E:\2021\NERS APRIL 2021\4-jurna 26 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 26–32 Gestation Period and Its Bio-Psychosocial and Economic Factors Analysis on Toddler Growth and Development JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 13/11/2020 Accepted, 18/02/2021 Published, 05/04/2021 Keywords: Biopsychosocial, Economy, Growth, Toddler Article Information Abstract The growth and development of toddlers is influenced by hereditary and environmental factors. Genetic factors, biologically have strong influences on toddlers’ growth in their early years of life. While psychologically, a good interpersonal relation of pregnant women with their families will make them more ready to undergo the pregnancy and childbirth. On the other hand, socially, the level of parental education might affect the nutrition intake and parenting patterns. For the economic factor, the level of family income and their ability to provide sufficient nutrition input might affect the nutritional status during gestation. The nutrition input during pregnancy highly con- tributes to the fetus growth and development. A poor nutrition input during gestation might cause an Intrauterine Growth Retardation (IUGR) and growth and development disorder. This study aimed to analyze the bio-psychoso- cial and economic factors of gestation period on toddler growth and devel- opment. This is a correlational analytic study with 80 mothers and toddlers as the sample. The data was analysed using univariat, bivariate with Chi square and multivariate with logistic regression. The results show that the statistically significant independent variables which influence the growth and development of toddlers are the mother height (p = 0.001), LILA (p = 0.008), family income (p = 0.007), infant birth weight (p = 0.009) and family support (p = 0.013). While the statistically insignificant independent vari- able is the mother level of education (p = 0.086). © 2020 Journal of Ners and Midwifery 26 Correspondence Address: STIKES Widyagama Husada Malang – East Java, Indonesia P-ISSN : 2355-052X Email: nicky_daanty@widyagamahusada.ac.id E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i1.ART.p026–032 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) Nicky Danur Jayanti1, Senditya Indah Mayasari2 1,2Midwifery Departement, STIKes Widyagama Husada Malang, Indonesia https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i1.ART.p026-032&domain=pdf&date_stamp=2021-04-15 https://doi.org/10.26699/JNK.V8I1.ART.P026-032 27Jayanti, Mayasari, Gestation Period and Its Bio-Psychosocial and Economic Factors Analysis on ... INTRODUCTION A significantly fast growth and development in human life is taken place during toddler. During this ‘golden age’ period, toddler’s cognitive, physical, motoric and psychosocial aspects are fastly deve- loped (Welasasih dan Wirjatmadi, 2012). Con- sequently, any disorder or late growth on them will be easily detected by their attentive family member. In addition, sufficient loving care and fulfilment of basic needs such as healthy diet and caring is particularly needed in this development period in order to have quality human resourse who are healthy, smart and productive, (Soetjiningsih, 2012). Factors affecting the children development in general are the genetic/ heredity, gender, race/ ethnicity, age a nd environment factor which comprises prenatal and post natal environment. Specifically, in gestation period, if any developmental obstacles take place previous to the 20th week of pregnancy, it might affect the brain and somatic development of te fetus which r esulted in unaccomplised of newborn growth on their childbirth (Anugraheni, 2012). Biologically, a person’early life growth indirectly effect his/her body size (Kusharisupeni, 2014). While psychologically, a mother interpersonal relationship with her family will give effect oh her readiness in undergoing the pregnancy and labor. On the socia l fa ctor, toodler gr owth a nd development are affected by their parent knowledge on healthy diet and appropriate parenting which highly correlated to the level of education. It means that sufficient diet and appropriate parenting will help in optimalizing the toddler growth and it works conversely (Chaudhury, 2013). A family income is one of important variable which affect the mother nutrition input during pregnancy. (Anindita, 2012). Balanced diet is needed during pregnancy and it affects