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Introduction

Pregnancy impacts various physiological changes that often make it difficult to diagnose
hematological diseases and their treatment, especially in anemia. Anemia in pregnant women
is called "Potential Danger To Mother And Child". Therefore anemia requires serious attention
from all parties involved in health services. (1)
Oxygen needed in pregnancy is higher, so it triggers the increase in erythroprotein
production. (1) According to WHO (World Health Organization), anemia is a condition when
the hemoglobin level is <11 gr / dl in pregnant women. The frequency of anemia during
pregnancy depends on previous iron status and maternal prenatal supplementation itself. (2)
The World Health Organization (World Health Organization) reports that the prevalence of
iron deficiency in pregnant women is around 37-75%, increasing with the increase of
gestational age and estimated 30-40% of the causes of anemia are often caused by iron
deficiency (3)
The most common cause of anemia in pregnant women is a deficiency of nutrients. (4)
Basic causes include insufficient intake, inadequate absorption, increased nutrient loss,
excessive need, and lack of utilization of hemopoietic nutrition. The most common anemia is
iron deficiency anemia of around 75% and megaloblastic anemia which can be caused by folic
acid deficiency and vitamin B12 deficiency. (4)
Early diagnosis in anemia is through monitoring the well-being of the fetus as well as
regular antenatal care. Based on the history, the most important physical examination and
investigations include measurement of hemoglobin, hematocrit and red blood cell indices, etc.
(1)
Management of anemia depends on the etiology or the cause of anemia itself. In iron
deficiency anemia we can usually give oral iron preparations. For other therapies, transfusions
can be given if this is possible. In this study, we will discuss more about the specific causes of
anemia, namely iron deficiency and non-iron deficiency anemia due to intervention efforts.

Material & Methods

Study Design and Population. This is a longitudinal descriptive study using cross-sectional
approach that took place between 28 Januari 2019 and 3 Februari 2019 in 10 stunting locus of
Sumedang district, Mekarsari Village, Cimarga Village, Sukahayu Village, Ungkal Village,
Kebon kelapa Village, Mekarbakti Village, Margamukti Village, Cilembu Village, Cijeruk
Village, and Malaka Village. The inclusion criteria were pregnant women within these villages
around 28 January 2019 till 3 February 2019; any trimester of pregnancy; readily to sign
informed consent form; willing to provide sample (hemoglobin, serum iron) within given
period. Otherwise, they were excluded from this study. Women who underwent abortion and
labor also excluded from the study. Samples were collected on specific dates for every villages.
Recruitment also included canvassing (door-to-door approached) in neighborhoods.
Measurement of anemia. Hemoglobin concentration was obtained from fingerprick blood test
using Easy-Touch GCHb assessment. Anemia was diagnosed when the Hb results were
<11.0mg/dL at first and third trimester, <10,5 mg/dL at second trimester.
Measurement of serum iron. Serum iron concentration was collected by Prodia (Indonesian
Laboratory Clinic) using Prodia standard of procedure. Iron deficiency was diagnosed when
the results were <35mg/dL

DISCUSSION
Table 3. Result of serum iron levels in pregnant women with iron deficiency anemia

Status Iron Deficiency Anemia

Valid Cumulative
Frequency Percent Percent Percent
Valid Positif 7 23.3 23.3 23.3
Negatif 23 76.7 76.7 100.0
Total 30 100.0 100.0
Status Iron Deficiency Anemia

Low Normal

Status Iron Deficiency Anemia

The graph shows the status iron deficieny anemia. We used the serum iron level. The diagnosis
of iron deficiency anemia can be confirmed by measuring the amount of serum iron. 7 (23,3%)
of them had Iron deficiency anemia and 23 (76,7%) had negative iron deficiency anemia.
Table 5.Characteristics of pregnant women with anemia and Iron Serum Levels

