Correlation between Zinc and Folic Acid Intake with Hemoglobin Levels in Pregnancy


Eka Darmayanti Putri Siregar
Arni Amir
Nuzulia Irawati


The deficiency of micronutrients and anemia are nutritional problems in pregnancy. WHO in 2019 and Riskesdas in 2018 reported that anemic pregnant women in Indonesia were 44.2% and 48.9%. Public Health Service also reported there was an increased prevalence of this problem in West Sumatra and Padang City in 2019 which was 18.1% and 11.2%. Micronutrient deficiency affected the hemoglobin (Hb) level, which is one of the indicators marking anemia in pregnancy. The objective was to determine the correlation between zinc and folic acid with hemoglobin levels in the third trimester of pregnancy. This analytical cross-sectional research was held in the Health Center and laboratory of Lubuk Kilangan on May-July 2022. The population and samples were 64 third-trimester pregnant women with total sampling. Intake data were collected through interviews using the Food Frequency Questionnaire (FFQ). Hemoglobin levels were examined by a hematology analyzer. Pearson correlation was used to identify the correlation of the variables (P< 0.05) . The mean levels of zinc and folic acid intake and hemoglobin levels were 7.35 mg, 215.56 mcg, and 11.08 g/dL. There was a positive correlation between zinc (p=0,015) and folic acid (p=0.004) with hemoglobin levels in the third trimester of pregnancy.


How to Cite
Siregar, E. D. P., Arni Amir and Nuzulia Irawati (2022) “Correlation between Zinc and Folic Acid Intake with Hemoglobin Levels in Pregnancy ”, Science Midwifery, 10(5), pp. 3767-3775. doi: 10.35335/midwifery.v10i5.896.


Agedew, E., Tsegaye, B., Bante, A., Zerihun, E., Aklilu, A., Girma, M., Kerebih, H., Wale, M. Z., & Yirsaw, M. T. (2022). Zinc deficiency and associated factors among pregnant women’s attending antenatal clinics in public health facilities of Konso Zone, Southern Ethiopia. PloS One, 17(7), e0270971.

Akhtar, M., & Hassan, I. (2012). Severe Anaemia during Late Pregnancy. Case Reports in Obstetrics and Gynecology, 2012, 1–3.

Atmasier, S. (2015). Prinsip Dasar Ilmu Gizi. PT. Gramedia Pustaka Utama.

Avantika Gupta. (2018). Iron Deficiency Anaemia in Pregnancy: Developed Versus Developing Countries - European Medical Journal. EMJ Hematol, August, 101–109.
Balarajan, Y., Ramakrishnan, U., Özaltin, E., Shankar, A. H., & Subramanian, S. v. (2011). Anaemia in low-income and middle-income countries. The Lancet, 378(9809), 2123–2135.

Ballestín, S. S., Campos, M. I. G., Ballestín, J. B., & Bartolomé, M. J. L. (2021). Is supplementation with micronutrients still necessary during pregnancy? A review. In Nutrients (Vol. 13, Issue 9). MDPI.

Chlon, T. M., & Crispino, J. D. (2012). Combinatorial regulation of tissue specification by GATA and FOG factors. Development (Cambridge), 139(21), 3905–3916.

Cortés-Albornoz, M. C., García-Guáqueta, D. P., Velez-Van-meerbeke, A., & Talero-Gutiérrez, C. (2021). Maternal nutrition and neurodevelopment: A scoping review. Nutrients, 13(10).

Cunningham, F. G., Leveno, K. J., Bloom, S. L., Dashe, J. S., Hoffman, B. L., Casey, B. M., & Spong, C. Y. (2018). William Obstetrics (25 th ed). McGraw-Hill Education.

Delchier, N., Herbig, A. L., Rychlik, M., & Renard, C. M. G. C. (2016). Folates in Fruits and Vegetables: Contents, Processing, and Stability. Comprehensive Reviews in Food Science and Food Safety, 15(3), 506–528.

