Clinical Epidemiology 2019

Placenta Weight on Anemia Mothers in Indonesia

A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2, Irmawati B2, Anggreani2, Wira
Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2,
Hajri Wahyuni2, Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, widyawati2,
Cahyani Putri2.

1. Midwifery, STIKES Widya Nusantara Palu

2. Public Health, University of Tadulako

*Email: andifahiranur1988@gmail.com

ABSTRACT

The development of fetus is very influenced by place volume. A bad condition of placenta volume
and after all happen to anemia mothers increase birth complication risk and the fetus
development. The average visit of pregnant women at one of the Central Sulawesi Provincial
Government Hospitals in Indonesia is 65,821 per year and with anemic incidence of 6,272
mothers. This research aims to find out the factor related to placenta weight on anemia mothers
in government hospital Anutapura of Palu city. This was an observational analytic research with
cross sectional approach. Sample number was 168 pregnant mothers selected using purposive
sampling. The research result reveals that Chi Square Test with CI 95%, that there is a
relationship among frequency ANC (ρ=0.028), obedience to take tablet Fe medicine (ρ=0.001),
mother’s age (ρ=0.004), and Paritas (ρ=0.030) with placenta weight on anemia mothers in
government hospital Anutapura of Palu city. It needs to have attention from pregnant mother to
visit ANC routinely, consume tablet Fe during pregnancy mainly for anemia mothers to avoid
light placenta weight, and also to plan a pregnancy in a productive age and arrange pregnancy
distance to prevent risk birth.

Keywords : Placenta, Anemia, ANC, Tablet Fe

Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 1
 Clinical Epidemiology 2019
INTRODUCTION

Anemia in pregnancy, defined as the concentration of hemoglobin (Hb) <11 g/dL is a

public health problems most broad and general that affects more than 56 million women around
the world, two-thirds of whom are in Asia[1]. Based on data the WHO in 2008 found that 41,8%
of pregnant women suffering from anemia of the entire global population. The highest proportion
contained on pregnant women in Africa and South Asia regionthat is 57,1% and 48,2%.Among
the South Asian countries, India is the country with the prevalence of anemia in pregnancy is
highest with 49,7%[2].

According to WHO, the incidence of pregnancy anemia ranged between 20 and 89% by
setting Hb 11 g% (g/dL) as the basis.The rate of anemia in Indonesia showed a high enough
value, ie 3.8% rate of anemia of pregnancy in the first trimester, second trimester 13,6% and
24,8% in the third trimester[3].

Based on the data and information according to the Ministry of Health, Central Sulawesi
Province The average visit of pregnant women at one of the Central Sulawesi Provincial
Government Hospitals (Indonesia) is 65,821 per year and with anemic incidence of 6,272
mothers. while pregnant women visit coverage do service Antenatal Care (ANC) K1 totaled
57.879 (87,93% ) and the number of visits of pregnant women who do ANC minimum of 4x
(K4) totaled 50.473 (76,68%)[4].

This research is aimed to determine the relationship of the frequency of Antenatal Care, the
compliance iron tablet consumption, maternal age, and parity with the weight of the placenta in
the mother anemia at RSU Anutapura in Palu, Indonesia.

METHODS
The study design using of Analytical Surveys with Cross Sectional Study. The study was
conducted in October and December 2018. The sampling technique is Purposive Sampling.The
total sample of 168 mothers. Collection of data through direct observation, a questionnaire and
data from relevant agencies. Analysis of data using a computer program.

RESULTS
This study using 168 women in Indonesia showed that all dependent variables had a
significant relationship with placental weight (Table 1). This study used a sample with criteria
for maternity women who have a history of anemia during pregnancy.

Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 2
 Clinical Epidemiology 2019
Table 1. Analysis of Factors Related to Placenta Weight on Anemia Mothers
in Government Hospital Anutapura Palu City Indonesia
Weight Placenta
Ρ-value
Risk Factors
Mild Normal
n % n %
Frequency ANC
Non adequate 59 64.8 32 35.2 0,028
Adequate 37 48.1 40 51.9
The Compliance Consumption Fe Tablets
Not obey 61 68.5 28 31.5 0,001
Obey 35 44.9 44 55.1
Maternal Age
Age at risk (< 21 and > 35 years) 61 67.0 30 33.0 0,004
Age is not at risk (21-35 years) 35 45.5 42 54.5
Parity
> 3 children 50 59.5 34 40.5 0,030
≤ 3 children 36 42.9 48 57.1
Source: Primary Data, 2018.

Based on the analysis using Chi Square test conducted on the frequency with placental
weight ANC showed the value ρ = 0,028. Tablet consumption fe the compliance with placental
weight showed the value ρ = 0,001. The age of the mother with placental weight showed the
value ρ = 0,004. And Based on the analysis using Chi-Square test performed on placental weight
with parity showed the value ρ = 0,030.

DISCUSSION
The results showed relationship between the frequency of the ANC and maternal anemia
placental weight. It shows that respondents who perform non inadequate ANC frequency during
pregnancy had a placental weight to get chances light compared to the ANC adequate
frequency.This is because there are factors that cause non inadequate ANC frequency of
respondents still less one of which is the knowledge and the lack of support/motivation of the
respondent's family members.

The results are consistent with research by Patimah et al [5] in his journal "International
Proceedings of Chemical Bilogical and Environmental Engineering" indicates that the use of
ANC significantly affect placental weight (ρ≤ 0,05). The role of husband is very important to
motivate wives during pregnancy, especially motivating in terms of staying healthy during
pregnancy and accompanied the wife of routine antenatal check.Besides her husband, parent
support pregnant women it also has an influence on ANC visit. ANC visit a preventive measure
of pregnant women to produce a healthy pregnancy through physical examination, supplements,

Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 3
 Clinical Epidemiology 2019
and health education of pregnant women. ANC regularly visits so that immediate detection of
various risk factors pregnancy anemia of pregnancy one[6].

