139

International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 

Original article:

Association Between Neck Circumference and Preeclampsia In Pregnant Women

Dwi Apriyanti1*, Uki Retno Budihastuti2, dan Kusnandar3

Abstract

The nutritional status of a person can be measured by neck circumference. This 
measurement uses a tape measure that is looped around the neck just below the larynx 
and perpendicular to the length of the neck. The parameters of neck circumference used 
to assess nutritional status are > 34 cm in women with BMI > 25 kg/m2 and > 36.5 cm in 
women with BMI > 30 kg/m2 with an accuracy rate of 99%. Being overweight and obese 
during pregnancy and childbirth will increase the risk of chronic disease in both mother 
and child. Pregnant women with obesity are at risk for pregnancy complications such 
as gestational hypertension, preeclampsia, gestational diabetes mellitus, and more often 
undergo cesarean delivery due to a baby born prematurely. An observational study with a 
case-control design using a cross-sectional approach was carried out by measuring neck 
circumference in 130 pregnant women with gestational age above 20 weeks which was 
divided into 65 respondents of pregnant women with preeclampsia and 65 respondents of 
pregnant women without complications. This research was conducted on pregnant women 
in Tangerang Regency. The chi-square test is used to analyze the data with a significant 
value of 0.05. The results of the Chi-Square test obtained a p-value of 0.000 (p<0.05), 
indicating a relationship between neck circumference and the occurrence of preeclampsia 
in pregnant women. The Contingency Coefficient value of 0.493 indicates the impact of 
obesity on the occurrence of preeclampsia by 49.3%, while other factors that influence 
preeclampsia are 50.7%. Neck circumference can be used as a method to assess nutritional 
status in pregnant women to prevent preeclampsia.

Keywords: Neck Circumference, Preeclampsia, Obesity

Correspondence to: DwiApriyanti, The Study Program oh Nutrition Science, Master’s Degree pro-
gram, SebelasMaret University, Surakarta, E-mail : dwiapriyanti@student.uns.ac.id

1. The Study Program of Nutrition Science, Master’s Degree Program, SebelasMaret University, 
Surakarta, Indonesia.

2. The Study Program of Obstetric and Gynecology, Faculty of Medical Science, SebelasMaret 
University, Surakarta, Indonesia (RSUD Dr. Moewardi)

3. The Study Program of Agribusiness, Faculty of Agriculture, SebelasMaret University, Surakarta, 
Indonesia

Introduction 

Based on Indonesia’s health profile in 2020, it 
can be seen that the increase in MMR cases in 
Indonesia from 4,221 deaths in 2019 increased 
to 4,726 in 2020. The main factors causing the 
high mortality include 25% bleeding in as many 
as 1,330 cases, 24% hypertension in pregnancy 
including preeclampsia, eclampsia, PEB in as 
many as 1,110 cases, 8% disorders of the blood 

circulation system in as many as 230 cases 
(Ministry of Health of the Republic of Indonesia, 
2021), (Nur &Adhar, 2017).  Preeclampsia is 
one of several health problems that exist during 
pregnancy and has the potential for complications 
in 2-3% of pregnancies (Sukmariah et al., 2019). 
Preeclampsia is a serious medical condition that 
can affect 3-5% of pregnancies and is a contributing 
factor to more than 35,000 maternal deaths in the 

International Journal of Human and Health Sciences Vol. 07 No. 02 April’23
DOI: http://dx.doi.org/10.31344/ijhhs.v7i2.564

mailto:dwiapriyanti@student.uns.ac.id


International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 

140

world every year. Preeclampsia can affect the 
work of other organs causing an increased risk of 
complications in pregnancy (Wen et al., 2018). 

