible to calculate
OR. There were four articles that were
excluded from being analyzed because confident
interval which is not good or has an upper
and lower limit of the width and has poor
reference validity. The process of filtering
articles can be seen in Figure 2.
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

Identification
122,000

104,400 outside the year limit

17,600

14,518 does not correspond

to the substance analyzed

82
Screening

8 duplications

74
36 excluding the inclusion criteria:
- not born twins
- born with stillbirth
- defects
Appropriateness

38

23 association sizes are not the same

15
Enter criteria

4 the contribution of the deviation is too large and

testing the validity of the reference is not good

11

Figure 2. Reference selection process using the PRISMA method

Eleven articles that can be analyzed were three and two articles. Acquisition of articles
obtained from various reference sources from each journal is summarized in the Table
with the most journals coming from BMJ 1.
Global Health and PLOS ONE, namely

Table 1. Number of references and journal sources

No. Journal source Number of references

1 Asian Pacific Journal of Reproduction 1

2 International Journal of Pediatrics 1
3 American Journal of Clinical Nutrition 1
4 BMJ Global Health 3
5 PLOS ONE 2
6 Pakistan Armed Forces Medical Journal 1
7 Indonesian Nutrition Media 1
8 International Journal of Medical Science and Public Health 1

Journal of Reproductive Health, 11 (2), 2020 167

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

Table 2. Characteristics of articles on the effect of anemia in pregnant women with LBW

Birth weight
No. Author Title Year Location Sample Subject Design Study results
baby
1 Mitao M, et al 9 Risk factors and adverse 2015 Tanzania 37,799 Mother and baby Retrospective Number of samples LBW related factors:

168
perinatal outcome North born cohort ( data Normal: anemia, preeclampsia,
associated with low birth secondary) 33,792 premature birth, heavy
weight in Northern LBW: 4,007 pregnant mother's body
Tanzania: a registry-
based retrospective
cohort study
2 Bhaskar RK, et al 18 A case control study on 2015 Nepal 159 cases; Mother and baby Case control Average LBW related factors:
risk factors associated East 159 birth controls birth weight: iron supplementation,
with low birth weight Case group: illness during pregnancy,
babies in Eastern Nepal 2.126.73 grams The first ANC, and the number
Control group: ANC visit
3.083.65 grams

3 Zerfu, et al 19 Dietary diversity during 2016 Ethiopia 374 Mother and baby Retrospective Average The pregnant mother
pregnancy is associated born cohort birth weight: consuming more than 4

Journal of Reproductive Health, 11 (2), 2020

with reduced risk of Inadequate food groups during
maternal anemia, group: pregnancy has risks
preterm delivery, and 2.690.9 ± 20.65 lower for
low birth weight in a gram have anemia during
prospective cohort study Adequate pregnancy and reduce
in rural Ethiopia group: risk of having a child born
3.192.3 ± 33.3 LBW and premature
gram

4 Nair M, et al 13 Association between 2016 Assam, 1,007 Mother and baby Retrospective Pregnant women
maternal anemia and India born cohort related to anemia
Pregnancy outcomes: a increased risk
cohort study in Assam, postpartum haemorrhage
India (PPH), LBW, and perinatal
mortality

168 Journal of Reproductive Health, 11 (2), 2020

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

Birth weight
No. Author Title Year Location Sample Subject Design Study results
baby
5 Kattula D, et al The first 1000 days of 2014 South India 497 Mother and Community- Percentage High morbidity in
20
life: prenatal and baby born based birth birth weight: poor areas of India in the
postnatal risk factors for cohort Normal: first 1000 days of life is

