The Effect Of Date Fruit Consumption On Hemoglobin Levels In Pregnant Women In Trimester III

Pregnancy is a period that is eagerly awaited because this period greatly determines the quality of human resources and the future of the fetus in the womb will greatly determine the development of the child in the future. Purpose: This study aims to determine the effect of consumption of dates on hemoglobin levels in trimester III pregnant women at Kolaka Public Health Center, Kolaka Regency, Southeast Sulawesi Province in 2020. This study used a quasi experimental research design. The study population was all pregnant women in the third trimester who experienced anemia in October-December 2020, as many as 22 people at the Kolaka Health Center. Results: There was an effect of hemoglobin levels before and after giving dates in the treatment group (p = 0.000). There was an effect of hemoglobin levels after giving dates between the treatment group and the control group (p = 0.001). There is an effect of hemoglobin before and after giving dates in a group of pregnant women who are given dates and Fe tablets at the Kolaka Health Center, Kolaka Regency, Southeast Sulawesi in 2020. Increase the provision of health education about nutrition, especially anemia to pregnant women in the working area of Puskemas Kolaka and carry out routine Hb level checks in the first and third trimester of pregnancy.


INTRODUCTION
Pregnancy is a very awaited period because this period greatly determines the quality of human resources and the future of the fetus in the womb will determine the growth and development of children in the future. One of the factors that affect the health of the mother and fetus is the nutrition obtained during pregnancy 1 Anemia in pregnancy cannot be separated from the physiological changes that occur during pregnancy, the age of the fetus, and the condition of the previous pregnant woman. During pregnancy, the body will experience significant changes, the amount of blood in the body increases by about 20-30%, thus requiring an increased supply of iron and vitamins to make hemoglobin (Hb). When pregnant, the mother's body will make more blood to share with her baby. The body needs up to 30% more blood than before pregnancy 2 Anemia in pregnant women is a condition of the mother with hemoglobin (Hb) levels in the blood <11.0 g% as a result of the inability of the red blood cell-forming tissue (Erythropoetin) in its production to maintain Hb concentrations at normal levels. Normally, pregnant women have Hb levels of at least 11 g% 3 Based on the 2013 National Health Demographic Survey (IDHS) data, the anemia rate in pregnant women is 40.1%, this condition shows that anemia is quite high in Indonesia. If it is estimated that from 2007 -2013 the prevalence of anemia is still 40%, there will be 18 thousand maternal deaths per year due to bleeding after childbirth. The Maternal Mortality Rate (MMR) in Indonesia is very high at 30 per 100,000 live births, the high number is caused, among other things, by the poor health and nutrition of the mother during pregnancy. 4 The government has carried out an anemia control program in pregnant women by giving 90 tablets of Fe with a dose of 60 mg to pregnant women during pregnancy with the aim of reducing anemia rate of pregnant women, but the incidence of anemia is still high (Badan Health Research and There are various ways to overcome and prevent anemia problems that occur in pregnant women, namely: by pharmacological and non-pharmacological methods. Pharmacological treatment For the treatment of nutritional deficiency anemia is the provision of supplementation iron tablets or iron tablets orally given 60 mg/day, whereas non-pharmacological methods can consume protein-rich ingredients that can obtained from animals and plants. Various fruits such as dates, beets, dragon fruit, pineapple, bananas, pomegranates are rich in minerals, both iron and iron which are needed to form red blood cells and hemoglobin. 6 Dates contain Fe, B12 and folic acid, which is a hemoglobin-forming factor. The content of protein, carbohydrates and fat in dates supports hemoglobin synthesis process. substance level The iron in dates is also quite high, namely 0.90 mg per 100 grams of dates (11% RDA), where iron is one of the components in blood to carry oxygen in the blood Because It is necessary to give dates in order to increase Hb levels to pregnant women 7 Based on the preliminary study conducted, according to the Kolaka Health Center report from the month From January to May 2019, 60 people suffer from anemia (34.3%) . In January to June 2020 the suffering from anemia as many as 45 people.