The World Health Organization (WHO) stated that 
the incidence of preeclampsia is 7 times higher 
in developing countries compared to developed 
countries. The prevalence of the incidence of 
preeclampsia in developed countries is 1.3% - 6% 
while in developing countries it is about 1.8% - 18%. 
The latest WHO report states that preeclampsia 
accounts for 70,000 maternal deaths every year 
in the world (Arikah, Rahardjo& Widodo, 2021). 
The risk factors for preeclampsia are primigravida 
pregnancy risk 4,654 times greater than that of 
multigravida pregnant women, age, gestational 
age, obesity, history of hypertension, pregnancy 
visits or Antenatal Care, family income, and 
the use of hormonal contraceptives (Nur and 
Arifuddin, 2017).

The prevalence of overweight and obesity is 
becoming a global health problem today. Obesity 
is significantly associated with the development 
of chronic disorders such as cardiovascular 
disease (CVD), type II diabetes mellitus, insulin 
resistance, hypertension, and cholesterol. Early 
detection is indispensable to prevent long-term 
effects that can be detrimental, especially for 
those with an unhealthy lifestyle (Ferrari et 
al., 2019). As many as a quarter to one-third of 
pregnant women are obese and have a BMI of 
> 30 kg/m2 in developed countries. Obesity can 
significantly increase the risk of non-emergency 
and emergency cesarean delivery (You-Ten et 
al., 2015). Based on the description above, it can 
be seen that being overweight and obese greatly 
affects the condition of pregnant women and risks 
causing preeclampsia and other chronic diseases 
during pregnancy. Therefore, efforts are needed to 
prevent obesity in pregnant women, one of which 
is by measuring neck circumference to monitor 
the nutritional status of pregnant women in 
addition to seeing weight gain during pregnancy.  
Neck circumference measurements can be used 
as an early screening for obesity.  This can be 
early intervention in preventing preeclampsia 
and hypertension in pregnancy so that it does not 
become a condition of severe preeclampsia to 
cause conditions that can harm the health of the 
mother and fetus. The aims

This study aims to see if there is a relationship 
between neck circumference and the incidence of 
preeclampsia in pregnant women.

Methods

This study is an observational study with a case-
control research design using a cross-sectional 
approach.  This performance grouped samples 
into cases and controls carried out at the same 
time(Probandari et al., 2020). This research 
wasconducted in July 2022 in Tangerang Regency.  
Sel was taken using a multistage sampling 
technique and obtained a study sample of 130 
pregnant women respondents which was divided 
into 65 respondents of normal pregnant women 
and 65 respondents of pregnant women with 
preeclampsia.  Data collection used primary data 
obtained by measuring the neck circumference 
of respondents and looking at data on pregnant 
women through the MCH book.  Data analysis 
was performed to see the relationship between 
the research variables.The measurement of neck 
circumference is carried out by measuring at a 
point just below the larynx (thyroid cartilage) 
and perpendicular to the axis The length of the 
neck (with a band line in front of the neck at the 
same height as the band line of the back of the 
neck). The tool used is an inelastic tape measure 
in centimeter units. Measurements are carried 
out twice to ensure accuracy and use the average 
value for analysis. If two readings are far different 
from the predetermined point (0.5 cm) then a third 
measurement is taken (Ferrari et al., 2019).

The hypothesis in this study is the assumption that 
the neck circumference can be used as one of the 
screenings for determining nutritional status and 
its relationship with the incidence of preeclampsia 
during pregnancy.

Result and Discussion

This study aims to find out whether there is a 
relationship between neck circumference and the 
incidence of preeclampsia in pregnant women. 
The data used in this study were primary data 
taken on pregnant women with a gestational age of 
more than 20 weeks in Tangerang Regency.  The 
following are the results of the research obtaine.