Journal of Reproductive Health, 11 (2), 2020

morbidity and growth in a 82.86% mainly due to
birth cohort in LBW: prenatal factors and
southern India 17.14% gastrointestinal and disease
ARI
6 Masukume G et al Risk factors and birth 2015 Zealand 5,069 Mother and Retrospective Percentage Anemia, especially ones
21
outcomes of anemia in New, baby born cohort LBW from mother occurs early in pregnancy,
early pregnancy in a Australia, anemia: 7.3% at risk for childbirth
Nulliparous Cohort English and Percentage
Ireland LBW from mother
non anemia:
5.2%
7 Feresu SA, et al 22 Risk factors for low 2015 Zimbabwe 3,110 Mother and Cross- Percentage LBW associated with
birthweight in baby born sectional ( LBW data: nutrition, reproduction, medical,
Zimbabwean Women: A. secondary 16.7%) and obstetric factors
secondary data analysis
8 Adane, AA, et al 23 Adverse birth outcomes 2014 Ethiopia 481 Mother and Cross- Number of samples Prevalence of LBW births from
among deliveries at baby born sectional mothers who are less good (stillbirth, anemia: 12
Gondar University ( hospital- preterm birth, and low
Hospital, Northwest based) birth weight) is still high
Ethiopia Number of samples become a health problem
LBW from mother In the main community in
non anemia: the area, birth weight was
42 associated with ANC
and hypertension

9 Anwar R 24 Impact of maternal 2019 Karachi, 643 Cohort A low maternal blood

169
Mother and Number of samples
anemia on perinatal Pakistan baby born LBW: 168 Hb level increases
outcome the risk of birth
preterm, infant LBW, APGAR
score <5 at 1 minute and the
IUD ( intrauterine fetal
death)

Journal of Reproductive Health, 11 (2), 2020 169

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

Birth weight
No. Author Title Year Location Sample Subject Design Study results
baby
10 Fajriana et al 25 Risk factors are 2018 Surabaya, 22 cases; Mother and Case control Pregnant women who gave birth to
associated with Indonesia 22 controls baby born premature babies had a 6.2 times
the incidence of low birth greater risk of experiencing LBW,

170
weight babies in Kecamatan while pregnant women who had
Semampir Surabaya KEK had a 6.6 times greater risk of
experiencing LBW.

11 Rajashree K, et al 10 Study on the factors 2015 Karnataka, 131 Mother and Cross- Percentage by weight The cause of LBW is
associated with low birth India baby born sectional born: multidimensional: age, number
weight among newborns ( hospital- Normal: 69% literacy, birth spacing, daytime rest
delivered in a tertiarycare based) LBW: 31% during pregnancy, maternal weight
hospital, Shimoga, gain during pregnancy, and Hb
Karnataka levels.

Journal of Reproductive Health, 11 (2), 2020

170 Journal of Reproductive Health, 11 (2), 2020
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

All study results in 11 articles stated that meaningful. Anemia in pregnant women is
anemia in pregnant women is a risk factor proven statistics cause LBW.
for LBW. A total of seven studies, namely While four studies other not
the Mitao study (2016) 9, shows a significant difference, namely the
Zefru (2016) 19, Nair (2014) 13, Enter the resume study of Bhaskar (2015) 18, Kattula (2014) 20 Adane
(2015) 21, Feresu (2015) 22, Anwar (2019) 24 and (2014) 23 and Fajriana (2018) 25. The results of this
Rajashere (2015) 10 yielded statistically study are detailed in Table 3.
significant or different results

Table 3. Data extraction based on references entered in the analysis

% amount Representative
No. Studies Year OR 95% CI Study design
weight sample sample
1 Mitao M, et al 9 2016 1.70 1.40-2.20 17.91 Retrospective 37,799 Representative
cohort ( data
secondary)
2 Bhaskar RK, et al 18 2015 1.27 0.59-2.71 2.55 Case control 318 Not
representative
3 Zerfu, et al 19 2016 2.29 1.62-3.24 4.37 Prospective 374 Not
cohort representative
4 Nair M, et al 13 2016 1.26 1.04-1.53 47.47 Retrospective 1,007 Not
cohort representative
5 Kattula D, et al 2014 2.00 0.98-4.06 1.21 Community-based 497 Not
20
birth cohort representative
6 Masukume G et al 21 2015 1.34 1.01-1.78 19.33 Prospective 5,069 Representative
cohort
7 Feresu SA, et al 22 2015 3.51 2,10-5,84 0.82 Cross-sectional 3,110 Representative
(secondary data)
8 Adane, AA, et al 23 2014 1.49 0.79-4.74 0.73 Cross-sectional 481 Not
( hospital-based) representative
9 Anwar R 24 2019 2.48 1.80-3.30 5.09 Cohort 643 Not
representative
10 Fajriana et al 25 2018 2.31 0.62-9.03 0.16 Case control 44 Not
representative
11 Rajashree K, et al 10 2015 4.06 1.50-14.4 0.07 Cross sectional 131 Not
( hospital-based) representative