Characteristics Serum Iron Levels

n Low n Normal
Age
16-25 3 42,9% 10 43,5%
26-35 4 57,1% 11 47,8%
36-45 0 - 2 8,7%
Age of Marriage
13-16 1 14,3% 0 -
17-20 4 57,1% 14 60,9%
21-24 0 - 8 34,8%
25-28 2 28,6% 1 4,3%
Education level
Primary 1 14,3% 3 13%
Secondary 6 85,7% 14 60,9%
Higher 0 - 6 26,1%
Trimester
Trimester 1 3 42,9% 2 8,7%
Trimester 2 4 57,1% 11 47,8%
Trimester 3 0 - 10 43,5%
Gravida
1 1 3,33% 8 26,67%
2 5 16,67% 9 30,00%
3 0 - 3 10,00%
4 1 3.33% 2 6,67%
8 0 - 1 3,33%

Paritas
0 1 14.3% 8 34.8%
1 6 85.7% 11 47.8%
2 0 - 2 8.7%
3-4 0 - 1 4.3%
>5 0 - 1 4.3%
Hereditary
Yes 2 6.67% 2 6,67%
No 5 16,67% 21 70,00%
Parasitic Infections
Yes - -
No 7 23,33% 23 76,67%
Distance of pregnancy
0 5 16,67% 11 36,67%
1 0 - 2 6,67%
>3 years 2 6,67% 10 33,33%
Knowledge
Good 6 20,00% 19 63,33%
Less 1 3,33% 4 13,33%
 Chronic Diseases
Yes - -
No 7 23,33% 23 76,67%
Consume Iron Tablet
Obedient 4 13,33% 16 53,33%
Not Obey 3 10,00% 7 23,33%

The graph above shows the distribution of characteristics pregnant women with anemia and
Iron Serum levels. Looking at differential by age group, We noted 7 pregnant women had
decreased serum iron. 4 (57,1%) of them had decreased serum iron (SI) level during the
pregnancy at 26-35 years and 3 (43,9%) at 16-25 years. The fact that younger ( <20 years old)
and older women (>35%) were more likely to be anemic .
The prevalence of anemia among ever married women at 17-20 years was 57,1%.
Women with secondary education were more likely to be anemic 85,7 % than those with higher
education.
4 (57,1%) of the women were anaemic at second trimester of pregnancy . Iron deficiency during
the third trimester, has a more negative impact on fetal growth than anemia during the second
trimester. Dilution of hemoglobin to occur in third semester. A relative decrease in serum iron
occurs from approximately 12 weeks through 32–34 weeks owing to the increase in plasma
volume. During the early postpartum period, serum iron again rapidly decreases over the first
4–5 days before returning to normal at the end of the first week.
Women with two or more children had a higher prevalence of anemia (16.67 %) than women
with one children (3.33 %).
Anaemia were more prevalent among primigravidae (85.7%) than the multigravidae
Primigravida are usually unplanned, and therefore these mothers may already experience
suboptimal nutritional status prior to conception making them at an even higher risk for
developing iron deficiency anemia
There are 16,67% of pregnant women not found iron deficiency anemia caused by hereditary
There are 23,33 % of pregnant women not found iron deficiency anemia caused by infection
and chronic diseases
Anemia were more prevalent among women who never have children 16.67% therefore these
mothers not already experience suboptimal nutritional status prior to conception making them
at an even higher risk for developing iron deficiency anemia
There are 4 (3,33%) of pregnant women compliance in consuming Fe tablet . The success of a
program providing iron tablet made by the government to combat anemia is strongly influenced
by the compliance of pregnant women in consuming Fe tablet but there are still pregnant
women who are poorly compliant because do not understand the benefits of tablet Fe, lazy to
consume can nausea, and forgotten.
Conclusion
Based on the result and discussion of the research, it can be concluded that 7 pregnant women
had Iron deficiency anemia in 10 stunting locus Villages of Sumedang,Distric. The prevalence
of anemia among married women of reproductive age, those with secondary education,
secondary trimester, non-pregnant (primigravidae), have significantly higher rates of iron
deficiency anemia