Characteristics of respondents



141

International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 

Table 1. Characteristics of respondents (n=130)

Characteristics Amount(n)
Percentage 

(%)

Age of respondents
(Year)

15 – 19 4 3.1

20 – 35 100 76.9

>35 26 20

Gestational age
(Sunday)

22 - 28 61 49.9

29 - 42 69 50.1

Parity
1-3 104 80

≥ 3 26 20

Neck circumference
(cm)

≤ 34 45 34.6

> 34 85 65.4

Source: Primary data,2022

Table 1 explained the characteristics of the 
study respondents, where respondents with risky 
pregnancies at the age of 15-19 years as many as 
4 people with a percentage of 3.1% and aged over 
35 years as many as 26 people with a percentage of 
20%. Respondents with a productive gestational 
age of 100 people at the age of 20-35 years with 
a percentage of 76.9%. The gestational age of the 
respondents in this study was a pregnancy of more 
than 20 weeks. Respondents with a gestational age 
of2 2 – 28 weeks were 61 people with a percentage 
of 61% and a gestational age of > 28 weeks as 
many as 69 people with a percentage of 69%.  The 
lowest gestational age is 20 weeks and the highest 
is 40 weeks.

Respondents with a parity of more than 3 children 
were 26 people with a percentage of 20%, while 
respondents who had children 1 to 3 children were 
104 people with a percentage of 60.8%.  pregnant 
women with a parity of more than 3 children are 
at risk of pregnancy complications in the next 
pregnancy compared to pregnant women with 
a parity of fewer than 3 Neck circumference 

characteristics are used to see the nutritional status 
of pregnant women, where the neck circumference 
is ≤ 34 cm as many as 45 people with a percentage 
of 34. 6% and > 34 cm as many as 85 people with 
a percentage of 65.4%.  Neck circumference data 
shows that at 20 weeks of gestation and above 
pregnant women begin to increase weight where 
the nutritional status of obesity is more than 
the normal nutritional status. children.  Neck 
circumference with preeclampsia

Source: Primary data, 2022 Table 2 shows the 
relationship of neck circumference with the 
incidence of preeclampsia in pregnant women. 
Pregnant women who experienced preeclampsia 
with obesity as many as 60 people or 70.6% and 
pregnant women with normal conditions were 
obese as many as 25 people with a percentage 
of 29.4%. These results show that mothers 
with preeclampsia have an obese nutritional 
status compared to pregnant women without 
complications.  A study on the relationship of 
excess weight gain to the risk of preeclampsia 
showed that women who had preeclampsia 
experienced more weight gain than women who 
did not experience preeclampsia with a difference 
of 3.5 kg in total body fluids observed at week 36 
but were inversely proportional between fat mass 
and the possibility of preeclampsia (Hillesund et 
al., 2018).

In this study, the results of the p-value of 0.000 
with a significant 0.05 which means that the p<0.05 
value shows a relationship between measuring 
nutritional status using neck circumference and the 
occurrence of preeclampsia in pregnant women.  
The numerical parameters used on a woman’s 
neck circumference are that a person with a BMI > 
of 25 kg/m2 has a cut of point> 34 cm and a BMI of 
> 30 kg/m2 with a cut of point> 36.5 cm.  From the 
validation results that have been carried out, neck 
circumference can be used as one of the obesity 

Table 2. Relationship of neck circumference withpreeclampsia in pregnant women

Variable Neck Circumference Sum X2 P Value

Normal Obesity

n % n % n %

Pregnancy status
Normal 40 88.9 25 29.4 65 50

39.3 0.000
Preeclampsia 5 11.1 60 70.6 65 50

Sum 45 100 85 100 130 100



International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 

142

screening methods with a sensitivity of 98%, 
specificity of 89%, the accuracy of 94% for men, 
and 99% for women (Par’iet al., 2017).  Obesity 
is one of the risk factors for the occurrence of 
preeclampsia 2 times every increase in body 
weight by 5-7 kg and an increase in BMI which is 
associated with the risk of preeclampsia and severe 
preeclampsia by 64%. This risk can increase two 
to three times due to an increase in BMI from 20 
kg/m2 to 30 kg/m2 (David et al., 2016),(Zahra and 
Rodiani, 2016).