infant growth and development. Imbalanced or insufficient nutrition might result on newborn baby with low body weight or ca lled Intrauterine Growth Retardation (IUGR) which consequently, the development of the toddler is in disorder or experience late blooming. On the other hand, a mother with quality nutrition input will result on healthy baby. (Anugraheni, 2012). Based on the review of related journals, it can be said that research focusing on bio-psychosocial and economic factors of gestation period on toddler growth and development is highly needed. The objective of this study is to analyse those factors in relation to toddler growth and development. MATERIALS AND METHODS This is a correlational analytic study which was conducted in Desa Mangliawan Kab. Malang from June to August 2019. The population is mother and toddler from the aforementioned research setting with the sample of 80 respondents. The data was collected using a set of questionaire and KPSP obser va tion checklist to monitor toddler development. After the collected data was sorted and coded, the next step was the data analysis using SPSS 22. The analysis was also analysed using univariat, bivariate with Chi square and multivariate with logistic regression respectively. FINDINGS Karakteristik Kriteria n % Mother Height < 145 cm 36 45  145 cm 44 55 LILA < 23.5 cm  23.5 cm 2456 3070 Family income < Rp. 2.781.564  Rp. 2.781.564 3248 4060 Mother level of education < High School  High School 2258 27.572.5 Infant birth weight < 2500 gr  2500 gr 3743 46.353.8 Family support Lemah Kuat 2060 2575 Source: Primary Data 2019 Table 1 Research Subject Characteristics 28 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 26–32 DISCUSSION A. The Relation of Mother height to Toddler Growth and Development Body weight is affected by heredity and environment factors. A toddler height during his/ her children growing period is influenced by their genetic factor (Levy, 2008). Low body height and poor nutrition status during pregnancy will increase the incident of intrauterine growth retardation (IUGR). This will also increase the incident of Variable OR p Late Normal n % n % Mother height < 145 cm 23 63.9 13 36.1 6.01 < 0.001  145 cm 10 22.7 34 77.3 LILA < 23,5 cm 16 66.6 8 33.4 4.58 0.003  23,5 cm 17 30.4 39 69.6 Family income < Rp. 2.781.564 22 68.7 10 31.3 7.40 < 0.001  Rp. 2.781.564 11 23 37 77 Mother level of education < High school 17 77.3 5 22.7 8.92 < 0.001  High school 16 27.6 42 72.4 Newborn weight < 2500 gr 24 64.8 13 35.2 6.97 < 0.001  2500 gr 9 21 34 79 Family support Weak 15 75 5 25 7.00 < 0.001 Strong 18 30 42 70 Source: Primary Data 2019 Table 2 Frequency Distribution of Bio-Psychosocial Economic Bivariate analysis of Gestation Period on Toddler Growth and Development Toddler Growth and Development Variable OR CI 95 % p Lower Range Upper Range Mother height 0.01 0.00 0.13 0.001 LILA 0.05 0.01 0.46 0.008 Family income 0.05 0.01 0.45 0.007 Mother level of education 0.15 0.02 1.31 0.086 Newborn weight 0.07 0.01 0.51 0.009 Family support 0.02 0.00 0.41 0.013 Source: Primary Data 2019 Table 3 Analysis on doubled multivariate logistic regression growth and development disorder on toddler. (Victora, 2008). As cited in Black et,al (2008), poor fetus growth during gestation will influence the newborn optimal growth and development. This disorder is affected by mother poor nutrition status and (shorter) mother height. It is inline to the result of this study which showed that 77,3% of the participants with body height  145 cm has todller with normal growth and development. 29Jayanti, Mayasari, Gestation Period and Its Bio-Psychosocial and Economic Factors Analysis on ... Mamabolo et,al (2015) explains that parents with genetically (shorter) body height will highly expecting (shorter) body height on their children. It does not apply on parents who have (shorter) body height due to the poor nutrition inpu. This study does not differentiate the participants based on those factor s (genetica lly or pa tologica lly) which consequently becomes one of the study limitations. Semba et al (2008), and Zottarelli et al (2007) study show that mother body heigth is significantly correlated to toddler nutrition status. Based on those data, it can be concluded that there is a significant statistical relation between mother height and toddler growth and development. A mother categorized as (high) body height with normal body mass indexwill