# Cumulative High-Risk Pregnancy Complications and Stunting Risk in Indonesian Children Younger Than 5 Years: Retrospective Analysis Using the Developmental Origins of Health and Disease Framework

## TL;DR

This study shows that multiple high-risk pregnancy complications increase the risk of stunting in Indonesian children under 5 years old.

## Contribution

The study demonstrates a dose-response relationship between cumulative high-risk pregnancy complications and stunting risk.

## Key findings

- Children with stunting had significantly higher rates of high-risk pregnancy complications compared to non-stunted children.
- Multiple HRP complications showed the strongest association with stunting (aOR 5.80) compared to individual complications.
- Maternal education, family income, and ANC visits were identified as protective factors against stunting.

## Abstract

Stunting affects 21.6% of Indonesian children younger than 5 years, with complications from high-risk pregnancies (HRPs) identified as a potential risk factor. The Developmental Origins of Health and Disease framework suggests that prenatal exposures may permanently alter physiological development and disease susceptibility later in life.

This study aimed to examine the cumulative effects of HRP complications on the risk of stunting in Indonesian children younger than 5 years while controlling for socioeconomic confounders.

A retrospective study was conducted in Sleman Regency, Indonesia, analyzing 450 children (300 children with stunting and 150 children without stunting) aged 12 to 59 months. Data were collected from maternal medical records, maternal and child health handbooks, and integrated health post reports. Multivariate logistic regression was used to adjust for socioeconomic confounders including maternal education, family income, and antenatal care (ANC) visits.

Mothers of children with stunting had significantly higher rates of any HRP complications (206/300, 68.7% vs 48/150, 32%; P<.001). After adjustment, multiple HRP complications (≥2 conditions) showed the strongest association with stunting (adjusted odds ratio [aOR] 5.80, 95% CI 3.26‐10.32), exceeding the risk associated with individual complications such as anemia (aOR 3.21, 95% CI 2.12‐4.86) or preeclampsia (aOR 4.37, 95% CI 2.18‐8.76). Maternal education (aOR 0.72, 95% CI 0.58‐0.89), family income (aOR 0.68, 95% CI 0.52‐0.89), and ANC visits (aOR 0.85, 95% CI 0.76‐0.95) were identified as protective factors.

The dose-response relationship between cumulative HRP complications and stunting supports the Developmental Origins of Health and Disease hypothesis. Current ANC protocols emphasizing single risk factors may be insufficient. Integrated prenatal care addressing cumulative risks is essential for stunting prevention in Indonesia.