The Contingency Coefficient value of 0.493 in 
this study showed the effect of obesity on the 
occurrence of preeclampsia by 49.3%, while 
other factors that affect preeclampsia but are not 
explained in this study were 50.7%.  Some of the 
risk factors associated with the development of 
preeclampsia include extreme age (too young / 
too old), parity, previous history of preeclampsia, 
a distance of pregnancy, IVF, family history of 
preeclampsia, obesity, having a comorbid medical 
history including gestational diabetes, previous 
chronic hypertension, kidney disease as well as 
autoimmune diseases such as systemic lupus 
erythematosus and antiphospholipid syndrome 
(Poon et al., 2019).  A study showed that pregnant 
women with obesity have a risk factor for 
preeclampsia 5,632 times greater than pregnant 
women without obesity (Nur and Arifuddin, 
2017).

In the human body whether pregnant or not, 
endothelial dysfunction occurs due to obesity. This 
leads to endothelial damage and further provokes 
the occurrence of preeclampsia in pregnant 
women. A woman who has preeclampsia has a 
lesion of the uteroplasent artery. These lesions 
have the characteristic presence of parts that 
undergo fibrinoid necrosis including macrophage 
cells that are lipid phagotiated.  Lesions that occur 
in the glomerulus are related to the occurrence of 
proteinuria. Changes in fat metabolism play a role 
in the destruction of endothelial lesions in people 
with preeclampsia. The severity of hypertension 
and proteinuria describes the severity of endothelial 
damage (Poon et al., 2019),(Wafiyatunisa Zahra 
and Rodiani, 2016).  Overweight and obese 
before and during pregnancy have a negative 
impact on fertility, during pregnancy and 

childbirth and increase the risk of developing 
chronic diseases for the mother and child. Women 
with overweight and obese increase the risk of 
developing complications such as gestational 
hypertension, preeclampsia, gestational diabetes 
mellitus and more often having cesarean delivery 
(Timmermans et al., 2019).

Conclusion

From the results of this study, there is a 
relationship between neck circumference and the 
occurrence of preeclampsia in pregnant women 
based on the cutoff point of nutritional status of 
obesity at gestational age above 20 weeks. This 
research was carried out in Tangerang Regency 
in June 2022 with a total sample of 130 people. 
Of the total number of respondents with a neck 
circumference of > 34 cm as many as 85 people 
(64.5%), preeclampsia pregnant women with 
obesity as many as 60 people (70.6%), and 
normal pregnant women with obesity as many 
as 25 people (29.4%). The p-value of 0.000 and 
Contingency Coefficient of 0.493 indicated the 
relationship between obesity and preeclampsia, 
where the effect of obesity on the occurrence of 
preeclampsia was 49.3%, while other factors 
affecting preeclampsia but not explained in 
this study were 50.7%. Suggestions for further 
research on the effect of neck circumference on 
lipid profiles with different characteristics of 
respondents.

Conflict of interest

The authors stated there was no conflict of interest 
in the study.

Ethical Clearance

This Study has been approved by the Research 
Ethics Committee of the Faculty of Medicine 
SebelasMaret UniversityNumber 35/UN27.06.11/
KEP/EC/2022.

Authors’ contribution

DwiApriyanti conceptualized and designed the 
study, prepared the draft of the manuscript and 
reviewed of the manuscript. UkiRetnoBudihastuti 
assisted in drafting of the manuscript, reviewed of 
manuscript. Kusnandar conducted the study, data 
analysis and interpretation and reviewed of the 
manuscript.



