{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:29Z","timestamp":1782841649905,"version":"3.54.5"},"reference-count":40,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian Pac Isl Nurs J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mothers of children with stunting had significantly higher rates of any HRP complications (206\/300, 68.7% vs 48\/150, 32%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). After adjustment, multiple HRP complications (\u22652 conditions) showed the strongest association with stunting (adjusted odds ratio [aOR] 5.80, 95% CI 3.26\u201010.32), exceeding the risk associated with individual complications such as anemia (aOR 3.21, 95% CI 2.12\u20104.86) or preeclampsia (aOR 4.37, 95% CI 2.18\u20108.76). Maternal education (aOR 0.72, 95% CI 0.58\u20100.89), family income (aOR 0.68, 95% CI 0.52\u20100.89), and ANC visits (aOR 0.85, 95% CI 0.76\u20100.95) were identified as protective factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/85742","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T21:00:10Z","timestamp":1769806810000},"page":"e85742-e85742","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7923-1703","authenticated-orcid":false,"given":"Widyawati","family":"Widyawati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7287-6753","authenticated-orcid":false,"given":"Hafifah Maulia","family":"Ristandiati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"R1","unstructured":"Child growth standards. World Health Organization. URL: https:\/\/www.who.int\/tools\/child-growth-standards [Accessed 08-10-2025]"},{"issue":"4","key":"R2","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1179\/2046905514Y.0000000158","article-title":"The stunting syndrome in developing countries","volume":"34","author":"Prendergast","journal-title":"Paediatr Int Child Health"},{"key":"R3","unstructured":"Levels and trends in child malnutrition: UNICEF\/WHO\/World Bank group joint child malnutrition estimates: key findings of the 2023 edition. World Health Organization; 2023. URL: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/ccd825e2-e6d0-4101-bedd-8189355dcd81\/content [Accessed 07-02-2026]"},{"key":"R4","unstructured":"SSGI 2024: national stunting prevalence drops to 19,8%. BKPK Ministry of Health: Health Development Policy Agency. May 27, 2025. URL: https:\/\/www.badankebijakan.kemkes.go.id\/en\/ssgi-2024-prevalensi-stunting-nasional-turun-menjadi-198\/ [Accessed 24-09-2025]"},{"key":"R5","unstructured":"Stunting in Indonesia and its determinants. Badan Kebijakan Pembangunan Kesehatan. 2023. URL: https:\/\/repository.badankebijakan.kemkes.go.id\/id\/eprint\/5530\/1\/06%20factsheet%20Gizi%20SKI_English.pdf [Accessed 07-02-2026]"},{"issue":"Suppl 3","key":"R6","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/j.1740-8709.2011.00349.x","article-title":"Long-term consequences of stunting in early life","volume":"7","author":"Dewey","journal-title":"Matern Child Nutr"},{"issue":"9609","key":"R7","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/S0140-6736(07)61692-4","article-title":"Maternal and child undernutrition: consequences for adult health and human capital","volume":"371","author":"Victora","journal-title":"Lancet"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.nlm.2025.108060","article-title":"Synergistic impact of early-life stress and prenatal immune activation on spatial memory and oxidative metabolism in rat cortico-limbic networks","volume":"219","author":"Sal-Sarria","journal-title":"Neurobiol Learn Mem"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.bpobgyn.2014.06.007","article-title":"Developmental origins of health and disease-global public health implications","volume":"29","author":"Hanson","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1056\/NEJMra0708473","article-title":"Effect of in utero and early-life conditions on adult health and disease","volume":"359","author":"Gluckman","journal-title":"N Engl J Med"},{"issue":"2S","key":"R11","doi-asserted-by":"publisher","first-page":"S745","DOI":"10.1016\/j.ajog.2017.11.577","article-title":"Pathophysiology of placental-derived fetal growth restriction","volume":"218","author":"Burton","journal-title":"Am J Obstet Gynecol"},{"key":"R12","unstructured":"Indonesian health survey (SKI) 2023. BKPK Ministry of Health: Health Development Policy Agency. 2023. URL: https:\/\/www.badankebijakan.kemkes.go.id\/en\/hasil-ski-2023\/ [Accessed 24-09-2025]"},{"issue":"6","key":"R13","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11060810","article-title":"Analysis of the determinants of stunting among children aged below five years in stunting locus villages in Indonesia","volume":"11","author":"Atamou","journal-title":"Healthcare (Basel)"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-18824-z","article-title":"Examining determinants of stunting in urban and rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS)","volume":"24","author":"Siramaneerat","journal-title":"BMC Public Health"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2023.112094","article-title":"Association between maternal anemia and stunting in infants and children aged 0-60 months: a systematic literature review","volume":"115","author":"Nadhiroh","journal-title":"Nutrition"},{"issue":"6","key":"R16","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1037\/a0031808","article-title":"Cumulative risk and child development","volume":"139","author":"Evans","journal-title":"Psychol Bull"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.appdev.2024.101710","article-title":"Cumulative risk predicting differential effectiveness of the incredible years parent-training","volume":"95","author":"Greve","journal-title":"J Appl Dev