Factors Associated with Anemia Among Pregnant Women: A Case-Control Study in Madiun Regency, Indonesia

Abstract

Anemia is a prevalent health problem among pregnant women in Indonesia, particularly in the working area of Balerejo Community Health Center, Madiun Regency. Anemia during pregnancy is associated with adverse maternal and fetal outcomes, including low birth weight, preterm birth, and maternal and fetal mortality. The prevalence of anemia in the Balerejo Community Health Center area increased from 27.3% in 2021 to 41.7% in 2024, representing the highest prevalence among community health centers in Madiun Regency. Several factors have been reported to be associated with anemia during pregnancy, including maternal age, adherence to iron supplementation, nutritional status, and dietary patterns.This study employed a quantitative case-control design involving 108 pregnant women, comprising 54 women with anemia in the case group and 54 women without anemia in the control group. Data were collected using questionnaires and analyzed using bivariate and multivariable analyses.Adherence to iron supplementation (p=0.000) and dietary patterns (p=0.005) were significantly associated with anemia. Maternal age (p=0.265) and nutritional status (p=0.533) were not significantly associated with anemia. In the multivariable analysis, adherence to iron supplementation showed the strongest association with anemia (aOR=30.000).Adherence to iron supplementation and dietary patterns were significantly associated with anemia among pregnant women. Non-adherence to iron supplementation showed the strongest association with anemia. However, the magnitude of the observed association (aOR=30.000) should be interpreted cautiously given the relatively small sample size and the potential for residual confounding and measurement bias. Strengthening antenatal counseling, adherence monitoring, and promotion of healthy dietary practices may inform targeted strategies for anemia prevention among pregnant women. Prospective studies with larger samples are needed to confirm these associations and establish temporal relationships.