Effect of Green Spinach Leaves Giving against Hemoglobin Levels

Increased in Pregnant Women with Mild Anemia

Kristin Natalia, Novrika Silalahi, Septa Dwi Insani, Megawati Sinambela

Midwifery Faculty, Institut Kesehatan DELI HUSADA Deli Tua

Keywords: Green Spinach Leaves Giving, Hemoglobin Levels Increased, Pregnant Women, Mild Anemia

Abstract Anemia in pregnancy is a condition of the mother with hemoglobin level below 11gr%. In 2013, there were

37.0% of cases of anemia in pregnant women in Indonesia. The incident in Agats, Asmat, Papua is an

iceberg phenomenon that has not received much attention. The Health Center (Puskesmas) in order to carry

out the program of First 1000 Days of Life (FDL) since 2016 to improve the quality of pregnancy and birth.

Green spinach leaves are very important and beneficial to increase the level of Hb in pregnant women who

are subjected to mild anemia because green spinach contains iron that can smooth the blood. By consuming

the green spinach leaves routinely can increase haemoglobin so good for pregnant women who have

anemia. The purpose of this study was to determine the effect of green spinach giving to hemoglobin

increased in pregnant women with mild anemia. This research used quasi experiment with One Group

pretest and posttest design. The population in this study were all pregnant women with mild anemia with

total sampling technique of 28 peoples. This research was conducted by giving pretest (initial observation)

before it is being given an intervention, after that it is given the intervention, then posttest (final

observation). The results showed that there was an effect of green spinach giving to hemoglobin levels

increased in pregnant women with mild anemia, based on the significant value obtained P value = 0,000. It

is hoped that pregnant women can consume foods which contain nutrients for pregnant women to increase

hemoglobin levels, for example green vegetables like green spinach.

1 INTRODUCTION

Anemia in pregnancy is a mother condition with

hemoglobin values below 11gr% in first and third

trimesters, or hemoglobin levels less than 10.5gr%

in the second trimester, prevalence of anemia in

pregnant women reaches 41.8% in the world, and

Asia ranks in the world after Africa with the

prevalence percentage of anemia sufferers in

pregnancy 48.2%. The prevalence of anemia in

pregnancy in Indonesia is 37.1%. Among them in

the first trimester as much as 3.8%, second trimester

13.6%, and third trimester 24.8%. Government

policy in dealing with the problem of anemia in

pregnancy is the provision of iron supplements and

folic acid. WHO recommends to giving 60 mg of

iron for 6 months to meet physiological needs during

pregnancy, but there is a lot of literature that

recommends a dose of 100 mg of iron every day for

16 weeks or more in pregnancy. Classification of

anemia according to WHO and Depkes RI: Normal

(The level of Hb in the blood ≥ 11 gr%), mild

anemia (blood levels in 8-10 gr%), severe anemia

(the rate of Hb in the blood of < 8 gr%).

The study result (1), maternal mortality in

developing countries is related to anemia in

pregnancy and most of them are caused by iron

deficiency and acute bleeding, and it is not

infrequently both of them interacts each other.

Pregnant women are very susceptible to get iron

deficiency anemia in pregnancy, namely

hemodilution which causes blood thinning, blood

gain is not proportional to plasma increase, lack of

iron in food and increased need for iron and

impaired of digestion and absorbs.

Research result (2) in the study of chlorophyll

and iron (Fe). Based on chlorophyll and iron levels

showed the type of green spinach (Amaranthus spp)

was more able to provide a real effect on the number

of white mouse erythrocytes anemic compared with

three other types of spinach. Susiloningtyas

research, by giving Fe preparat of 60 mg for 30 days

can increase Hb levels by 1 gr%. The content of iron

in spinach serves to form red blood cells in the body

Natalia, K., Silalahi, N., Insani, S. and Sinambela, M.

Effect of Green Spinach Leaves Giving against Hemoglobin Levels Increased in Pregnant Women with Mild Anemia.

DOI: 10.5220/0009462100280035

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 28-35

ISBN: 978-989-758-460-2

thereby reducing the risk of blood loss. Iron also

plays a role in the production of hemoglobin and

supports the immune system.