have positive impact on their newborn growth and development. B . The Relation of LILA to Toddler Growth and Development A mother nutrition status before and during gestation is a crucial to have a healthy newborn. In addition, LILA (size of upper arm) of the pragnant mother is one of indicators to check their nutrition status. Those who have LILA < 23.5cm might have cronic energy deficiency/ KEK (Proverawati, 2009). In another word, conversely, a mother with LILA  23.5 cm shows her good nutrition status. Someone nutrition status is influenced by his/her diet (Francis, 2005). On a case of pregnant mother, her nutrition status will affect the fetus growth. Her normal condition will result on a healthy newborn with normal body weight to support an optimal growth. This is supported by this study result that most of participants (69,9%) with LILA  23,5 cm have newborn and toddler with normal growth and development. Mother nutrition status during pregnancy will affect the infant and the newborn nutrition status. During the gestation period, the fetus development is highly influenced by the mother nutrition status. To have a healthy newborn with normal body weight, and born without birth defects so the the mother should have normal nutritional status. The mother with the aforementioned condition will not experience newborn with low birth weight (BBLR) which may lead into toddler growth disorder. It is empirically supported by this study result that 16 (sixteen) mothers with LILA < 23.5 cm have babies with low birth weight (BBLR). C. The Relation of Family Support to Toddler Growth and Development Higher degree of anxiety and stressed condition is experienced concurently during the pregnancy. This condition is not only experienced by the pregnant mother but also her family, especially them who live at the same house with her. It also affects her husband. Any changes and adaptation process during pregnancy will be experienced by the whole family which makes them to indirectly involved. The family support (love caring and motivation) will give the pregnant mother feeling comfort, feeling secured and relaxed so she is not too worried and or occupied by her pregnancy (Susanti, 2008). Friedman in Suryanto et al (2014) states that any positive perception and acts by any family member is called family support. Any support and help will be given by the family member who possesses good motivation and support believe. This kind of support is needed during any part of someone’s life. A family with its various functions both physically or mentally will have the effect on family adaptation process and health. The family support, especially on health care matter, is highly needed by mother during her pregnancy. Every woman will experience anxiety on her pregnancy regardless her amount of pregnancy. This anxiety mostly applies to women who are very content with her pregnancy. Every pregnant woman is in doubt in undergoing her nine (9) month pregnancy with all its discomfort or changes especially on the changes of roles once the baby was born. The husband support will help the mother to have smooth labor and breast feeding. With a good quality of family relationship, a pregnant mother will have an ease in dealing with any problems during her pregnancy. Her husband will also pay more attention and accompany her during her pregnancy (Kusmiyati, 2010). In dealing with problems, anyone needs family support which plays a vital role to successfully solve the problems. With this good support, the person will have higher confidence and motivate himself to solve the problems he is facing. Psychologically and emotionally, the support from the family is one of the factors needed to have a succesfully developed pregnancy. A woman who has a good relationship and live-in harmony with her husband and her family will benefit good emotional effect for her pregnancy. 