143

International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 

References
1. Arikah, T., Rahardjo, T.B.W., Widodo, S. Incidence of 

Hypertension in Pregnant Women. Jurnal Research 
and Development of Indonesian Community Health 
2021;(1) : 115–124.https://doi.org/10.15294/jppkmi.
v1i2.40329

2. David, H., Han, A., Hanson, Claudia, Helewa, Michael, 
Hoodbhoy, Zahra, Hutcheon, Jenn, Jaime, J., Katageri, 
G., Kintu, A., Oladapo A. Ladipo, André Lalonde, Laura 
A. Magee, A.M., Mathai, M., Miller, S., Jean-Marie M, 
J.W. The FIGO Textbook of Pregnancy Hypertension 
An evidence-based guide to monitoring, prevention 
and management, Medicine, Biomedical Sciences, 
Health and Social Care Science Cranmer. The Global 
Library of Women’s Medicine, London (UK), 2016. 
https://www.researchgate.net/publication/312916347_
The_FIGO_Textbook_of_Pregnancy_Hypertension

3. Ferrari, L.D.M., Gerson, Kovalskys, I., Fisberg, M., 
Gomez, G., Rigotti, A., Sanabria, L.Y.C., García, 
M.C.Y., Torres, R.G.P., Herrera-Cuenca, M., Zimberg, 
I.Z., Guajardo, V., Pratt, M., Pires, C., Solé, D., Moreno, 
L.A., Lloyd, B., Lynch, B., Jauregui, M., Guidi, A., 
Costa, L., Fisberg, R.M., Koletzko, B.,  Tucker, K.L., 
Amigo, M.P., Janezic, X., Cardini, F., Echeverry, M., 
De França, N.A.G., Echeverría, G., Landaeta, L., 
Castillo, Ó., Vargas, L.N., Tobar, L.F., Castillo, Y.M., 
Rojas, R.M., Chinnock, A., Fontana, M.E.H., Cáceres, 
M.V., Ocampo, M.B., Torres, R.P., Liria, M.R., Meza, 
K., Abad,  M., Penny, M., Landaeta, M., Méndez, B., 
Vasquez, M., Rivas, O., Meza, C., Ruiz, S., Ramirez, G., 
Hernández, P., Chiavegatto Filho, A.D.P., Gonçalves, 
P.B., Alberico, C., De Moraes Ferrari, G.L. Association 
of moderate-to-vigorous physical activity with neck 
circumference in eight Latin American countries. 
BMC Public Health 2019; (19):1–8.DOIhttps://doi.
org/10.1186/s12889-019-7153-y

4. Hillesund, E.R., Seland, S., Bere, E., Sagedal, L.R., 
Torstveit, M.K., Lohne-Seiler, H., Vistad, I., Øverby, 
N.C. Preeclampsia and gestational weight gain in the 
Norwegian Fit for Delivery trial NCT0100168 NCT. 
BMC 2018; (11) : 1–6. DOI https://doi.org/10.1186/
s13104-018-3396-4

5. Holil M. Par’i, SugengWiyono, Titus PriyoHarjatmo.  
Nutritional Status Assessment. In: Widyasari, 
Nofaldo, D.A., Supriyadi (Eds.), Nutritional Teaching 
Materials. PPSDM Ministry of Health of the Republic 
of Indonesia, Jakarta, 2017: 315.

6. Ministry of Health of the Republic of Indonesia, 
2021. Indonesia Health Profile Jakarta, 2020

7. Nur Fahira. A, Arifuddin, A.. Risk factors for the 
incidence of preeclampsia in pregnant women at 

Anutapura Hospital, Palu City. TadulakoJournal 
of Health 2017;(3): 69–75.https://123dok.com/
d o c u m e n t / y e r p 2 3 4 q - f a k t o r - r i s i k o - k e j a d i a n -
preeklampsia-hamil-anutapura-fahira-arifuddin.html

8. Poon, L.C., Shennan, A., Hyett, J.A., Kapur, A., 
Hadar, E., Divakar, H., McAuliffe, F., da Silva Costa, 
F., von Dadelszen, P., McIntyre, H.D., Kihara, A.B., 
Di Renzo, G.C., Romero, R., D’Alton, M., Berghella, 
V., Nicolaides, K.H., Hod, M. The International 
Federation of Gynecology and Obstetrics (FIGO) 
initiative on pre-eclampsia: A pragmatic guide for 
first-trimester screening and prevention. International 
Journal Gynecology Obstetric 2019. https://doi.
org/10.1002/ijgo.12892