To see whether the number of samples Of the 11 studies included in the analysis, the
from each study can represent the largest contribution in calculating the combined
population under study, the minimum risk was from the Nair (2016) study. 13 that is
sample size that should be met is 47.47 percent and the smallest contribution
calculated. The sample calculation uses came from the Rajashere study (2015) 10 that is
the sample size formula estimating and 0.07 percent. The biggest risk factor for anemia
odds ratio with specified
relative precision, with in pregnant women to the incidence of LBW in
using by using Badshah research in 2008 3, namelybabies born comes from the study of Rajashere
the proportion of anemic pregnant (2015). 10 with 131 samples of pregnant women.
women who gave birth to LBW by From this study, it was found that the risk of
12.3 percent, while pregnant women who were not anemic gave pregnant women with anemia to give birth to
birth to LBW babies at 8.5 percent and an OR value of 1.5. With a LBW babies was 4.06 times compared to
precision value of 25 percent and pregnant women without anemia. While the
confidence level 95 percent, then the smallest OR value comes from the study of
recommended minimum sample size is 1,028. Nair (2016), 13 that is, the risk of anemia for
In Table 3, it can be seen that a representative pregnant women to have babies with low birth
sample size from each study is compared to weight is 1.26 times compared to pregnant
the number of samples that should be. women who do not have anemia.

Journal of Reproductive Health, 11 (2), 2020 171

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

This meta-analysis resulted in the magnitude
of the risk of pregnant women with anemia
affecting the occurrence of LBW in babies
born by 1.495 times compared to mothers
without anemia (95% CI: 1.36-1.66). This
means that a mother who suffered from
anemia during her pregnancy had almost 2
times the risk of giving birth to a child with
low birth weight, compared to a mother who
was not anemic during her pregnancy, with
a significant difference in risk (p <0.001). As
many as seven of the 11 journals studied
stated that there was a significant
relationship between events
anemia in pregnant women with LBW
cases in babies born. 9, 13, 20, 21, 22, 10,
24
The quality of the data that constructs the combined
risk factors (combined OR) can be seen from
chi-squared heterogeneity ( Figure 3), which
shows the results that the combined OR has a
heterogeneous distribution (p = 0.017 below p
<0.05). This can also be seen from the width confidence
interval ( 95% CI) of the combined ORs that did
not cut across the whole
confidence interval study (lower limit <1.33
and> 1.66).

Information:
Heterogeneity chi-squared = 21.61 (df = 10) then p = 0.017
Variance I-squared (variation in OR attributable to heterogeneity) = 53,7%
Test of OR = 0; z = 17.31; p = 0.000

Figure 3. Distribution forest plot the effect of anemia in pregnant women with LBW

Apart from looking at the magnitude of the combined evenly, the value of all the risks is above 1.
effect of the 11 studies, reference bias also needs to be Reference more found in the center axis.
looked at. Figure 4 shows that the results funnel plot Studies with OR values above 1 and
of the 11 studies were not scattered below 0.5 are underrepresented.

