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Original Article Maternal pre-pregnancy anemia and childhood anemia in Indonesia: a risk assessment using a population-based prospective longitudinal study
Fadila Wirawan1orcid , Dieta Nurrika2orcid
Epidemiol Health 2022;44e2022100-0
DOI: https://doi.org/10.4178/epih.e2022100
Published online: November 1, 2022
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1Department of Public Health Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
2Department of Public Health, Banten School of Health Science, South Tangerang, Indonesia
Corresponding author:  Fadila Wirawan,
Email: fadila.wirawan@gmail.com
Received: 25 August 2022   • Accepted: 1 November 2022
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Abstract

OBJECTIVES
Anemia in children under 5 years of age is often overlooked despite its detrimental effects. The public health approach to anemia prevention includes the maternal pre-pregnancy phase. This study investigated the association between pre-pregnancy anemia and the risk of anemia in children under 5 years of age.
METHODS
This cohort study included non-pregnant women from the 2007 Indonesian Family Life Survey (IFLS) and their children under 5 in the 2014 IFLS. The anemia status of mothers and children was determined based on hemoglobin (Hb) levels using Hemocue. Mantel-Haenszel adjusted relative risks (aRRs), including risk stratification by covariates, were used for the final risk assessment.
RESULTS
In total, 637 children in the 2014 IFLS were included. The risk of having a child with anemia was 1.71-fold higher in women with pre-pregnancy anemia than in women without pre-pregnancy anemia (aRR, 1.71; 95% confidence interval [CI], 1.03 to 2.85). After risk stratification based on potential confounding variables, maternal pre-pregnancy anemia remained an independent risk factor for anemia in children who still breastfed at the time of data collection (relative risk [RR], 2.11; 95% CI, 1.16 to 3.86), in children who were given water earlier than 6 months of age (RR, 2.08; 95% CI, 1.20 to 3.61), in children of mothers with a normal or underweight pre-pregnancy body mass index (RR, 1.94; 95% CI, 1.20 to 3.14), and in children of mothers without current anemia (RR, 2.20; 95% CI, 1.21 to 3.99).
CONCLUSIONS
Pre-pregnancy anemia increased the risk of childhood anemia. A public health approach emphasizing pre-conception maternal health would enable better maternal and child morbidity risk prevention.

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