30 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 26–32 Her good emotional state will give good influence for her baby and it affects the growth and development of the fetus which in consequence will give effect on the toddler gr owth a nd development. It is supported by data gathered from this study which shows that emotional support from the family (for about 70 %) have effect on normal growth and development of the toddler. Moreover, psychosocial factor which plays a vital role during a woman pregnancy or after her- giving birth is the family support, which consequenly followed by the growth of the toddler. It then follows by the simulation, support and parenting style which will affect the development of the toddler (Barros et al, 2008). Considering that, we can say that this study resulted the same conclution. D. The Relation of Mother Education Level to Toddler Growth and Development Education is a long-life learning effort made to improve someone’s skill and character which can be taken thr ough academic or non-a cademic measures. How educated the person is, can be seen from how he/she manages and disseminate the information. More educated the person, easier for them to get and absorb the information to improve their knowledge. On the other hand, less educated people will have problems in perceiving and absorving new information. A person acts is highly influenced by his/her education level which also affect how the person respond problems and find the solution in his/her life. Most commonly, he/she will act more logically and much easier in accepting new good ideas and opinion. In this case, an educated mother might pay more attention on her health during her pregnancy and in having her pregnancy regularly checked. Furthermore, the parents’ level of education will affect their knowledge about nutrition and parenting style. In reverse, a good parenting and normal nutritional status will optimize the growth and development of the toddler. (Chaudhury, 2013). As reported by Febrianto (2012) the parents’ level of education have effect on the toddler nutritional status which becomes the indicator of their gr owth and development dur ing home monitoring. It happens because the educated parents receive a lot of information which benefit them to have better life quality to improve their universal health state. Mother with good education level, based on statistically significant bivariate analysis, has 8.92 times chances to have toddler with normal growth and development, yet on multivariate analysis it shows that the mother level of education does not statistically significant to the toddler growth and development. E. The Relation of Family Income to Toddler Growth and Development The family income plays a big role in the family survival and eco-social status of the household. It indirectly influences the nutritional status of the whole family member. A family with low-income status might result on low inadequate nutritional staus of the family member, especially the infant and toddler. This is a cliché excuse for the problem of low nutritional familty status worldwide. Riyadi et al (2006) states that common indicator of low nutritional family status is their low-income status which indicates a very low budget on basic meals. The study result indicates that most of the respondent’s family income derives from the husbands. Additionally, Febrianto (2012) states that someone health state is specifically influenced by his/her income. Lower their income and socio- economic status the bigger the effect on their future health state. Toddler and children health status can be confirmed by looking at their growth indicated by their body weight and height which is checked periodically. It can be concluded that there is a significant relation between their family income level and the toddler nutritional status. In line to that, Rukmana dan Indawati (2014) mentions that there is a significant relation bettwen socio-eco status of the family, especially the parents’ income, with the toddler growth. A family with high income level might provide better parenting and can fulfill their children nutritional intake to grow, provide safe environment, avoid ilnesses and exposure of patogen (Astari et al, 2005). The higher someone’s income level, it usually affects their diet which becomes varied and balanced. On the other hand, it might also provoke them to consume unhealthy diet or junk food. It mostly due to their busy life and changes in life style. Eating habit usually changes concurrently with the changes on income level. This means that besides an improvement on income level, the family needs to improve their knowledge in healthy diet to have normal family nutritional status (Suhardjo, 1999). 