A Comparative Quasi-Experimental Study of Beetroot–Red Guava Juice and Salak Pondoh Juice on Hemoglobin Levels in Pregnant Women with Anemia in Depok, Indonesia
Abstract
Introduction: Anemia remains a common concern during pregnancy due to increased iron requirements. Alternative nutritional approaches from natural food sources may help improve hemoglobin levels, particularly among women who are reluctant to consume iron supplements. This study aimed to compare the effectiveness of beetroot–red guava juice and salak pondoh juice in increasing hemoglobin levels among third-trimester pregnant women with anemia.
Methods: This research employed a quasi-experimental design with a pretest-posttest control group methodology. Purposive sampling was used to choose 150 anemic pregnant women in their third trimester. Participants were categorized into two groups: Seventy-five participants were administered beets combined with red guava juice (intervention group), whereas another seventy-five participants received salak pondoh juice (comparison group). Hemoglobin levels were evaluated pre- and post-intervention utilizing a hemoglobin assessment observation sheet. Data were analyzed utilizing paired t-tests to evaluate within-group differences and independent t-tests to compare inter-group differences.
Results: The average elevation in hemoglobin levels was 0.46 g/dL (95% CI: 0.35–0.57) for the beetroot–red guava group and 0.34 g/dL (95% CI: 0.32–0.37) for the salak pondoh group. The intergroup difference was 0.30 g/dL (95% CI: 0.15–0.45), indicating a moderate effect size (Cohen’s d = 0.62). The effect size analysis indicated a substantial effect in the beetroot–red guava group (Cohen’s d = 0.92) and an exceedingly large effect in the salak pondoh group (Cohen’s d = 3.2). The intergroup comparison produced a moderate effect size (Cohen’s d = 0.62).
Conclusion: These findings indicate short-term increases in hemoglobin levels associated with both interventions. However, the modest magnitude of change and short duration of intervention warrant cautious interpretation and further longitudinal investigation.
References
Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data. The Lancet Global Health. 2022;10(5): e627–39. https://doi.org/10.1016/S2214-109X(22)00084-5
Savy M, Briaux J, Seye M, Douti MP, Perrotin G, Martin-Prevel Y. Tailoring process and impact evaluation of a “Cash-Plus” program: the value of using a participatory program impact pathway analysis. Current Developments in Nutrition. 2020;4(7): nzaa099. https://doi.org/10.1093/cdn/nzaa099
Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta?analysis. Annals of the New York Academy of Sciences. 2019;1450(1):47–68. https://doi.org/10.1111/nyas.14093
Means RT. Iron deficiency and iron deficiency anemia: implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients. 2020;12(2):447. https://doi.org/10.3390/nu12020447
Indrayani T, Choirunissa R, Tambunan MH. Pengaruh Pemberian Jus Umbi Bit Terhadap Kenaikan Kadar Haemoglobin Pada Ibu Hamil Dengan Anemia Di BPM Miftah Wahyudi Kec. Jatijajar Depok Tahun 2019. Journal for Quality in Women’s Health. 2020;3(2):146–52.
Keats EC, Haider BA, Tam E, Bhutta ZA. Multiple?micronutrient supplementation for women during pregnancy. Cochrane Database of Systematic Reviews. 2019;(3). https://doi.org/10.1002/14651858.CD004905.pub6
Rodríguez-Roque MJ, de Ancos B, Sánchez-Vega R, Sánchez-Moreno C, Cano MP, Elez-Martínez P, et al. Food matrix and processing influence on carotenoid bioaccessibility and lipophilic antioxidant activity of fruit juice-based beverages. Food & Function. 2016;7(1):380–9. https://doi.org/10.1039/C5FO01060H
Clifford T, Howatson G, West DJ, Stevenson EJ. The potential benefits of red beetroot supplementation in health and disease. Nutrients. 2015;7(4):2801–22. https://doi.org/10.3390/nu7042801
Sari SIP, Susilawati E, Devi S, Pamudi BF. Combination of Beetroot Juice, Honey and Green Apple on Hemoglobin Levels in Anemia Pregnant Women at Payung Sekaki Health Center, Pekanbaru. Pharmaceutical and Biomedical Sciences Journal (PBSJ). 2023;5(2):104–9. https://doi.org/10.15408/pbsj.v5i2.31539