Psychol"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1111\/j.1469-7610.2004.00351.x","article-title":"When more is not better: the role of cumulative risk in child behavior outcomes","volume":"46","author":"Appleyard","journal-title":"J Child Psychol Psychiatry"},{"issue":"14","key":"R19","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14145051","article-title":"The compounded risk of maternal anemia and preeclampsia: neonatal outcomes and predictive modeling in a low-resource tertiary center","volume":"14","author":"Buciu","journal-title":"J Clin Med"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12617","article-title":"A review of child stunting determinants in Indonesia","volume":"14","author":"Beal","journal-title":"Matern Child Nutr"},{"key":"R21","unstructured":"National strategy to accelerate stunting prevention 2018-2024. Global Financing Facility (GFF); Nov 2018. URL: https:\/\/www.globalfinancingfacility.org\/sites\/default\/files\/Indonesia-GFF-Investment-Case-ENG.pdf [Accessed 07-02-2026]"},{"key":"R22","unstructured":"Anaemia in women and children. World Health Organization. 2023. URL: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/anaemia_in_women_and_children [Accessed 24-09-2025]"},{"issue":"15","key":"R23","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18157844","article-title":"Effectiveness of community nutrition-specific interventions on improving malnutrition of children under 5 years of age in the eastern mediterranean region: a systematic review and meta-analysis","volume":"18","author":"Ghodsi","journal-title":"Int J Environ Res Public Health"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2023.1155928","article-title":"Evidence-based interventions to reduce maternal malnutrition in low and middle-income countries: a systematic review","volume":"3","author":"Shenoy","journal-title":"Front Health Serv"},{"key":"R25","unstructured":"Chronic hypertension in pregnancy. American College of Obstetricians and Gynecologists. Jan 2019. URL: https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-bulletin\/articles\/2019\/01\/chronic-hypertension-in-pregnancy [Accessed 24-09-2025]"},{"key":"R26","unstructured":"Hern\u00e1n MA Robins JM . Causal Inference: What If. Chapman & Hall\/CRC; 2020. ISBN: 9781420076165"},{"key":"R27","unstructured":"STROBE Statement. 2023. URL: https:\/\/www.strobe-statement.org\/ [Accessed 24-09-2025]"},{"key":"R28","unstructured":"Kish L . Survey Sampling. John Wiley & Sons; 1965. ISBN: 9780471489009"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","first-page":"676","DOI":"10.2337\/dc09-1848","article-title":"International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy","volume":"33","author":"International Association of Diabetes and Pregnancy Study Groups Consensus Panel","journal-title":"Diabetes Care"},{"key":"R30","unstructured":"Global strategy for asthma management and prevention. Global Initiative for Asthma. 2024. URL: https:\/\/ginasthma.org\/2024-report\/ [Accessed 05-01-2026]"},{"issue":"10431","key":"R31","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"Phelps","journal-title":"The Lancet"},{"key":"R32","unstructured":"Croft TN Allen CK Zachary BW . Guide to DHS statistics. The DHS Program. Dec 2023. URL: https:\/\/www.dhsprogram.com\/pubs\/pdf\/DHSG1\/Guide_to_DHS_Statistics_DHS-8.pdf [Accessed 07-02-2026]"},{"key":"R33","unstructured":"Cogill B . Anthropometric indicators measurement guide. ULBI Repository. Jun 2001. URL: https:\/\/eprints.ulbi.ac.id\/1685\/1\/Athropometric%20Indicators%20Measurement%20Guide.pdf [Accessed 07-02-2026]"},{"issue":"20","key":"R34","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","author":"World Medical Association","journal-title":"JAMA"},{"key":"R35","unstructured":"Beauchamp TL Childress JF . Principles of Biomedical Ethics. 8th ed. Oxford University Press; 2019. ISBN: 978\u20110190640873"},{"issue":"8","key":"R36","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1042\/CS20220300","article-title":"Circulating biomarkers associated with placental dysfunction and their utility for predicting fetal growth restriction","volume":"137","author":"Hong","journal-title":"Clin Sci (Lond)"},{"issue":"9","key":"R37","doi-asserted-by":"publisher","DOI":"10.3390\/life15091348","article-title":"Pregnancy under pressure: oxidative stress as a common thread in maternal disorders","volume":"15","author":"Assani","journal-title":"Life (Basel)"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2024.100453","article-title":"Early life origins of the epidemic of the double burden of malnutrition: life can only be understood backwards","volume":"28","author":"Yajnik","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"R39","unstructured":"Renstra: Rencana Strategis 2023-2026. Pemerintah Daerah: Daerah Istimewa Yogyakarta; 2023. URL: https:\/\/rsprespira.jogjaprov.go.id\/wp-content\/uploads\/2024\/09\/Cetak-Renstra-Dinas-Kesehatan-DIY-2023-2026_blur-dikompresi.pdf [Accessed 07-02-2026]"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.2196\/68918","article-title":"Social and environmental determinants of childhood stunting in Indonesia: national cross-sectional study","volume":"8","author":"Arief","journal-title":"JMIR Pediatr Parent"}],"container-title":["Asian\/Pacific Island Nursing Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/apinj.jmir.org\/2026\/1\/e85742","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:13:56Z","timestamp":1782839636000},"score":1,"resource":{"primary":{"URL":"https:\/\/apinj.jmir.org\/2026\/1\/e85742"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":40,"URL":"https:\/\/doi.org\/10.2196\/85742","relation":{},"ISSN":["2373-6658"],"issn-type":[{"value":"2373-6658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"article-number":"v10i4e85742"}}