31Jayanti, Mayasari, Gestation Period and Its Bio-Psychosocial and Economic Factors Analysis on ... This because the family economic status has significant effect on the incidents of children whether they will have normal or abnormal body weight and height. With this in mind, we can say that the study result is inline to the previous research. F. The Relation of Newborn Weight to Toddler Growth and Development The average of life expectancy, globally, in the future is highly affected by some factors. One of them is newborn body weight (Zareian et al, 2014). From the data of newborn body weight, we can relate them with the children development, level of education, and their behaviour during childhood or teenage. The most crucial period of someone’s life is during his/her golden age period. During this life phase, the fastest growth and development takes place. Any disorder or late blooming will easily be detected. Some of the aspects which are fastly developed are cognitive, physical, motoric, and its psycho-social aspects. (Welasasih dan Wirjatmadi, 2012). The newborn body weight is one of indicators for healthy society. This indicates the child potential growth and development in the future. Those who are born with normal body weight have less mortality rate especially during perinatal. Additionally, they might have less ilnesses both mentally and physically. El Taquri et al (2008) reported that in Lybia the newborn body weight also significantly related to the nutritional status. Babies who are born with abnormal body weight (low) will mostly experience late blooming compared to those who are born with normal body weight. Hamam (2005) states that newborn baby with low body weight might have higher chnaces in getting infected especially when they do not get adequate nutritional intake. Based on Rahmad et al (2013) and Mardani et al (2015), babies with low borth weight might have poor nutritional status compared to those who are born with normal body weight. The quality of the toddler growth and development is crucially affected by their newborn body weight. Ba bies body weight indica tes their life development and most importantly they will have normal antropometri correspond to their age. Arifin et al (2012), states that infants born with normal body weight who are supported by adequate nutritional intake and balanced diet will decrease their illnesses incidents and grow optimally especially when it is also supported by good healthcare, complete vaccination, and good immune system. Baby mortality rate is caused by multiple factors. One of the most crucial factors is the low- newborn birth weight. Those babies born with this condition might experience mental and physical disorders in their early development years which mostly give burden financially. This study result indicates that 79% of the normal growth and development takes place on babies born with normal body weightwhis is  2500 gram. In another word, it can be concluded that this study result is inline with those previous studies. CONCLUSION Based on the data analysis, it can be concluded that the statistically significant independent variables which affects the toddler growth and development are mother height (p=0.001), LILA (p=0.008), family income (p=0.007), newborn weight (p=0.009) and family support (p=0.013). While the independent varible which is not significant statistically is the mother level of education (p=0.086). SUGGESTION It is suggested to the healthcare professionals to give counselling on good diet and nutritional intake. Besides, social support from the family is highly needed because the family commonly does not have sufficient knowledge on good diet or healthcare, especially in taking care the mother during gestation. For the r espondents, it is suggested to understand the importance of having adequate nutritional intake to optimize the fetus growth and development to avoid the growth disorder in their toddler golden age. Furthermore, for women in general, they need to understand the importance of having sufficient nutritional intake in preparing them for their pregnancy to have quality toddler growth and development. REFERENCES Anindita P. 2012. Hubungan Tingkat Pendidikan Ibu, Pendapatan Keluarga, Kecukupan Protein Dan Zinc Dengan Stunting Pada Balita Usia 6 – 35 Bulan Di Kecamatan Tembalang Kota Semarang. Jurnal Kesehatan Masyarakat. 