Maternal Anemia in the Third Trimester and Related Maternal and Fetal Outcomes: Results from a Study in Jember Regency

Devi Arine Kusumawardani; Farhan Dwi Purnama; Andrei Ramani

doi:10.33096/woh.vi.1606

Devi Arine Kusumawardani Departement of Biostatistics and Population, Faculty of Public Health, University of Jember, Indonesia
Farhan Dwi Purnama Departement of Biostatistics and Population, Faculty of Public Health, University of Jember, Indonesia
Andrei Ramani Departement of Biostatistics and Population, Faculty of Public Health, University of Jember, Indonesia

DOI: https://doi.org/10.33096/woh.vi.1606

Keywords: Anemia, third trimester pregnancy, maternal outcome, fetal outcome

Abstract

Anemia in pregnant women is at risk of becoming one of the causes of poor maternal and fetal outcomes. Specific interventions to increase hemoglobin levels in anemic pregnant women may significantly influence maternal and fetal outcomes. Jember Regency is one area in East Java Province that is prioritized for reducing cases of poor maternal and fetal outcomes. This quantitative, analytical, and observational study used a cross-sectional design. The study population comprised third-trimester pregnant women from January to December 2022 in the Arjasa Health Center's working area, totaling 550 women. The sample size calculation yielded a sample of 115 third-trimester pregnant women by simple random sampling. The analysis test used in this study was the contingency coefficient test. Data collection used secondary data from the maternal and child health clinic register book, the pregnant women's cohort book, and the Arjasa Health Center laboratory examination book for 2022. The study results showed that the majority of respondents did not have a history of anemia, and those who did mostly had mild anemia (42.6%). The study revealed a correlation between anemia history in third-trimester pregnant women and maternal outcomes (p-value = 0.005, C = 0.291), categorized as a weak correlation, and low birth weight (p-value = 0.015, C = 0.220), also categorized as a weak correlation. The analysis of the history of anemia incidents in third-trimester pregnant women with the age of delivery and infant mortality did not show a significant correlation. Maternal anemia in third-trimester pregnant women is associated with a higher risk of poor maternal outcomes and low birth weight. Strengthening early anemia screening and adherence to iron–folic acid supplementation, integrated into maternal nutrition programs with robust referral systems, is essential to reduce adverse maternal outcomes and low birth weight in Jember Regency.

References

Septiyaningsih, Rochany, Yunadi FD. Analisis Faktor Yang Mempengaruhi Kejadian Anemia Dalam Kehamilan. Jurnal Ilmu Kesehatan Ar-Rum Salatiga. 2021;6.

Babah OA. Anaemia and iron deficiency anaemia during pregnancy in Nigeria : Risk factors , treatment options and impact on maternal and perinatal outcomes. Karolinska Institutet; 2025.

World Health Organization (WHO). Anaemia [Internet]. World Health Organization. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/anaemia

Kementerian Kesehatan RI. Riset Kesehatan Dasar Tahun 2018. Jakarta; 2019.

Wang R, Xu S, Hao X, Jin X, Pan D, Xia H, et al. Anemia during pregnancy and. 2025;(January). Available from: https://doi.org/10.3389/fgwh.2025.1502585

Biradar B, Arasu S, Ramesh N. Anemia burden in pregnancy and birth outcomes among women receiving antenatal care services from a secondary level hospital in South India : A record review. Journal of Family Medicine and Primary Care. 2023;12:2352–8.

Anggreny RV, Zulkarnain, Fajar NA. Analisis Faktor-Faktor Kejadian Anemia Pada Ibu Hamil dan Dampak Terhadap Bayi. Jurnal Kesehatan. 2023;14(1):108–14.

Obeagu GU, Obeagu EI. Complications of anemia in pregnancy. Medicine (Baltimore). 2025;104(January 2024):1–5.

Beckert RH, Baer RJ, Anderson JG, Rogers LLJ pawlowski EE. Maternal anemia and pregnancy outcomes : a population-based study. J Perinatol [Internet]. 2019;d. Available from: http://dx.doi.org/10.1038/s41372-019-0375-0

Reitsma A, Simioni J, Brunton G, Kaufman K, Hutton EK. Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine. 2020;21:100319.

Moges S, Kussa S, Endale A, Lajore BA, Mekango DE. Understanding Anemia and Predictors of Adverse Maternal and Neonatal Outcomes : A Multicenter Prospective Cohort Study in Southern Ethiopia. 2016;

Farhan K, Dhanny DR. Anemia Ibu Hamil dan Efeknya pada Bayi. Muhammadiyah Journal of Midwifery. 2021;2(1):27.

Jember DKK. Profil Kesehatan Kabupaten Jember Tahun 2022 [Internet]. Jember; 2022. Available from: http://scioteca.caf.com/bitstream/handle/123456789/1091/RED2017-Eng-8ene.pdf?sequence=12&isAllowed=y%0Ahttp://dx.doi.org/10.1016/j.regsciurbeco.2008.06.005%0Ahttps://www.researchgate.net/publication/305320484_S

Kementerian Kesehatan Republik I. Buku Saku Pencegahan Anemia pada Ibu Hamil dan Remaja Putri. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.