172 Journal of Reproductive Health, 11 (2), 2020

The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
Figure 4. Distribution funnel plot the effect of anemia in pregnant women with LBW
DISCUSSION
Based on the results of the meta-analysis of
this study, anemia in pregnant women has a
significant effect on the incidence of low birth
weight (LBW). According to a 2009 Mutthaya
study 26 who reviewed articles on the
importance of nutrition during pregnancy and
LBW, most of the incidence of anemia in
pregnant women is caused by iron (Fe)
deficiency. Meanwhile, a study conducted by
Allen in 2001 27 explain the mechanism of
anemia that affects birth weight can be
explained by several circumstances, namely
the lack of iron intake can interfere with the
immune system which in turn can increase the
body's vulnerability to infectious diseases such
as genital infection, urinary tract infection,
malaria, and hepatitis. In addition, iron deficiency
can increase the production of stress hormones
norepinephrine and cortisol. Low blood Hb
levels can result fetal hypoxia
which then stimulates the body to produce
hormones corticotrophine. This hormone
can affect the development of the placenta
by reducing blood flow to the fetus. If this
happens continuously, as a result the fetus
will experience growth retardation and the
mother is at risk of giving birth to LBW. A
study conducted by Novianti and Aisyah in
2018 stated that it was
Journal of Reproductive Health, 11 (2), 2020
the relationship between anemia in
pregnant women with the incidence of LBW.
Anemia in pregnancy can be bad for both
the mother and the fetus. Anemia in
pregnancy will disrupt the flow of oxygen
and nutrient supply from mother to fetus. As
a result, the fetus will experience weight
gain problems, causing LBW. 28
The study conducted by Jwa at The National
Center for Child Health and Development
Tokyo Japan from January 2010 to December
2012 observed 3 times the measurement of blood
Hb at 16 weeks, 1627 weeks of gestation, and
pregnancies of more than 28 weeks, showing the
result of an inverse relationship between changes
in blood Hb levels and body weight of babies
born. The higher the mother's blood Hb level
during pregnancy, the lower the risk of the
mother giving birth to a baby weighing less than
2500 grams. From 1,986 pregnant women, 6.6
percent gave birth to LBW babies. Of the 132
mothers who gave birth to LBW babies, there
were 24.2 percent who experienced a decrease in
Hb blood, amounting to <-1.9 g / dl; 28.9 percent
experienced a decrease in blood Hb between -
1.9-1.0 gr / dl; and 46.9 percent
experienced a decrease in blood Hb> -1 g /
dl. The study also found that every 1 g / dl
increase in blood Hb levels increased the
baby's weight gain by 57.9 grams. 29
173
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
In 2020 Patel undertook a study
prospective observational cohort in
Maharashtra India among 72,750 pregnant
women, with the result that 90 percent of
pregnant women are anemic, underweight or
both. Mild anemia experienced by the mother
increased the risk of LBW by 1.1 times and the
risk was significantly increased in conditions of
moderate and severe anemia, namely 1.3 times.
Less weightDuring period pregnancy too
contributes to the incidence of LBW by 1.2
times and the risk of LBW is 1.5 times
greater if the mother is anemic and
underweight during her pregnancy. 30
According to a study conducted by Fajriana
in Surabaya Indonesia in 2018 25 mother
pregnant with chronic energy deficiency
conditions (KEK) has a 6.6 times greater risk
of experiencing LBW. A study conducted by
Aminin in 2014 in Tanjung Pinang Kepulauan
Riau stated that there was a relationship
between KEK in pregnant women and the
incidence of anemia. 31 Meanwhile, according
to a study conducted by Feresu in 2015 22
reported that maternal upper arm circumference
below 28.5 cm was associated with the incidence
of LBW. If pregnant women experience KEK, the
fetus does not get optimal nutritional intake
so that growth and
impaired fetal development. Mothers with
KEK conditions experience a lack of energy
for a long time even before the pregnancy
period. 32 Chronic energy deficiency in
pregnancy has a close relationship based
on research conducted by Larasati in 2018
in the city of Makassar. 33
Unbalanced food consumption and absorption
patterns during pregnancy greatly affect a
person's nutritional status. If pregnant women
do not consume balanced nutrition, both
macronutrients and micronutrients during
their pregnancy, the pregnant woman is at risk
of experiencing nutritional disorders or
deficiency. chronic energy which can
resulting in anemia. 31
Blood-added tablet supplementation in
pregnant women is associated with the
incidence of LBW. Mothers who consumed
iron for less than 90 days were almost 3
times more likely to have LBW babies than
mothers who consumed more than 90
days. 18 In line with this, studies were
174 Journal of Reproductive Health, 11 (2), 2020
Rizki conducted in 2017, showing a
