The effects of papaya leaf juice for breastfeeding and working mothers on increasing prolactin hormone levels and infant's weight in Tangerang

Abstract

Based on preliminary studies, it is known that 80% of working mothers fail to make exclusive breastfeeding, on average babies are given formula milk 2–4 months old and stop breastfeeding at 6–18 months of age. Papaya leaves are one of the galactagogues that contain quercetin which can activate the hormone prolactin and help increase breastmilk. The purpose of this study was to determine the effect of giving papaya leaf juice for nursing mothers who work toward increasing levels of the hormone prolactin and infant weight in Tangerang. The research design used was a pre-experimental model with one group pretest–posttest design. Samples taken as many as 10 mothers who have babies aged 0–6 months who have difficulty in breastfeeding because the amount of breastmilk was a little. The study was conducted in several clinics in Tangerang. The intervention was giving papaya leaf juice for 7 consecutive days. The results obtained from this study are as follows: 90% of mothers aged between 20 and 35 years, 70% of mothers have a history of spontaneous labor and have no complications at the time of delivery, 40% of mother's education is junior high school (SMP), and 70% of mothers are primiparas. The average increase in the amount of prolactin after the intervention was 19.59 ng/ml, while the average weight gain of the newborn after the intervention was 165 g. Wilcoxon test results for increased levels of the hormone prolactin p-value of 0.047 < 0.05 and for an increase in body weight of newborns p-value of 0.009 < 0.05.

Conclusion
There is an effect of giving papaya leaf juice for nursing mothers who work on increasing levels of the hormone prolactin and infant weight in Tangerang. Papaya leaf juice can be a galactagogue for mothers who experience problems with a small amount of breastmilk.

Full text

Enferm
Clin.
2020;30(S5):202---205
www.elsevier.es/enfermeriaclinica
The
effects
of
papaya
leaf
juice
for
breastfeeding
and
working
mothers
on
increasing
prolactin
hormone
levels
and
infant’s
weight
in
Tangerang夽
Marthia
Ikhlasiaha,∗,
Lastri
Mei
Winarnib,
Sandeep
Poddarc,
Amiya
Bhaumikc
aHasanuddin
University,
Makassar,
Indonesia
bMidwifery
in
STIKes
Yatsi
Tangerang,
Banten,
Indonesia
cLincoln
University
College,
Malaysia
Received
25
September
2019;
accepted
11
November
2019
KEYWORDS
Papaya
leaf
juice;
Breastfeeding
mothers;
Breastmilk
production;
Levels
of
the
hormone
prolactin;
Baby
weight
Abstract
Based
on
preliminary
studies,
it
is
known
that
80%
of
working
mothers
fail
to
make
exclusive
breastfeeding,
on
average
babies
are
given
formula
milk
2 --- 4
months
old
and
stop
breastfeeding
at
6---18
months
of
age.
Papaya
leaves
are
one
of
the
galactagogues
that
contain
quercetin
which
can
activate
the
hormone
prolactin
and
help
increase
breastmilk.
The
purpose
of
this
study
was
to
determine
the
effect
of
giving
papaya
leaf
juice
for
nursing
mothers
who
work
toward
increasing
levels
of
the
hormone
prolactin
and
infant
weight
in
Tangerang.
The
research
design
used
was
a
pre-experimental
model
with
one
group
pretest---posttest
design.
Samples
taken
as
many
as
10
mothers
who
have
babies
aged
0 --- 6
months
who
have
difficulty
in
breastfeeding
because
the
amount
of
breastmilk
was
a
little.
The
study
was
conducted
in
several
clinics
in
Tangerang.
The
intervention
was
giving
papaya
leaf
juice
for
7
consecutive
days.
The
results
obtained
from
this
study
are
as
follows:
90%
of
mothers
aged
between
20
and
35
years,
70%
of
mothers
have
a
history
of
spontaneous
labor
and
have
no
complications
at
the
time
of
delivery,
40%
of
mother’s
education
is
junior
high
school
(SMP),
and
70%
of
mothers
are
primiparas.
The
average
increase
in
the
amount
of
prolactin
after
the
intervention
was
19.59
ng/ml,
while
the
average
weight
gain
of
the
newborn
after
the
intervention
was
165
g.
Wilcoxon
test
results
for
increased
levels
of
the
hormone
prolactin
p-value
of
0.047
<
0.05
and
for
an
increase
in
body
weight
of
newborns
p-value
of
0.009
<
0.05.
夽Peer-review
under
responsibility
of
the
scientific
committee
of
the
3rd
International
Conference
on
Healthcare
and
Allied
Sciences
(2019).
Full-text
and
the
content
of
it
is
under
responsibility
of
authors
of
the
article.
∗Corresponding
author.
E-mail
address:
marthiaiik@gmail.com
(M.
Ikhlasiah).
https://doi.org/10.1016/j.enfcli.2019.11.054
1130-8621/©
2020
Elsevier
Espa˜
na,
S.L.U.
All
rights
reserved.