Anemia is the most common nutritional problem

in the world and affects more than 600 million

peoples. With a high enough frequency, it ranges

between 10% and 35%. In 2016 WHO reported that

the prevalence of pregnant women with iron

deficiency in Philippines was 55%, Thailand 45%,

Malaysia 30%, and Singapore 7%. According to

WHO, the incidence of anemia ranges between 20-

89% by setting Hb 11gr% as the basis. In Indonesia,

Anemia in pregnancy shows quite high value around

50-70 million peoples suffering from iron deficiency

anemia.

Based on (3) the prevalence of anemia in

pregnant women in Indonesia by 37.1%, based on

the Health Profile in 2009, the incidence of anemia

in pregnant women in Central Java province was

57.7%. It is still higher than the national figure of

50.9%. Based on the survey result in 2012, the

incidence of anemia in Surakarta was 9.39%. it is

recorded that from 11,441 pregnant women there

were 1,074 who experienced pregnancy anemia.

In 2011, in the world, there were 38.2% of

maternal mothers who experienced anemia, with the

highest prevalence in Africa (44.6%), followed by

Asia with a prevalence of 39.3%. Whereas, in 2013,

it is found that the anemia prevalence which is

suffered for pregnant women reached 37.0% in

Indonesia. Some studies suggest that anemia in

pregnancy contributes indirectly 23.0% of maternal

mortality cases in developing countries. Bleeding at

birth that is not dangerous for mothers generally

with normal hemoglobin levels, it can cause severe

complications in mothers with anemia. In addition,

anemia in pregnant women is also often associated

with neonatal complications such as an increased

risk of premature births, low birth weight, fetal

death, and slow-growing fetuses.

Spinach is one of the alternative plants in

meeting iron needs. According to the research result

conducted by (4) states that spinach is a green

vegetable that can overcome anemia, because green

vegetables have the most sources of vitamins,

minerals, and iron.

The importance of providing iron needed in

pregnancy is used for fetal and placental growth and

for increasing the period of maternal red blood cells

during pregnancy, it is based on an initial survey at

Rosmery Barus clinic, there were 25 pregnant

women and those with mild anemia of 13 pregnant

women (52%) so researchers are interested in raising

the issue with a study entitled "The Effect of

Spinach Giving on Hemoglobin Levels Increased in

Pregnant Women with Mild Anemia at Rosmery

Barus Clinic".

Green spinach has good benefits for the body

because it is a source of calcium, vitamin A, vitamin

E, and vitamin C, fiber and also beta-carotene.

Besides that, spinach also has a very high iron

content to prevent anemia. The mineral content in

spinach is quite high, especially Fe which can be

used to prevent fatigue due to anemia. Because of Fe

content in spinach is quite high, plus vitamin B

content especially folic acid (9).

In meeting the iron needs, a person usually

consumes supplements, but one alternative to meet

the iron needs can be done by consuming vegetables

that contain iron in the diet. Iron is found in green

vegetables such as spinach (Amaranthus spp). Leafy

vegetables such as spinach are a source of nonheme

iron. Cooked spinach contains 8.3 mg / 100gr of

iron. The content of iron in spinach plays a role in

the formation of hemoglobin (13).

Government policy in dealing with the problem

of anemia in pregnancy is the provision of iron

supplements and folic acid. WHO recommends

giving 60 mg of iron for 6 months to meet

physiological needs during pregnancy, but there is a

lot of literature that recommends a dose of 100 mg

of iron every day for 16 weeks or more in

pregnancy. In areas with a high prevalence of

anemia it is recommended to provide iron

supplements for up to three months post partum

(12).

Pregnant conditions will require more nutrients

than non pregnant women, such as the needs for

macro nutrients needed for the process of formation

of the fetus into humans, namely protein, and

micronutrients that act as the formation of fetal

organs and cells such as folic acid, calcium, vitamin

D and iron, apart from fulfilling adequate food

intake sometimes the problem that arises from

pregnant woman is a high level of anemia.