Saraswathy V, Subashini M, Jayavani RL, Vaithiyanathan U, Mohan R, Sindhuri R. Predictors of maternal and fetal outcome in severely anemic pregnant mothers : A sequential mixed methods study. 2023;9–13.

Jember DKK. Profil Kesehatan Kabupaten Jember Tahun 2022. 2023.

Filippi V, Chou D, Barreix M, Say L, Barbour K, Cecatti JG, et al. A new conceptual framework for maternal morbidity. International Journal of Gynecology and Obstetric. 2018;141:4–9.

Rahmawati A, Alamanda Irwan A, Nulanda M, Darma S. Hubungan Anemia Pada Ibu Hamil Dengan Angka Kejadian Prematuritas Di Rsia Sitti Khadijah I Makassar Tahun 2022. PREPOTIF Jurnal Kesehatan Masyarakat. 2024;8(1):367–75.

Lauer JM, Bhaise S, Dhurde V, Gugel A, Shah M, Hibberd PL, et al. Maternal Anemia during Pregnancy and Infant Birth Outcomes : A Prospective Cohort Study in Eastern Maharashtra , India. Current Development in Nutrition [Internet]. 2024;8(11):104476. Available from: https://doi.org/10.1016/j.cdnut.2024.104476

Barut A, Mohamud DO. The association of maternal anaemia with adverse maternal and foetal outcomes in Somali women: a prospective study. BMC Women's Health. 2023;23(1):1–8.

Kwak DW, Kim S, Lee SY, Park HJ, Han YJ, Kim MY, et al. Effects of anaemia development during pregnancy on maternal psychological health. 2025;1–7.

Kharate MA, Choudhari SG. Effects of Maternal Anemia Affecting Fetal Outcomes : A Narrative Review. 2024;16(7).

Ratnaningtyas M, Indrawati F. Karakteristik Ibu Hamil dengan Kejadian Kehamilan Risiko Tinggi. Higeia Journal of Public Health Res Dev. 2023;7(3):334–44.

Widoyoko APH, Septianto R. Pengaruh Anemia terhadap Kematian Maternal. Jurnal Penelitian Perawat Profesi. 2020;2(1):1–6.

Rahmah N, Karjadidjaja I. Hubungan anemia pada ibu hamil terhadap kejadian berat badan lahir rendah (BBLR) di Puskesmas Kecamatan Pasar Rebo Jakarta Timur. Tarumanagara Medical Journal. 2020;2(2):378–83.

Jelita MMS, Zubaidah, Alkai S. Hubungan Ibu Hamil Anemia dengan Kejadian Risiko Berat Badan Lahir Rendah di Puskesmas Martapura Timur. Jurnal Ilmu Kesehatan Insan Sehat. 2022;10:2.

Yordian KS, Husni Syam H, Pribadi A. Analisis Kadar Hemoglobin dan Hematokrit Maternal terhadap Kejadian Bayi Berat Lahir Rendah di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Indonesian Journal of Obstetrics & Gynecology Science. 2021;4(2):143–50.

Mustika E, Fika Minata. Analisis Hubungan Faktor Maternal Dan Penyakit Kronik Pada Persalinan Prematur. Jurnal Kesehatan dan Pembangunan. 2021;11(21):19–27.

Solama W. Faktor-Faktor Yang Berhubungan Dengan Kejadian Persalinan Prematur. Jurnal Kebidanan STIKES ‘Aisyiyah Palembang. 2019;3:110–22.

Obianeli C, Afifi K, Stanworth S, Churchill D. Iron Deficiency Anaemia in Pregnancy : A Narrative Review from a Clinical Perspective. 2024;1–17.

Wati S, Adi MS. Gambaran Kematian Neonatal Berdasarkan Karakteristik Ibu di Kota Semarang. Jurnal Epidemiologi Kesehatan Komunitas. 2020;5(2):82–7.

Taqiyya N, Nuswantoro D, C.L MA. Pentingnya Status Anemia Dalam Kehamilan Dengan Perdarahan Postpartum Primer. Indonesian Midwifery and Health Sciences Journal. 2021;3(4):359–66.

Kasminawati, Hakim BHA, Tahir AM. Nutritional Status and History of Pregnancy Complications as A Determinant Childbirth Complications events in District Mamuju. 2015;2(1):99–107.

Sihombing N, Saptarini I, Sisca Kumala Putri D, Penelitian dan Pengembangan Upaya Kesehatan Masyarakat P, Litbang Kesehatan B. Determinan Persalinan Sectio Caesarea Di Indonesia (Analisis Lanjut Data Riskesdas 2013). Jurnal Kesehatan Reproduksi. 2017;8(1):63–75.

Novianti S, Aisyah IS. Hubungan Anemia Pada Ibu Hamil Dan Bayi Berat Lahir Rendah. 2018;4(1):6–8.

Surya SS, Jamil NA, Cahyanti D, Rahma A, Amalia Adityas DS, Dewi TM. Anemia in Pregnancy and Low Birth Weight Before and During the COVID-19 Pandemic in Kalijambe. Media Kesehat Masyarakat Indonesia. 2021;17(4):152–62.