Dinkes Kota Padang. (2020). Laporan Tahunan Tahun 2019 Edisi 2020. Dinkes Kota Padang Tahun 2020.

Farias, P. M., Marcelino, G., Santana, L. F., Almeida, E. B. de, Guimarães, R. de C. A., Pott, A., & Freitas, P. A. H. K. de C. (2020). Minerals in Pregnancy and Their Impact on Child Growth and Developmen. 13–24.

Gibore, N. S., Ngowi, A. F., Munyogwa, M. J., & Ali, M. M. (2021). Dietary Habits Associated with Anemia in Pregnant Women Attending Antenatal Care Services. Current Developments in Nutrition, 5(1), 1–8.

Grüngreiff, K., Gottstein, T., & Reinhold, D. (2020). Zinc deficiency—an independent risk factor in the pathogenesis of haemorrhagic stroke? Nutrients, 12(11), 1–11.

Grzeszczak, K., Kwiatkowski, S., & Kosik-Bogacka, D. (2020). The role of fe, zn, and cu in pregnancy. Biomolecules, 10(8), 1–33.

Iqbal, S., & Ali, I. (2021). Effect of maternal zinc supplementation or zinc status on pregnancy complications and perinatal outcomes: An umbrella review of meta-analyses. Heliyon, 7(7), e07540.

Jyotsna, S., Amit, A., & Kumar, A. (2015). Study of serum zinc in low birth weight neonates and its relation with maternal zinc. Journal of Clinical and Diagnostic Research, 9(1), SC01–SC03.

Kambe, T., Tsuji, T., Hashimoto, A., & Itsumura, N. (2015). The physiological, biochemical, and molecular roles of zinc transporters in zinc homeostasis and metabolism. Physiological Reviews, 95(3), 749–784.

Kaneko, S., Morino, J., Minato, S., Yanai, K., Mutsuyoshi, Y., Ishii, H., Matsuyama, M., Kitano, T., Shindo, M., Aomatsu, A., Miyazawa, H., Ueda, Y., Ito, K., Hirai, K., Ookawara, S., & Morishita, Y. (2020). Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study. Frontiers in Medicine, 7(September), 1–6.

Karimi, A., Bagheri, S., Student, P., & Health, R. (2012). Zinc Deficiency in Pregnancy and Fetal - Neonatal Outcomes and Impact of the Supplements on Pregnancy Outcomes. Iranian Journal of Neonatology IJN, 3(2), 77–83.

Katsumura, K. R., DeVilbiss, A. W., Pope, N. J., Johnson, K. D., & Bresnick, E. H. (2013). Transcriptional mechanisms underlying hemoglobin synthesis. Cold Spring Harbor Perspectives in Medicine, 3(9), 1–19.

Kemenkes RI. (2018). Laporan Nasional Riset Kesehatan Dasar. Kemenkes RI, 1–582.

Koury, M. J., & Ponka, P. (2004). New insights into erythropoiesis: The roles of folate, vitamin B 12, and iron. In Annual Review of Nutrition (Vol. 24, pp. 105–131).

Linder, M. C. (2006). Nutritional Biochemistry and Metabolism with Clinical Application (2nd Ed.). Appeton & Lange.

Lipoeto, N. I., Masrul, & Nindrea, R. D. (2020). Nutritional contributors to maternal anemia in Indonesia: Chronic energy deficiency and micronutrients. Asia Pacific Journal of Clinical Nutrition, 29(December), 9–17.

Maggio, M., De Vita, F. D., Lauretani, F., Buttò, V., Bondi, G., Cattabiani, C., Nouvenne, A., Meschi, T., Dall’Agli, E., & Ceda, G. P. (2013). IGF-1, the cross road of the nutritional, inflammatory and hormonal pathways to frailty. Nutrients, 5(10), 4184–4205.