Insufficient energy and protein intake in pregnant

women can cause Chronic Energy Deficiency

(CED). Pregnant women with CED at risk of giving

birth to low birth weight babies (LBWB), it can also

be an indirect cause of maternal death. For this

reason, pregnant women with the risk of CED, i.e.

those with Upper Arm Circumference (UAC) <23,

5cm, is given additional food. PSG results in 2016

found 79.3% of pregnant women with the risk of

CED getting additional food is greater than the

national target in 2016 of 50% (5).

Anemia in pregnancy is most commonly found

are the result of iron deficiency and acute bleeding

Effect of Green Spinach Leaves Giving against Hemoglobin Levels Increased in Pregnant Women with Mild Anemia

is not uncommon even both are interrelated

(Leveno, 2016). handling that usually done to treat

anemia in pregnant women is to give 60 mg tablet

Fe and 50 nanograms of folic acid during pregnancy

(Riau Health Office, 2016). Iron therapy can be

combined with complementary therapies derived

from herbs, two of which are spinach and tomatoes.

Based on the results of the World's Healthiest

Food Rating, spinach is a rich green plants in

various nutrients, especially iron (Fe), which is high

enough that as much as 6.43 mg per 180 grams, and

none of the substances which can harm the body is

contained in spinach (The George Mateljan

Foundation, 2016). Research conducted by

Wijayanti (2016) states spinach juice with

concentration 50% effective in increasing

hemoglobin who first tested on white mice with

affinity to nature and genes with humans.

Iron is a substance that is poorly absorbed by the

body and so we need vitamin C so that iron can be

absorbed optimally. This is consistent with results

Zulaekah study (2017) which states that the

supplementation of iron and vitamin C more

effectively increase hemoglobin levels and red blood

cell counts compared to the addition of iron alone or

vitamin C alone.

Preliminary studies conducted by researchers in

five pregnant women who often experience

dizziness, weakness, and pale, the a sign of the

symptoms of anemia, said that none of the mother

who never drank combination therapy spinach and

tomato juice. Therefore, researchers interested in

conducting research entitled Combination Therapy

Effectiveness Spinach and Tomato Juice on

Improvement of Hemoglobin Levels in Pregnant

Women with Anemia. The purpose of this study was

to determine the effectiveness of the combination

therapy of spinach and tomato juice to increase

hemoglobin levels in pregnant women with anemia.

This research is expected to benefit the

development of nursing science as the basis Nursing

and enter the learning process for the students in the

Nursing Science Program add a reference to a

complementary therapy for pregnant women

suffering from anemia and can be used as a basis for

further research. The results also can be used by

health workers in the institution where the study as a

reference for drafting the promotional and

preventive efforts to the community to prevent and

reduce the prevalence of the incidence of anemia

with complementary therapies.

This study is also expected to be useful for

people, especially respondents to add insight and

can be practiced in everyday life for therapeutic

ingredients needed are easy to find and affordable.

Figure 1: How to give green spinach stew (a)

spinach leaves put into place (b) boil water (c) put

spinach leaves in boiling water (d) cook until cooked

(e) serve spinach.

2 METHOD

In this study it is proposed to provide counseling and

health education to pregnant women about the

importance of consuming nutritious foods such as

green spinach stew during pregnancy preparation,

during pregnancy so as not to become anemic and in

collaboration with health workers. The activity was

carried out by using a lecture method in general with

very large number of pregnant women to enable the

effectiveness of this activity. This research has

obtained approval from the ethics committee.

Determination of classification of anemia carried out

by categoric means of collecting all expectant

mothers that exist in the research and then

researchers do check haemoglobin checks in every

pregnant mother. For pregnant mothers who have

Hb 8-10 gr% are made samples in this research and

get the form of health information the importance of

consuming green spinach leaves to increase the

levels of haemoglobin in the blood so that pregnant

women do not suffer from anemia Light. Anemi in

pregnancy can cause low birth baby weight and baby

birth less months.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

Symptoms of anemia arising in pregnant women:

appear pale in the skin, lips, and nails, tired,

dizziness, shortness of breath, palpitations, difficulty

concentrating. In the early phases, pregnant women

may not exhibit any meaningful symptoms. Even

many of the symptoms above it, can arise even

though pregnant women are not experiencing

amnesia. Therefore, it should be necessary to

conduct routine and blood prenatal examinations

when found indications. How to determine anemia

in pregnant women by conducting haemoglobin

examination. If the level of Hb in the blood mother

8-10 gr% then the mother is categorized as mild

anemia.