Results Fe tablet consumption compliance analysis showed association between placental

weight on maternal anemia. It shows that respondents who do not abide in consuming Fe tablets
during pregnancy to get chances have a mild placental weight compared with respondents who
dutifully consume the Fe tablet. This happens because there are factors that cause the poor
adherence Fe tablet respondents consumed less well one of them is the influence of the drug's
side effects, it is this which may also affect placental weight mild.

The results are consistent with research which get the result that there is a relationship
between adherence to drink tablets fe against placental weight in the third trimester pregnant
women in health centers Kalikajar I Wonosobo Indonesia 2014 with Chi Square correlation
value (ρ = 0,035) [7].

Pregnant women need for iron increases (for the formation of the placenta, and red blood
cells) of 200-300%. Estimates of the amount of iron that needs to be stockpiled during pregnancy
is 1.040 mg of this amount, 200 mg of iron retained by the body during child birth and 840 mg of
the rest is lost.This amount may not be fulfilled only through diet or food, so that iron
supplementation is essential to put in place, even in a well-nourished women[8]

Prevention efforts improve compliance fe tablet consumption is to increase the adequate

nutrition is also pretty and needs fehb concentration does not decline, so there is no interference
uteroplacental circulation.As such efforts to improve nutrition in pregnant women will contribute
significantly both to the health of mother and fetus, and directly or indirectly contribute to the
viability of the fetus in the womb and after birth.

Based on the analysis of maternal age, show that there is a relationship between the age of
the mother with placental weight maternal anemia.This means that the respondents were age risk
< 21 years and > 35 years old to get chances have a mild placental weight compared to
respondents of reproductive age is 21-35 years. This occurs because of competition for food
between fetus and mother are still in the growth, as well as hormonal changes during pregnancy
so that women have the body needs to nutrients larger than the other adult women.
Supplementary needs for nutrition caused by pregnancy adjust to the necessary growth would
increase the risk to the pregnancy. Other than that age who are too young have a risk because
biologically and psychologically immature and ready with the pregnancy through[9,10,11].

Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 4
 Clinical Epidemiology 2019
The results are consistent with research conducted in Tanzania showed that age <20 years
and >35 years is a risk factor affecting the health of babies born.The study of HM Hanif at
Pakistan in 2011 explained that women who become pregnant the first time at older ages (ie, 40-
49 years) had a significantly greater risk for perinatal deaths, which is 50% greater than in the
age group of 20-29 years [12].

The low placental weight was higher in young mothers aged less than 20 years. Young
mothers often give birth to low weight of the placenta.This happens because the young mother is
not mature and do not have placental transfer system as efficiently as adult women. Other than
that, pregnancy at less than 20 years of age the pelvis and uterus are still small and immature
reproductive organs [13].

Efforts to prevent the occurrence of placental weight important age-related mild maternal
age is too young (<21 years) or too old (> 35 years) is to consider the age at the time wanted to
conceive are of reproductive age (21-35 years) and routine ANC visit at least 4 times during
pregnancy, so that complications or complications-complications of pregnancy and childbirth can
be prevented or minimized and anemia of pregnancy does not occur.

Based on the analysis of parity, shows that there is a relationship between placental weight
parity with maternal anemia.This means that parity with low risk or ≤ 3 children the less likely
the mother anemic and has a mild placental weight.This happens because the relationship
between placental weight parity with incident light associated with the nutritional status of
pregnant women.The higher parity will further enable the respondents had an iron
deficiency.Iron deficiency anemia is the cause of the respondents that may impact on the size of
the maternal placental weight.Conversely, if pregnant women with low parity over a minimum
potential for iron deficiency.

The results are consistent with research with the title of the journal "The Effects of Mother's
Age, Parity and Antenatal Clinic Attendance on Infant Birth Weight", which indicates that
placental weight low and neonatal death more serious teenage mothers and parents with high
parity because they deplete nutrients in the body[14].

Mothers who have given birth five (5) times or more, have stretched uterus excessive
thereby creating voids at risk of abnormalities in the placenta [15]. Efforts to prevent mild
placental weight with parity > 3 children in pregnant women can fulfill a balanced nutrition with
high calories to prevent pregnancy complications, especially the Chronic Energy Deficiency and
anemia. Other than that, the importance of pregnant women ANC visit regularly at least 4 times
and to get counseling if anemic or Chronic Energy Deficiency [16,17].

Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 5
 Clinical Epidemiology 2019
CONCLUSION
Frequency ANC, Compliance Consumption Tablet Fe, age of mother, and Parity are
factors associated with maternal anemia placental weight.

RECOMMENDATION

To pregnant women for routine ANC, raising awareness about the importance of tablets fe,
expected in young mothers under the age of 20 years in order to delay pregnancy and women
aged over 35 years in order to terminate the pregnancy to be acceptors of family planning
programs, as well as not to have more children of three.

ACKNOWLEDGMENT
We would like to show our gratitude to the all contributors who participated by giving
comments on an earlier version of the manuscript, although any errors are our own and should
not tarnish the reputations of these esteemed people.

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Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
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Placenta Weight on Anemia Mothers in Indonesia (A Fahira Nur*1, Adhar Arifuddin2, Vidyanto2, Fendi Pradana2,
Irmawati B2, Anggreani2, Wira Trisnaini2, Arvanita Pariua2, Nurfajriana2, Nur Rahmadana2, Dewi Sartika Hakim2, Shinta2, Hajri Wahyuni2,
Rahayu Murti Ningrum2, Chruysita Veronika Patiri2, Widyawati2, Cahyani Putri2) Page 7