Pandey AK, Gupta A, Tiwari M, Prasad S, Pandey AN, Yadav PK, et al. Impact of stress on female reproductive health disorders: Possible beneficial effects of shatavari (Asparagus racemosus). Biomedicine & pharmacotherapy. 2018; 103:46–9. https://doi.org/10.1016/j.biopha.2018.04.003
Lane DJ, Richardson DR. The active role of vitamin C in mammalian iron metabolism: much more than just enhanced iron absorption! Free radical biology and medicine. 2014; 75:69–83. https://doi.org/10.1016/j.freeradbiomed.2014.07.007
Paramitha IA, Lufar N, Rosidi A, Khaqiqi K, Fatmawati A, Syakira W. Comparison of The Effectiveness of Beetroot Juice with Red Guava Juice in Anemic Pregnant Women. Jurnal MID-Z (Midwivery Zigot) Jurnal Ilmiah Kebidanan. 2024;7(1):22–31. https://doi.org/10.56013/jurnalmidz.v7i1.2754
Zhou Y, Lyu Y, Ye W, Shi H, Peng Y, Wen Z, et al. The prevalence of anemia among pregnant women in China: a systematic review and meta-analysis. Nutrients. 2024;16(12):1854. https://doi.org/10.3390/nu16121854
Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007 Aug 11;370(9586):511–20. https://doi.org/10.1016/S0140-6736(07)61235-5
Lam V, Romses K, Renwick K. Exploring the relationship between school gardens, food literacy and mental well-being in youth using photovoice. Nutrients. 2019;11(6):1354. https://doi.org/10.3390/nu11061354
Strahler J, Stark R. Perspective: Classifying orthorexia nervosa as a new mental illness—Much discussion, little evidence. Advances in Nutrition. 2020;11(4):784–9. https://doi.org/10.1093/advances/nmaa012
Febyawati HFA, Indarto D, Handayani S. Nutritional Analysis of Aqueous Extract of Snake Fruit Seeds (Salacca Edulis Reinw) for Development of Anemia Treatment. Proceedings of the International Conference on Nursing and Health Sciences. 2023 Jun 19;4(1):297–302. https://doi.org/10.37287/picnhs.v4i1.1818
Camaschella C. Iron deficiency. Blood, The Journal of the American Society of Hematology. 2019;133(1):30–9. https://doi.org/10.1182/blood-2018-05-815944
Labudda M, Ró?a?ska E, Gietler M, Fidler J, Muszy?ska E, Prabucka B, et al. Cyst nematode infection elicits alteration in the level of reactive nitrogen species, protein S-nitrosylation and nitration, and nitrosoglutathione reductase in Arabidopsis thaliana roots. Antioxidants. 2020;9(9):795. https://doi.org/10.3390/antiox9090795
Jakubowicz D, Wainstein J, Tsameret S, Landau Z. Role of high energy breakfast “big breakfast diet” in clock gene regulation of postprandial hyperglycemia and weight loss in type 2 diabetes. Nutrients. 2021;13(5):1558. https://doi.org/10.3390/nu13051558
Bin Zarah A, Enriquez-Marulanda J, Andrade JM. Relationship between dietary habits, food attitudes and food security status among adults living within the United States three months post-mandated quarantine: a cross-sectional study. Nutrients. 2020;12(11):3468.
Stevens GA, Beal T, Mbuya MNN, Luo H, Neufeld LM, Global Micronutrient Deficiencies Research Group. Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys. Lancet Glob Health. 2022 Nov;10(11): e1590–9. https://doi.org/10.1016/S2214-109X(22)00367-9
Abbeddou S, Yakes Jimenez E, Somé JW, Ouédraogo JB, Brown KH, Hess SY. Small-quantity lipid-based nutrient supplements containing different amounts of zinc along with diarrhea and malaria treatment increase iron and vitamin A status and reduce anemia prevalence, but do not affect zinc status in young Burkinabe children: a cluster-randomized trial. BMC Pediatr. 2017 Feb 2;17(1):46. https://doi.org/10.1186/s12887-016-0765-9
Jiménez-Escrig A, Rincón M, Pulido R, Saura-Calixto F. Guava fruit (Psidium guajava L.) as a new source of antioxidant dietary fiber. J Agric Food Chem. 2001 Nov;49(11):5489–93. https://doi.org/10.1021/jf010147p
Alshafie S, El-Helw GO, Fayoud AM, Elrashedy AA, Gbreel MI, Alfayoumi SS, et al. Efficacy of dietary nitrate-rich beetroot juice supplementation in patients with chronic obstructive pulmonary disease (COPD): A systematic review and meta-analysis. Clin Nutr ESPEN. 2021 Apr; 42:32–40. https://doi.org/10.1016/j.clnesp.2021.01.035.
Copyright (c) 2026 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