This study used quasi-experimental design. With

the design of One Group pretest and posttest. This

research was conducted by giving a pretest (initial

observation) first before being given an intervention,

after that given the intervention, then posttest (final

observation). This research was conducted at the

Rosmeri Barus Clinic in March-July 2019. The

populations in this study were all pregnant women

with mild anemia. Sampling in this study used total

sampling method that is a technique by taking the

entire population. The total samples of this study

were 28 pregnant women who have mild anemia.

Variables are characteristics possessed by a group

member that is different from the other groups (6).

 Independent variable is a variable that

influences or determines the value of other

variables. The independent variable of this

research was the provision of spinach.

 Dependent variable is a variable whose value is

influenced by other variables. The dependent

variable of this research was hemoglobin levels

increased.

Operational definition is a definition based on

the observed characteristics (measured) of

something that is defined (7). In this study the

variables to be examined were as follows:

 Giving Spinach

Plants consumed by pregnant women with mild

anemia can increase hemoglobin levels as much as

100 grams per day for 7 days, it is boiled for ± 2

minutes with 300cc of boiled water.

 Hemoglobin Levels Increased

A state of pigment increased in red blood cells in

pregnant women who have mild anemia by

measuring the hemoglobin value after 7 days of

treatment.

Table 1: Measurement aspects

Varia

ble

easu

ing

nstru

ent

How to

measure

Measur

ing

Results

Measu

ring

Scale

Indep

enden

Varia

ble :

Givin

spina

Scale Direct

observati

on by

giving

spinach

that has

been

processe

1.Prete

2.Postt

est

Inter

val

Depe

ndent

Varia

ble :

Hemo

globi

Level

Incre

ased

Hemo

globin

meter

digital

portab

Direct

observati

on by

measurin

hemoglo

bin

levels on

day

1.Incre

ased

2.Stabl

Ordi

nal

Method of Data Collection

Primary Data

Method of Primary data collection was by direct

survey of pregnant women and conducted interviews

at Rosmery Barus clinic, Patumbak District, Deli

Serdang Regency in 2019.

Secondary Data

Data is obtained from reports and other official

documents. In this study secondary data were

obtained from Rosmery Barus clinic, Patumbak

District, Deli Serdang Regency in 2019.

Data Analysis Method

Univariat Analysis

Univariate analysis by analyzing each variable of

research results with the aim of finding out the

frequency distribution of each data variable research

variable which is presented in tabular form.

Bivariat Analysis

Data analysis was performed by computerization

using SPSS software used T Test with α: 0.05.

Statistical test is an inferential statistical test that is

used to compare the results of group observations

Effect of Green Spinach Leaves Giving against Hemoglobin Levels Increased in Pregnant Women with Mild Anemia

before and after an intervention which is carried out

in one experimental group only.

3 RESULTS AND DISCUSSION

This chapter describes the study result which is

conducted in March-July 2019 for 7 days regarding:

"The Effect of Green Spinach on I Hemoglobin

Levels Increased in Pregnant Women with Mild

Anemia at Rosmery Barus Clinic, Patumbak

District, Deli Serdang Regency in 2019". This

section also described the complete research result

which is presented in the table based on the research

objectives that have been prepared.

This research was conducted at Rosmery Barus

clinic, Patumbak District, Deli Serdang Regency

with sample of 28 peoples. The study results

described the demographic data of pregnant women

including (age, education, and occupation). It is

done by providing green spinach and hemoglobin

levels increased in pregnant women for 7 days.