significant relationship between iron
supplementation and anemia status of
pregnant women in the 3rd
trimester.Pregnant mothers need for iron,
especially during the 2nd and 3rd
trimesters due to an increase in blood
volume and plasma volume during
pregnancy. This will cause hemodilution,
the amount of iron absorbed from food
and reserves in the body is usually not
sufficient pregnancy
for the mother's
so that
needs required
for
addition intake substanceiron through
Fe tablet supplementation. 34
Apart from KEK in pregnant women, there are other factors
that influence the occurrence of LBW in this meta-analysis
study. Bhaskar Research (2015) 18, Kattula (2014) 20 and Adane
(2014) 23
revealed that antenatal visit time (ANC) was
associated with LBW incidence. Antenatal
screening is important for screening
high-risk mothers, monitoring pregnancy
weight gain, screening for anemia, providing
nutritional supplements that are essential
for good pregnancy outcomes, and helping
reduce and / or prevent maternal and
newborn complications and death.
Increasing the number of ANC visits will
reduce the chances of giving birth to LBW
babies. In this study, children born to
mothers with ANC were less than four times
as likely to be 6 times more likely to deliver
LBW babies. Performing ANC routinely can
detect anemia in pregnant women early to
be followed up with iron and folic acid
supplements as well as good and proper diet
counseling. 20
A study in Ethiopia 19 shows that pregnant
women who eat a variety of foods (milk,
animal source foods, fruits, and vegetables
rich in vitamin A) have a lower risk of
developing anemia, LBW and preterm birth.
The incidence of LBW is also related to the
condition of pregnant women with
preeclampsia 9, eclampsia, 22 and hypertension
chronicles. 9,18,22,23 Another thing that also
influences the occurrence of LBW in this
haveis not couple
meta-analysis wedding 21
smoking habit, 9 nutritional status (deficiency and
obesity) in pregnant women, 9 maternal HIV status, 9
mother's height, 18 mother's education, 18 residence, 22
malaria, 22 literacy age, 10 distance
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
birth, 10 habit of resting during the day, 10
and weight gain during pregnancy. 10
In this meta-analysis, there are also studies
which reveal that there is no significant
relationship between anemia in pregnant
women and the incidence of LBW. The
insignificant results of the study were due to
the fact that most mothers did not have
anemia. This study was conducted in 2018 in
Surabaya Indonesia using a case-control
design. 25 Study conducted by Enterume in
2015 21 also reported that the incidence of
anemia in pregnant women did not affect outcome
pregnancy, however
bad pregnancies are more common in
those who are anemic than in those who
are not.
A meta-analysis study on the relationship
between anemia and LBW pregnant women
in children was carried out by Figueiredo. 35 This
study did not limit the number of years of
publication but limited the study design to
the cohort and case-control study of 68
articles. The results of the study concluded
that anemia in pregnant women is a risk
factor for low birth weight in infants (OR:
1.23; 95% CI: 1.06-1.43). Meanwhile, a
meta-analysis study conducted by Rahmati
in 2016 on 30 articles showed that anemia in
pregnant women in the first trimester
showed a significant relationship with low
birth weight (RR: 1.28, 95% CI: 1.10-1.50, p
<0.01). 36
The weakness of this meta-analysis is that the reference
year is limited to the last five years. This is because the
anemial context of pregnant women and the incidence
of LBW requires data from the latest study results to be
relevant to the current situation. In addition, this
analysis does not limit the study design because of the
limited references that describe the OR and prevalence
values exposure in detail.
CONCLUSION
This meta-analysis resulted in the magnitude of the risk
of pregnant women with anemia which affected the
occurrence of LBW in children, which was 1.49 times
compared to pregnant women who did not.
Journal of Reproductive Health, 11 (2), 2020
anemia. Anemia in pregnant women is
mostly caused by iron (Fe) deficiency. Lack of
iron consumption can reduce hemoglobin
(Hb) levels in the blood of pregnant women
so that blood flow to the fetus becomes
obstructed and causes disruption of oxygen
flow and nutrient supply from the mother to
the fetus. fetus. Thing this disturb
fetal growth and leads to inhibition of fetal
weight gain. There is an inverse
relationship between changes in maternal
blood Hb levels during pregnancy and
weight gain in babies born. The lower the
blood Hb level of the pregnant woman,
the greater the risk of the mother giving
birth to a low birth weight baby.
SUGGESTION
It is necessary to innovate intervention programs in
the management of anemia in pregnant women that
can be carried out by collaborating across programs
and cross sector in a manner
continuous, for example with
detect anemia in pregnant women as early as
