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

BACKGROUND: Stunting affects 21.6% of Indonesian children under five, with complications from high-risk pregnancies (HRP) identified as a potential risk factor. The Developmental Origins of Health and Disease (DOHaD) framework suggests that prenatal exposures may permanently alter physiological development and disease susceptibility later in life. OBJECTIVE: This study aimed to examine the cumulative effects of HRP complications on the risk of stunting in Indonesian children under five, while controlling for socioeconomic confounders. METHODS: A retrospective study was conducted in Sleman Regency, Indonesia, analyzing 450 children (300 stunted and 150 non-stunted) aged 12-59 months. Data were collected from maternal medical records, Maternal and Child Health (MCH) handbooks, and integrated health post reports. Multivariate logistic regression was used to adjust for socioeconomic confounders including maternal education, family income, and antenatal care visits. RESULTS: Mothers of stunted children had significantly higher rates of any HRP complication (68.7% vs. 32.0%, p < 0.001). After adjustment, multiple HRP complications (≥2 conditions) showed the strongest association with stunting (adjusted odds ratio [aOR]=5.80; 95% confidence interval [CI]: 3.26-10.32), exceeding the risk associated with individual complications such as anaemia (aOR=3.21; 95% CI: 2.12-4.86) or pre-eclampsia (aOR=4.37; 95% CI: 2.18-8.76). Maternal education (aOR = 0.72), family income (aOR = 0.68) and antenatal care visits (aOR = 0.85) were identified as protective factors. CONCLUSIONS: The dose-response relationship between cumulative HRP complications and stunting supports the DOHaD hypothesis. Current antenatal care protocols emphasizing single risk factors may be insufficient. Integrated prenatal care addressing cumulative risks is essential for stunting prevention in Indonesia.