METHOD
This study used a quasi-experimental research design with a pretest posttest control group design where there were two groups of subjects as treatment and control groups who were randomly selected and both received pretest and posttest. This design was used to compare the results of measuring hemoglobin levels of pregnant women before and after treatment and to compare the two groups. Checking Hb levels in pregnant women, if Hb is less than normal, namely 8-10.9 g / dl then used as research samples.Respondent doneGiving ajwa dates once a day for 7 days in the morning as much as 7 items/day and coordinate with the respondent to provide documentation when consuming dates and then measuring hb levels after the 8th day of research.
The instrument used in the study was an observation sheet used to measure hemoglobin levels, respondent's number, name, age, Hb level examination tool and hemoglobin level observation sheet.
Univariate analysis is to determine the average value of hemoglobin levels pre-test and posttest. Bivariate analysis was carried out to determinethe effect of dates with hemoglobin levels in third trimester pregnant women with anemia using the test Paired T-test.

Average Hemoglobin Levels Before and After Giving Dates to Pregnant Women who received Fe tablets and Dates
Based on the research results obtained an increase in hemoglobin levels of 1,273 g/dl in anemic pregnant women before and after being given Fe tablets and dates.
Dates which are rich in iron can increase hemoglobin levels in the blood. In addition to iron, the content of protein, carbohydrates, and fat in dates can help the process of hemoglobin synthesis.consuming dates for 7 days as much as 100 grams or approximately 5-7 pieces on a regular basis will Helps increase hemoglobin levels in the blood. Enhancement Hb levels are possible because of nutrition adequate coupled with consumption Dates 25 grams / day for 10 days as well as consumption of Fe tablets. 8 Dates which are rich in iron can increase hemoglobin levels in the blood. In addition to iron, the content of protein, carbohydrates, and fat in dates can help the process of hemoglobin synthesis.
Carbohydrates are broken down into monosaccharides and then into glucose. Glucose as the main fuel for metabolism will undergo glycolysis (breakdown) into 2 pyruvate and produce energy in the form of ATP and each of the pyruvate is oxidized to succinyl CoA 9 Treatment of date palm juice has a lot of influence on increasing hemoglobin levels after being given 3 tablespoons a day, it is recommended before eating at a dose of 15 cc for one week. It can be said that the administration of date palm juice has an effect on increasing hemoglobin levels in third trimester pregnant women. 10 SDates that are rich in iron can increase hemoglobin levels. The content of protein, carbohydrates, and fat in date juice as well as the content of glucose, Ca, Fe, Zn, Cu, P, and Niacin with palmyra which is rich in Vitamin A supports the synthesis of hemoglobin. mineral substances such as iron which are essential for the formation of hemoglobin. Iron which is immediately needed for the production of red blood cells is absorbed into the blood to be distributed to the bone marrow and will be used to form hemoglobin for new red blood cells which will bind oxygen for the needs of cell metabolism, especially to the liver so that the liver can carry out its functions properly including producing hormones.
thrombopoietin 11 According to the researcher's assumptions, consuming dates and Fe tablets during pregnancy can increase hemoglobin levels in pregnant women, especially pregnant women who experience anemia because dates contain iron which can increase hemoglobin levels in the blood, so if you add dates and consume tablets regularly during pregnancy It can reduce the risk of anemia in pregnancy.

Dates
Based on the results of the study, it was found that there were differences in the results of hemoglobin levels before and after giving dates to pregnant women, meaning that there was an effect of giving Fe tablets and dates on hemoglobin levels. The increase in hemoglobin levels occurs due to: nutritional content in dates. In this research the increase in hemoglobin levels was more in the treatment group.
Dates are rich in iron which increases levels of hemoglobin. In addition, dates also contain protein, fiber, glucose, vitamins, biotin, niacin, and folic acid. Dates also contain minerals such as calcium, sodium and potassium. Protein content in Dates are around 1. According to the researcher's assumptions, based on research that has carried out, it was found that there the effect of the difference in hemoglobin levels from both groups. Therefore, Dates can be used as one of the alternative choice in fulfilling the need for iron during pregnancy to be an additional consumption of Fe tablets which are routinely consumed by pregnant women.

CONCLUSIONS AND SUGGESTION
Based on the results of research on the effect of consumption of dates on hemoglobin levels in third trimester pregnant women at the Kolaka Health Center, Kolaka Regency, Southeast Sulawesi, it can be concluded that The average hemoglobin level before giving dates in the treatment group was 9,718 gr/dl and after giving dates 10,991 gr/dl. The value of p = 0.000 means that there is an influence between dates on hemoglobin levels in third trimester pregnant women with anemia.
Increase counseling activities about the importance of consuming Fe tablets during pregnancy regularly and can be added with dates and provide health education about nutrition, especially anemia to pregnant women in the working area of the Kolaka Health Center and carry out regular Hb levels checks in the first trimester and third trimester of pregnancy. It is hoped that other researchers will