possible. Pregnant women who experience
anemia must be monitored by health personnel
and cadres so that the provision of Fe tablets and
local food ingredients sources of Fe can be given
freely routine During period pregnancy.
Massive outreach to young women as
prospective mothers at schools and posyandu
is a mustheld in a manner routine and
continuous.
BIBLIOGRAPHY
1. Blencowe H, Krasevec J, de Onis M, Black
RE, An X, Stevens GA, et al. National,
regional, and worldwide estimates of low
birthweight in 2015, with trends from
2000: a systematic analysis. Lancet Glob
Heal [Internet]. 2019; 7 (7): e849–60.
Available on:
http://dx.doi.org/10.1016/S2214-
109X (18) 30565-5
2. WHO. Low birth weight. Department of
Nutrition for Heath and Development.
2014.
3. Badshah S, Mason L, McKelvie K, Payne
R, Lisboa PJG. Risk factors for low
175
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)
birthweight in the public-hospitals at
Peshawar, NWFP-Pakistan. BMC Public
Health. 2008; 8: 1–10.
4. World Health Organization. World health
assembly global nutrition targets 2025: Low
birth weight policy brief. World Heal Organ
[Internet]. 2019; 1–7. Available at:
http://www.who.int/nutrition/topics/global
targets_stunting_policybrief.pdf
5. UNICEF. LOW BIRTH WEIGHT
[Internet]. 2019. Thing.
https://data.unicef.org/topic/nutrition/low-
birthw. Available on:
https://data.unicef.org/topic/nutrition/low-
birthweight /
6. Ministry Health RI. Research
Basic Health 2010. Research and
Development Agency for Health [Internet].
2010; 78. Available on:
http://www.riskesdas.litbang.depkes.go.id
/download/TabelRiskesdas2010.pdf
7. Ministry of Health of the Republic of
Indonesia. Indonesia Basic Health Research
Report (Riskesdas) 2013.2013.
8. Ministry of Health of the Republic of Indonesia.
Report on the Results of Indonesian Basic
Health Research (Riskesdas) 2018. Basic Health
Research 2018. 2018. p. 182–3.
9. Mitao M, Philemon R, Obure J, Mmbaga
BT, Msuya S, Mahande MJ. Risk factors
and adverse perinatal outcome associated
with low birth weight in Northern
Tanzania: A registry-based retrospective
cohort study. Asian Pacific J Reprod
[Internet]. 2016; 5 (1): 75–9. Available at:
http://dx.doi.org/10.1016/j.apjr.2015.12.0
14
10. Rajashree K, Prashanth H, Revathy R.
Study on the factors associated with low
birth weight among newborns delivered
in a tertiary-care hospital, Shimoga,
Karnataka. Int J Med Sci Public Heal.
2015; 4 (9): 1287.
11. Sutan R, Mohtar M, Mahat AN, Tamil AM.
Determinant of Low Birth Weight Infants:
A Matched Case Control Study. Open J
Prev Med. 2014; 04 (03): 91–9. Kamariyah
12. N. Kamariyah, Musyarofah: The
Circumference of Mother Hamiil's Upper
Arm Will Affect The Weight Gain Of Babies
Born At BPS Artiningsih Surabaya
98.: 98–106.
13. Nair M, Choudhury MK, Choudhury SS,
Kakoty SD, Sarma UC, Webster P, et al.
Association between maternal anemia
176 Journal of Reproductive Health, 11 (2), 2020
and pregnancy outcomes: A cohort
study in Assam, India. BMJ Glob Heal.
2016; 1 (1): 1–9.
14. Tabrizi. Maternal Hemoglobin Levels
during Pregnancy and their relation with
Birth Weight of Neonates. J Med Sci Clin
Res. 2018; 6 (7).
15. Kaur M, Chauhan A, Manzar MD, Rajput
MM. Maternal anemia and neonatal
outcome: A prospective study on urban
pregnant women. J Clin Diagnostic Res.
2015; 9 (12): QC04–8.
16. Luntz WNGR. Medical Research. Br Med
J. 1944; 1 (4346): 572.
17. Moher D, Liberati A, Tetzlaff J, Altman DG,
Altman D, Antes G, et al. Preferred
reporting items for systematic reviews
and meta-analyzes: The PRISMA
statement. PLoS Med. 2009; 6 (7).
18. Bhaskar RK, Deo KK, Neupane U,
Chaudhary Bhaskar S, Yadav BK,
Pokharel HP, et al. A Case Control Study
on Risk Factors Associated with
LowBirth Weight Babies in Eastern
Nepal. Int J Pediatr. 2015; 2015: 1–7.
19. Zerfu TA, Umeta M, Baye K. Dietary diversity
during pregnancy is associated with reduced
risk of maternal anemia, preterm delivery,
and low birth weight in a prospective cohort
study in rural Ethiopia. Am J Clin Nutr. 2016;
103 (6): 1482–8. Kattula D, Sarkar R,
20. Sivarathinaswamy P, Velusamy V, Venugopal
S, Naumova EN, et al. The first 1000 days of
life: Prenatal and postnatal risk factors for
morbidity and growth in a birth cohort in
southern India. BMJ Open. 2014; 4 (7).
21. Masukume G, Khashan AS, Kenny LC,
Baker PN, Nelson G.Risk factors and birth
outcomes of anemia in early pregnancy in
a nulliparous cohort. PLoS One.
2015; 10 (4): 1–15.
22. Feresu SA, Harlow SD, Woelk GB. Risk factors
for low birthweight in Zimbabwean women:
A secondary data analysis. PLoS One. 2015;
10 (6): 1–17.
23. Adane AA, Ayele TA, Ararsa LG, Bitew
BD, Zeleke BM. Adverse birth outcomes
among deliveries at Gondar University
Hospital, Northwest Ethiopia. BMC
Pregnancy Childbirth. 2014; 14 (1): 1–8.
24. Rabiah anwar, Kashif Razzaq NN. I
mpactofmaternalanemia onperinataloutcom
e. 2019; 69 (2): 397–402. Fajriana A,
25. Buanasita A. Risk Factors
The Effect of Anemia in Pregnant Women on… (Aditianti and Sri Poedji Hastoety Djaiman)