1(2) : 617 – 626. Anugraheni, HS. 2012. Faktor Risiko Kejadian Stunting pada Anak Usia 12-36 Bulan di Kecamatan Pati, 32 Jurnal Ners dan Kebidanan, Volume 8, Issue 1, April 2021, page 26–32 Kabupaten Pati. Program Studi Ilmu Gizi Fakultas Kedokteran Universitas Diponegoro. Semarang. Arifin DZ, Irdasari SY dan Sukandar H. (2012). Analisis Sebaran Dan Faktor Risiko Stunting Pada Ba- duta di Kabupaten Purwakarta 2012 [manuscript on internet]. Bandung: Universitas Padjajaran Astari LD, Nasoetion A, dan Dwiriani CM. (2005). Hubungan Karakteristik Keluarga, Pola Pe- ngasuhan dan Kejadian Stunting Anak Usia 6- 12 Bulan. Media Gizi & Keluarga, 29 (2) : 40-4 Barros AJ, Matijasevich A, Santos IS dan Halpern R. (2008). Child development in a birth cohort: effect of child stimulation is stronger in less educated mothers. International Journal off Epidemiology. Vol 39 (1): 285-294 Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, River J. (2008). Maternal And Child Undernutrition: Global And Regional Exposures And Health Consequences. Lancet, 371, 243-260. Chaudhury RH. Determinants Of Dietary Intake And Dietary Adequacy For Pre- School Children In Bangladesh. Bangladesh Institute of Development Studies. [accessed April, 2019]. Available from: URL: http://archive.unu.edu/unupr ess/food/8F064e/ 8F064E04.htm Damayanti M. (2006). Kuesioner Pra Skrining Per- kembangan (KPSP) Anak. Sari Pediatri 8 (1) Febrianto ID. (2012). Hubungan Tingkat Penghasilan, Tingkat Pendidikan Dan Tingkat Pengetahuan Orang tua Tentang Makanan Bergizi Dan Status Gizi Siswa Tk Islam Zahrotul Ulum Karang Ampel Indramayu. Skripsi. Universitas Negeri Yogyakarta. Yogyakarta. Francis. (2005). Gizi Dalam Kesehatan Reproduksi. Jakarta. EGC Hadi, Hamam. 2015. Beban Ganda Masalah Gizi dan Implikasinya terhadap Kebijakan Pembangunan Kesehatan Nasional. Pidato Pengukuhan Jabatan Guru Besar Fakultas Kedokteran Universitas Gajah Mada Kusharisupeni. (2014). Peran Status Kelahiran Terhadap Stunting pada Bayi. Jurnal Kedokteran Trisakti, Volume 23: 73-80 Kusmiyati, Yeni. (2010). Perawatan Ibu Hamil. Yogyakarta: Fitramaya Levy, Teresa Shamah. (2008). Maternal Characteristic Determine Stunting in Children of Less than Five Years of Age Results from a National Probabilistic Survei. Clinical Medicine: Pediatrics, 1, 43-52 Lin Chen CW, Chen PT, Lu TH, Li CY. (2007). Risks And Causes Of Mortality Among Low Birthweight Infants In Childhood And Adolescence. Paediatric and Perinatal Epidemiology. 21: 465-72 Mamabolo RL, Alberts M, Steyn NP, re-van de Wall HAD, dan Levitt NS. 2005. Prevalence and determinants of stunting and overweight in 3-year- old black South African children residing in the Central Region of Limpopo Province, South Africa. Public Health Nutrition, 8(5), 501—508 Mardani RAD, Wetasin K, Suwanwaiphatthana W. (2015). Faktor Prediksi Yang Mempengaruhi Terjadinya Stunting Pada Anak Usia Dibawah Lima Tahun. Jurnal Kesehatan Masyarakat. 2015; 11 (1): 1-7. Proverawati, Atikah. (2009). Buku Ajar Gizi Untuk Kebidanan. Nuha Medika: Jakarta. Rahmad AH, Miko A, Hadi A. (2013). Kajian Stunting Pada Anak Balita Ditinjau Dari Pemberian ASI Eksklusif, MP-ASI, Status Imunisasi Dan Karak- teristik Keluarga Di Kota Banda Aceh. Jurnal Kese- hatan Ilmiah Nasuwakes. 2013; 6 (2): 169-84 Riyadi H, A Khomsan, S Dadang, A Faisal dan ES Mudjajanto. (2006). Studi tentang Status Gizi pada Rumah Tangga Miskin dan Tidak Miskin. Gizi Indonesia, 1 Rukmana, Umu Komariah, Rachmah Indawati. (2014). Kondisi Sosioekonomi dan Demografi Keluarga Pra Sejahtera dan Sejahtera I Di Kota Mojokerto. Departemen Biostatistika dan Kependudukan Fakultas Kesehatan Masyarakat Universitas Airlangga Surabaya Semba RD, et al. (2008). Effect of Parental Formal Education on Risk of Child Stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet, 371, 322—328. Soetjiningsih. (2012). Buku Ajar I: Ilmu Perkembangan Anak Dan Remaja. Jakarta: Sagungseto. Pp 86-90. Suhardjo (1999). Sosio Budaya Gizi. Bogor: IPB PAU Pangan dan Gizi Supariasa Susanti. (2008). Psikologi Kehamilan. EGC; Jakarta. Victoria, G Cesar. (2008). Maternal and Child Under- nutrition 2 Maternal and Chils Undernutrition: Consequences For Adult Health and Human Capital. Lamcet Community Health, 55 (6), 394-8 Welasasih, BD dan Wirjatmadi, RB. (2012). Beberapa Faktor yang Berhubungan dengan Status Gizi Balita Stunting. The Indonesian Journal of Public Health, 8 (3) Maret 2012: 99–104 Zareian E, Saeedi F, dan Rabbani V. (2014). The Role of Birth Order and BirthWeight in the Balance of Boys Aged 9-11 Years Old. Ann Appl Sport Sci.2(2) : 51-53 Zottarelli LK, Sunil TS, Rajaram S. (2007). Influence of Parental and Socioeconomics Factors on Stunting in Children Under 5 Years in Egypt. Eastern Mediterranean Health Journal