The findings come at a time when maternal anemia continues to affect many pregnancies in Indonesia despite widespread iron supplementation programs. Anemia during pregnancy is more than a condition of low blood levels. It can increase the risk of postpartum hemorrhage, low birth weight, restricted fetal growth, and other complications that threaten maternal and neonatal health.
Langi and Sirait argue that nutritional assessment through MUAC is still underutilized in routine maternal care. Yet this simple measurement can reflect a pregnant woman’s energy and protein reserves, which are essential for hemoglobin formation and healthy pregnancy outcomes.
The study, titled “The Relationship between Nutritional Status Based on Mid-Upper Arm Circumference (MUAC) and Hemoglobin Levels in Pregnant Women,” used a quantitative cross-sectional design. Researchers collected data from 190 randomly selected pregnant women receiving care at Bogor Timur Health Center. Data collection took place from December 22, 2025, to February 14, 2026, and statistical analysis was conducted using the Chi-Square method to examine relationships between nutritional status, gestational age, and anemia incidence.
Most participants were within the recommended reproductive age range of 20–35 years, accounting for 77 percent of the sample. The majority also showed adequate nutritional status based on MUAC measurements. However, anemia remained common, affecting 43 women or approximately 23 percent of participants.
The study’s central finding is clear: maternal MUAC is significantly associated with anemia risk. Women with MUAC measurements below 23.5 centimeters, an indicator of chronic energy deficiency, were substantially more likely to experience anemia than those with normal measurements.
Key findings include:
- 23% of pregnant women were anemic with hemoglobin levels below 11 g/dL
- 16% of participants had MUAC below 23.5 cm
- Pregnant women with at-risk MUAC showed an anemia rate of 38.7%
- Women with normal MUAC experienced anemia at 19.5%
- The association between MUAC and anemia was statistically significant (p=0.019)
The research also identified another important factor: gestational age. Anemia prevalence increased as pregnancy progressed.
Only 7.9 percent of women in the first trimester experienced anemia. The figure rose to 33.3 percent in the second trimester and reached 40 percent in the third trimester. This relationship was highly significant, with a p-value of 0.000.
According to the researchers, this trend reflects normal physiological changes during pregnancy. Plasma volume expands more rapidly than red blood cell production, causing hemoglobin concentrations to decline. At the same time, fetal iron demands increase sharply during late pregnancy, further depleting maternal iron stores.
Interestingly, the study did not find significant relationships between anemia and either maternal age or parity. This suggests that anemia may affect women across different age groups and pregnancy histories, depending more heavily on nutritional status and adherence to nutritional support, including iron supplementation.
Langi and Sirait explain that the relationship between MUAC and anemia has a biological basis. When energy and nutrient intake are insufficient, the body begins breaking down muscle protein for energy. This process reduces the availability of protein needed for heme production, an essential component of hemoglobin, ultimately increasing the risk of anemia.
The implications for healthcare providers are substantial. MUAC measurement is inexpensive, non-invasive, and easy to perform in primary healthcare settings without sophisticated laboratory equipment. As a result, it can serve as an accessible screening tool during early antenatal visits to identify women at nutritional risk before anemia becomes severe.
The researchers recommend three major strategies for healthcare facilities:
- Early nutritional screening using MUAC beginning at the first antenatal visit
- Trimester-specific interventions, particularly during the third trimester when anemia risk peaks
- Integrated nutritional education focused on high-protein and iron-rich diets, especially for women with MUAC below 23.5 cm
The study reinforces an important message for maternal health policy: preventing anemia cannot rely solely on iron tablets. Maternal nutritional reserves before and during pregnancy are equally critical for maintaining healthy hemoglobin levels and supporting fetal development.
As maternal health programs continue to evolve, the findings from UKI offer a practical reminder that simple community-based screening methods may play a decisive role in reducing pregnancy-related anemia and improving outcomes for mothers and newborns alike.
Author Profile
Dr. Louisa Ariantje Langi is affiliated with the Department of Community Medicine, Faculty of Medicine, Universitas Kristen Indonesia. Her academic work focuses on public health and maternal health research.
Dr. Batara Imanuel Sirait is a faculty member in the Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Kristen Indonesia, specializing in reproductive and maternal health.
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