From the results of this study can be seen that

pregnant women who have mild anemia experienced

changes in the level of Hb in the blood after

consuming green spinach leaves. This is in line with

the results of the research (7) which mentions that

there is the influence of green spinach leaves to

increase levels of Hb expectant mothers who have

anemia in mother and child hospitals.

3.1 Demography Characteristic of

Pregnant Women

Respondents Characteristics based on data of age

demographic, the majorities who have aged 19-30

years were 17 peoples (60.71%) and the minorities

who have aged> 30 years were 11 peoples (39.28%).

Based on data of educational demographic, the

majority of respondents had junior high school

education were 10 peoples (35.71%) and minority of

respondents had high school education were 8

peoples (28.57%). Based on data of occupational

demographic, it is found that the majority of

respondents who work as housewives as many as 18

peoples (64.28%) and the minority of respondents

who work as civil servants as many as 2 peoples

(7.14%).

Table 2: Frequency Distribution Based on the

Respondents Characteristics of Pregnant about the Effect

of Green Spinach Giving against Hemoglobin Levels

Increased in Pregnant Women with Mild Anemia at

Rosmery Barus Clinic Kec. Patumbak Regency. Serdang

District in 2019

No. Respondent

Characteristics

f %

1 Aged

19-30 Years Old 17 60,71

>30 Years Old 11 39,28

Total 28 100

2 Education

Junior High School 10 35,71

Senior High School 8 28,57

University 10 35,71

Total 28 100

3 Occupation

Housewife 18 64,28

Entrepreneurship 8 28,57

Civil Servant 2 7,14

Total 28 100

3.2 Green Spinach Giving

In giving green spinach, it can be seen that

respondents who consume long bean leaves as many

as 28 peoples (100%). In the table below, it can be

seen that from 28 pregnant women who have mild

anemia, they have hemoglobin levels increased by

an average of 0.2-0.4 gr% after they consumed green

spinach.

Table 3: Distribution of Hemoglobin Levels Increased in

Pregnant Women

Respondent

Hemoglobin

level before

green

spinach

given

Hemoglobin

level after

green spinach

given

1 9 gr % 10 gr %

2 10 gr % 11,2 gr %

3 10 gr % 10,4 gr %

4 10 gr % 10,4 gr %

5 9 gr % 9,8 gr %

6 10 gr % 10,8 gr %

7 9 gr % 10,2 gr %

8 10 gr % 10,8 gr %

9 9 gr % 10 gr %

10 9 gr % 9,8 gr %

11 9 gr % 10,4 gr %

12 9,4 gr % 10,2 gr %

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

13 9,6 gr % 11 gr %

14 9,2 gr % 10 gr %

15 9,6 gr % 10 gr %

16 9 gr % 9,4 gr %

17 9 gr % 9,8 gr %

18 9 gr % 9,8 gr %

19 9,2 gr % 10 gr %

20 9,2 gr % 10 gr %

21 9,4 gr % 10 gr %

22 9,4 gr % 9,6 gr %

23 9,4 gr % 9,8 gr %

24 9 gr % 9,6 gr %

25 9,8 gr % 10 gr %

26 9,2 gr % 10 gr %

27 9 gr % 9,6 gr %

28 9,4 gr % 10 r %

3.3 Hemoglobin Level Increased

It is known that the hemoglobin levels increased

in pregnant women with mild anemia were (100%)

with a mean of 10.2308 of 28 peoples as sample.

3.4 Effect of Green Spinach Giving

against Hemoglobin Levels Increased

In this study, it was explained that the

hemoglobin levels increased in pregnant women

with mild anemia before consumed green spinach

the average hemoglobin levels increased in pregnant

women was 9.88538 with standard division of

0.52060, after they consumed green spinach the

average hemoglobin levels increased in pregnant

women was 10.2308 with standard division of

0.57646. P value = 0,000 <from α value (0.05), then

the hypothesis 0 is rejected, meaning that there is an

influence between an increase in hemoglobin levels

before the treatment with after the treatment (Table

4).