Related to the incidence of low birth of the evidence. Albert Canada Inst Heal
weight babies in the Semampir District, Econ [Internet]. 2008; (December
Surabaya. Indonesian Nutrition Media. 2008): 1–284. Available on:
2018; 13 (1): 71. http://scholar.google.com/scholar?hl=en&
26. Muthayya S. Maternal nutrition & low btnG = Search & q = intitle: Determinants + an
birth weight - What is really important? d + Prevention + of + Low + Birth + Weight +: +
Indian J Med Res. 2009; 130 (5): 600–8. A + Synopsis + of + the + Evidence # 0
27. Alen LiH. Biological Mechanisms That 33. Widya Larasati E. Relationship between
Might Underlie Iron's Effects on Fetal Deficiencies Energy Chronic (SEZ)
Growth and Preterm Birth. J Nutr. 2001; against the incidence of anemia in pregnant
131: 616–35. women at RSKDIA Siti Fatimah Makassar 2018. J
28. Novianti S, Aisyah IS, Study P, Society Health Pomegranate Pelamonia.
K, Health I, Siliwangi Tasikmalaya U. Relationship 2018; 2 (2): 131–4.
between anemia in pregnant women and pregnant 34. Rizki F, Lipoeto NI, Ali H. Relationship between Fe
women. 2018; 4 (1): 6–8. tablet supplementation and hemoglobin levels in
29. Jwa SC, Fujiwara T, Yamanobe Y, Kozuka third trimester pregnant women at Air Cold Health
K, Sago H. Changes in maternal Center, Padang City. J Andalas Health. 2018; 6 (3):
hemoglobin during pregnancy and birth 502–6.
outcomes. 2015; 1–10. 35. Figueiredo ACMG, Gomes-Filho IS, Silva
30. Patel A, Prakash AA, Das PK, Gupta S, RB, Pereira PPS, Da Mata FAF, Lyrio AO, et
Pusdekar YV, Hibberd PL. Maternal al. Maternal anemia and low birth weight:
anemia and underweight as determinants of A systematic review and metaanalysis.
pregnancy outcomes: cohort study in Nutrients. 2018; 10 (5): 1–18.
eastern rural. 2018; 1–15. 36. Rahmati S, Delpisheh A, Parizad N,
31. Fidyah A, Atika W, Pratidina LR. The Effect Sayhmiri K. Maternal anemia and
of Chronic Energy Deficiency (KEK) With pregnancy outcomes: A systematic
The Incidence of Anemia in Pregnant reviewmeta-analysis.
and Int J Pediatr.
Women. J Health. 2014; 5: 167–72. Ohlsson 2016; 4 (8): 3323–42.
32. a, Shah P. Determinants and prevention of
low birth weight: a synopsis

Journal of Reproductive Health, 11 (2), 2020 177