Medlock, A. E., & Dailey, H. A. (2022). New Avenues of Heme Synthesis Regulation. In International Journal of Molecular Sciences (Vol. 23, Issue 13). MDPI.

Meilinda Sembiring, E., Novianti, A., Purwara, L., & Wahyuni, Y. (2020). Asupan Folat, Vitamin B12, Vitamin E Berhubungan dengan Kadar Hemoglobin (Hb) Ibu Hamil Di Puskesmas Kebon Jeruk (Folate, Vitamin B12, Vitamin E Intake Correlation with hemoglobin (Hb) levels among pregnant women). Darussalam Nutrition Journal, 4(2), 112–121.

Nishiyama, S., Kiwaki, K., Miyazaki, Y., & Hasuda, T. (2015). Zinc and IGF-I Concentrations in Pregnant Women with Anemia before and after Supplementation with Iron and/or Zinc. Journal of the American College of Nutrition, 18(3), 261–267.

Obeng, E. (2021). Apoptosis (programmed cell death) and its signals - A review. Brazilian Journal of Biology = Revista Brasleira de Biologia, 81(4), 1133–1143.

Prakash, S., & Yadav, K. (2015). Maternal Anemia in Pregnancy: An Overview (Vol. 4, Issue 3).

Prawirohardjo, S. (2013). Ilmu Kebidanan. Edisi Keempat. Cetakan Ketiga. Bina Pustaka Sarwono Prawirohardjo.

Rodwell, V. W., David A. Bender, Kathleen M. Botham, Peter J. Kennelly, & P. Anthony Weil. (2020). Biokimia Harper (Edisi 31). EGC.

Saaka, M. (2012). Combined iron and zinc supplementation improves haematologic status of pregnant women in Upper West Region of Ghana. Ghana Medical Journal, 46(4), 225–233.

Suzuki, H., Tashiro, S., Hira, S., Sun, J., Yamazaki, C., Zenke, Y., Ikeda-Saito, M., Yoshida, M., & Igarashi, K. (2014). Heme regulates gene expression by triggering Crm1-dependent nuclear export of Bach1. EMBO Journal, 23(13), 2544–2553.

Takahashi, A. (2022). Role of Zinc and Copper in Erythropoiesis in Patients on Hemodialysis. Journal of Renal Nutrition, 1–8.

Tamrin, A., Hendrik, A., Lestari, R. S., Gizi, J., Kemenkes, K., & Gizi, A. J. (2019). Asupan Zat Besi, Asam Folat, Dan Seng Terhadap Kadar Hemoglobin Pada Ibu Hamil Di Puskesmas Paccerakkang Kecamatan Biringakanaya Kota. In Asupan Zat Gizi (Vol. 26).

Tarini, A., Manger, M. S., Brown, K. H., Mbuya, M. N. N., Rowe, L. A., Grant, F., Black, R. E., & Mcdonald, C. M. (2021). Enablers and Barriers of Zinc Fortification; Experience from 10 Low- and Middle-Income Countries with Mandatory Large-Scale Food Fortification. Nutrients, 1–14.

WHO. (2020a). Serum ferritin concentrations for the assessment of iron status in individuals and populations: technical brief. 10, 1–6.

WHO. (2020b). WHO Guidelines on use of ferritin concentrations to assess iron status in individual and populations. World Health Organization, 2020.

WHO. (2021). Prevalence of anaemia in pregnant women (aged 15-49) (%).

Wieringa, F. T., Dahl, M., Chamnan, C., Poirot, E., Kuong, K., Sophonneary, P., Sinuon, M., Greuffeille, V., Hong, R., & Berger, J. (2016). The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders.

Zhou, D., Li, Z., Sun, Y., Yan, J., Huang, G., & Li, W. (2022). Early Life Stage Folic Acid Deficiency Delays the Neurobehavioral Development and Cognitive Function of Rat Offspring by Hindering De Novo Telomere Synthesis. International Journal of Molecular Sciences, 23(13).