Table 4: Standart Deviation Pre test and post test

Cons

umpti

Hemoglobin

level

Std.De

viation

Value

Cons

umed

Pre

test

9,85

0,5206

0,000 -

5,2

Pos

test

10,2

308

0,5764

4 DISCUSSION

Data of Pregnant Women Demography

The mothers characteristics which as variables in

this study were age, education and job. Respondents

characteristics based on age in the intervention

group can be known that, the majority of

respondents aged 19-30 years were 17 peoples

(60.71%) and the minority of respondents aged> 30

years were 11 peoples (39.28%).

Characteristics of respondents based on

education in the intervention group can be seen that,

the majority of respondents had a junior high school

(SMP) as many as 10 peoples (35.71%), and a

minority of tertiary education as many as 10 peoples

(35.71%). And those with high school education

(SMA) were 8 peoples (28.57%).

Characteristics of respondents based on job in

the intervention group can be seen that, the majority

of respondents who had job as housewives as many

as 18 peoples (64.28%), the minority of respondents

who had job as civil servants as many as 2 peoples

(7.14%), and respondents who had job as

entrepreneurs as many as 8 peoples (28.57%).

It can be seen that maternal age can affect

hemoglobin levels in pregnant women, because

according to theory (8), the age group <20 years is at

risk of anemia because in this age group biological

development is not optimal. In addition, pregnancy

in the age group> 35 years is also prone to anemia

because the immune system begins to decline and is

susceptible to various infections during pregnancy.

According to the Health Ministry of Indonesia

Republic quoted by (9), explained that age greatly

determines maternal health and it is related to

conditions of pregnancy, childbirth, childbirth, and

how to care. A good age for reproduction is 20-30

years.

The theory about education is made clear by (10)

that, the low education level of pregnant women

influences the reception of information so that

knowledge about anemia and its associated factors is

limited, especially knowledge about the importance

of iron.

According to (11) said that the higher level of

one’s education, the easier it is to provide

information, so the more knowledge she has. And

according to (12) said people who have high

education will be easier to understand the

information received compared to people who have

low education.

For occupational theory based on (13), said that

pregnant women with socioeconomic status and

adequate employment will easily obtain the

Effect of Green Spinach Leaves Giving against Hemoglobin Levels Increased in Pregnant Women with Mild Anemia

information needed, while pregnant women with low

socioeconomic tend to have fears of the magnitude

of the cost of antenatal care. In line with this study,

the variables above can affect hemoglobin levels

increased in pregnant women, it can be explained in

the study (14) on the Effect of Green Spinach Juice

Giving Against Hemoglobin Levels increased in

Pregnant Women Anemia at the Work Area of Pasar

Minggu Health Center in South Jakarta, said there is

a relationship between age, education and

occupation with an hemoglobin levels increased and

confirmed by the results of P value 0,000 which

means <0.05 then it shows Ho is rejected and there

is influence among them.

For the results about the effect of green spinach

giving on hemoglobin levels increased in pregnant

women with mild anemia, it was found that the

intervention group respondents viewed from the

hemoglobin level, the majority rose by 28 peoples

(100%).

It can be attributed that green spinach able to

increase hemoglobin levels. It is confirmed by

Fatimah's theory which says that in meeting iron

needs, a person usually consumes supplements, but

one alternative to meeting iron needs can be done by

consuming vegetables that contain iron in the diet.

Iron is found in green vegetables such as spinach

(Amaranthus spp). Leafy vegetables such as spinach

are a source of nonheme iron. Cooked spinach

contains 8.3 mg / 100gr of iron. The content of iron

in spinach plays a role in the formation of

hemoglobin.

This research has been conducted by several

experts. The first was carried out by Rohmatika et al

at Gambirsari Surakarta Public Health Center, they

gave spinach as much as 100 gr / day for 7 days

which showed the results that there was a significant

increase in Hb levels after consumption of green

spinach with a statistical test of significance value

smaller than alpa p 0,000 (p <0.05). Secondly, it was

done according to Fatimah's research, in the study of

chlorophyll and iron (Fe) given to white rats. Based

on chlorophyll and iron levels showed the type of

green spinach (Amaranthus spp) was more able to

provide a real effect on the number of erythrocytes

in anemic white rats compared with three other types

of spinach.