9. Probandari, A.N., Pamungkasari, E. poncorini, 
Febrinasari, R.P., Sumardiyono, Widyaningsih, V. 
Quantitative research methods, 1st ed. UNS Press, 
Surakarta, 2020

10. Sukmariah, H., Nisrina, Agustina, T.A., Ismiyati. Efforts 
to prevent Hypertension in Pregnancy (HDK) with non-
pharmacological methods (nutrition and stress factors). 
In: Prevention of Non-Communicable Diseases. PUI-
PK PoltekkesKemenkes Banten, Banten, 2019

11. Timmermans, Y.E.G., Van De Kant, K.D.G., Reijnders, 
D., Kleijkers, L.M.P., Dompeling, E., Kramer, 
B.W., Zimmermann, L.J.I., Steegers-Theunissen, 
R.P.M., Spaanderman, M.E.A., Vreugdenhil, A.C.E., 
2019. Towards Prepared mums (TOP-mums) for 
a healthy start, a lifestyle intervention for women 
with overweight and a child wish Study protocol 
for a randomized controlled trial in the Netherlands. 
BMJ Open,2019; (9):1–14.https://doi.org/10.1136/
bmjopen-2019-030236

12. Wafiyatunisa Zahra, Rodiani. Obesity Relationship 
with the Occurrence of Preeclampsia. Majority2019 
; (5) : 184–190.

13. Wen, S.W., White, R.R., Rybak, N., Gaudet, L.M., 
Robson, S., Hague, W., Simms-Stewart, D., Carroli, 
G., Smith, G., Fraser, W.D., Wells, G., Davidge, S.T., 
Kingdom, J., Coyle, D., Fergusson, D., Corsi, D.J., 
Champagne, J., Sabri, E., Ramsay, T., Mol, B.W.J., 
Oudijk, M.A., Walker, M.C. Effect of high dose folic 
acid supplementation in pregnancy on pre-eclampsia 
(FACT):  Double-blind, phase III, randomized 
controlled, international, multicentre trial. BMJ, 2018 
; (362):1–8.https://doi.org/10.1136/bmj.k3478

14. You-Ten, K.E., Desai, D., Postonogova, T., Siddiqui, 
N. Accuracy of conventional digital palpation and 
ultrasound of the cricothyroid membrane in obese 
women in labor. Anaesthesia, 2015; (70):1230–1234. 
doi: 10.1111/anae.13167

https://doi.org/10.15294/jppkmi.v1i2.40329
https://doi.org/10.15294/jppkmi.v1i2.40329
https://www.researchgate.net/publication/312916347_The_FIGO_Textbook_of_Pregnancy_Hypertension
https://www.researchgate.net/publication/312916347_The_FIGO_Textbook_of_Pregnancy_Hypertension
https://doi.org/10.1186/s12889-019-7153-y
https://doi.org/10.1186/s12889-019-7153-y
https://doi.org/10.1186/s13104-018-3396-4
https://doi.org/10.1186/s13104-018-3396-4
https://123dok.com/document/yerp234q-faktor-risiko-kejadian-preeklampsia-hamil-anutapura-fahira-arifuddin.html
https://123dok.com/document/yerp234q-faktor-risiko-kejadian-preeklampsia-hamil-anutapura-fahira-arifuddin.html
https://123dok.com/document/yerp234q-faktor-risiko-kejadian-preeklampsia-hamil-anutapura-fahira-arifuddin.html
https://doi.org/10.1002/ijgo.12892
https://doi.org/10.1002/ijgo.12892
https://doi.org/10.1136/bmjopen-2019-030236
https://doi.org/10.1136/bmjopen-2019-030236
https://doi.org/10.1136/bmj.k3478