In line with previous studies, in this study there

was also an influence between green spinach giving

with hemoglobin levels increased which was seen

based on significant results with the T test of P value

0,000 <0.05 and it is obtained a correlation value of

0.894, meaning that there was a very strong

influence.

5 CONCLUSION

There is an effect of giving green spinach to

hemoglobin levels increased in pregnant women

with mild anemia, based on the significant value

obtained P value = 0,000. If the P value (0,000)

<(0.05), then Ho is rejected, which means that there

is a significant influence between the provision of

green spinach on increasing hemoglobin levels. The

category of the effect of giving green spinach on

increasing hemoglobin levels can be seen that the

majority of hemoglobin levels increase as many as

28 peoples (100%).

The results are consistent with research Sinurat

(2010) that 80 pregnant women earned 26 mothers

are anemic by age group first trimester of pregnancy

as much as 1 (5%), the second trimester of 4 people

(20.0%), and trimester III 21 persons (52.5%). The

iron requirement is different for each quarter in the

first trimester of pregnancy in which the iron

requirement is not high, while the second and third

trimester increases the need for iron because iron is

required for the development and fetal growth

(Sinclair, 2010). Hb levels during the second and

third trimesters of pregnancy ranging from 11.6 g /

dL as a result of blood dilution (hemodilution)

mother due to increased plasma volume (Stright,

2017). So it is in line with the results of research

which will anemia is more common in the third

trimester of gestation group.

The results of the study in Puskesmas Sail shows

that out of 30 respondents obtained maternal anemia

19 respondents (63.3%) is multigravida (gestation>

1 time) and 11 respondents (36.7%) were

primigravida (1x pregnancy). Anemia tends to occur

in women with ≥3 pregnancy because pregnancy

can spend reserves of nutrients the mother's body

(Arisman, 2004). The results are consistent with

research Nasyidah (2016) in which the pregnant

women with anemia is most often found in

multigravida group that is equal to 52.6% followed

by 44.9% primigravida group, and the group

grandemultigravida only 2.6%. Research Madhavi

& Singh (2016) entitled "Nutritional status of rural

pregnant women" also found pregnant women with

anemia most in multigravida as many as 79.48% and

20.52% as much primigravidas.

A mother who is often anemic pregnant have an

increased risk in subsequent pregnancies if not pay

attention to nutritional needs. A mother with her

first pregnancy may also be at risk of anemia

because they have not had the experience so the

impact on behaviors related to nutrition (Madhavi &

Singh, 2016).

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

Results of research conducted in Puskesmas Sail

shows that the majority of education is high school

education that is as much as 13 respondents

(43.3%). Education is learning knowledge, skills,

and habits of a group of peopletransferred from one

generation to the next through teaching, training, or

research. Education is often the case under the

guidance of others, but also a self-taught

menmungkinkan (MoH RI, 2013). Educational

background is a factor which affects a person's

mindset. Educational background will shape the way

people think, including forming the ability to

understand the factors associated with the disease

and to use this knowledge to maintain health (Perry

& Potter, 2016).

The results are consistent with research Empress

(2016) entitled "Relationship hemoglobin of

antepartum haemorrhage with Apgar score" which

examined further on the characteristics of the

mother's education level, and the results of the

analysis are not significantly different between

groups anemia and anemia (p = 0.7), but the mother

of the level of education low (not school,

elementary, junior) 1.16 times more likely to have

anemia than the higher education level.

Science and knowledge can be acquired through

learning. Learning can be done anywhere, by

anyone, anytime. The world of education can take

place at three places, namely education in families,

schools, and communities (Erfandi, 2015).

Therefore, any person may obtain information from

a variety of places and media although it has a lower

school education background.

ACKNOWLEDGMENT

This research was supported by Institut

Kesehatan Deli Husada Deli Tua, Institut Kesehatan

Medistra Lubuk Pakam, Sembiring Hospital

Foundation, and Grand Med Hospital Foundation,

Indonesia.

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