The
effects
of
papaya
leaf
juice
for
breastfeeding
and
working
mothers
203
Conclusion:
There
is
an
effect
of
giving
papaya
leaf
juice
for
nursing
mothers
who
work
on
increasing
levels
of
the
hormone
prolactin
and
infant
weight
in
Tangerang.
Papaya
leaf
juice
can
be
a
galactagogue
for
mothers
who
experience
problems
with
a
small
amount
of
breastmilk.
©
2020
Elsevier
Espa˜
na,
S.L.U.
All
rights
reserved.
Introduction
World
Health
Organization
stated
that
only
38%
infants
in
the
world
gets
exclusive
breastfeeding,1and
the
percent-
age
of
mothers
that
fail
to
breastfeed
is
about
10---15%,2
while
in
Indonesia,
based
on
Indonesian
Health
Profile
in
2017,
it
is
known
that
only
40.42%
infants
get
exclusive
breastfeeding,
it
means
that
59.58%
infants
has
not
got
exclusive
breastfeeding.3The
failure
in
exclusive
breast-
feeding
caused
the
cessation
of
breastfeeding
process
and
early
recognition
of
formula
milk.4The
failure
in
breast-
feeding
gives
bad
impacts
on
infants,
such
as
increasing
the
incidence
of
infection
like
otitis
media,
gastroenteri-
tis,
pneumonia,
obesity,
diabetes
type
1
and
2,
leukemia,
and
sudden
death
syndrome,
while
the
negative
impacts
also
happen
to
the
mother
are
increasing
the
probability
of
breast
cancer
before
menopause,
ovary
cancer,
overweight,
and
metabolic
syndrome.5
The
factors
that
cause
breastfeeding
failure
are
late
ini-
tiation
of
breastfeeding,
the
feeling
of
insufficient
amount
of
breastfeed
from
the
mother,
and
no
discharge
of
breastfeed.6,7 The
insufficient
amount
can
be
caused
by
some
factors,
such
as
the
insufficient
production
of
breast-
feed,
small
breast
nipples
that
cause
the
lack
of
baby
suction.2 --- 8 Based
on
preliminary
studies
on
March
2018,
80%
of
10
mothers
that
have
6---24
months
kids
admitted
that
they
failed
to
breastfeed,
in
average
2 --- 4
months
old
infants
were
given
formula
milk
and
stop
milking
at
the
age
of
6---18
months.
This
incident
was
caused
by
some
problems
such
as
the
inability
to
fully
breastfeed,
the
lack
of
baby
suction,
and
there
is
even
infants
that
refused
to
breastfeed
even
there
is
a
little
amount
of
breastfeed.
Breastfeeding
gives
metabolic
burden
on
mother’s
phys-
iology
process;
it
needs
a
minimum
of
480
kcal
of
energy
per
day
to
exclusive
breastfeeding.9Therefore,
some
addi-
tional
nutrition
is
needed
to
increase
the
production
of
breastfeed
so
that
mothers
can
play
their
role
to
breastfeed-
ing.
The
breastfeeding
process
also
assisted
by
consuming
galactogogues,
the
example
of
galactogogues
that
has
been
studied
and
succeed
to
increase
the
amount
of
breastfeed
are
Katuk
Leaf,10 green
bean
juice
and
fennel,11 papaya
fruit
boiled
water,12 and
papaya
leaf
powder.13 Researcher
is
attracted
to
the
usage
of
papaya
leaf
in
increasing
the
amount
of
breastfeed,
because
based
on
Setyono
et
al.’s
study
in
2016,14 Papaya
leaf
is
one
of
the
galactogogues
that
contain
quercetin
that
can
activate
the
prolactin
hormone.
The
study
on
the
usage
of
papaya
leaf
to
increase
the
amount
of
breastfeed
is
not
much
done.
In
2015,
Turlina
et
al.15 also
studied
the
effect
of
giving
papaya
leaf
powder
in
continuity
of
breastfeeding
also
gave
a
positive
impact
with
p-value
of
0.004
<
p-table.
This
research
will
focus
on
giving
papaya
juice
because
it
is
easier
to
do
than
giving
papaya
leaf
powder.
The
ease
can
be
used
by
mother
to
make
papaya
juice
by
herself
at
home
and
it
does
not
cost
highly,
so
that
the
aim
of
this
research
is
the
effects
of
giving
papaya
juice
to
prolactin
hormones
and
infants
weight.
Method
The
research
design
that
will
be
used
in
this
research
is
the
pre-experimental
which
is
an
experiment
study
that
still
affected
by
external
variable
that
affects
the
giving
of
papaya
leaf
juice
with
the
amount
of
prolactin
hormones
and
infant’s
weight
(dependent
variable).
This
research
uses
a
group
pretest---posttest
design
approach,
which
compares
the
state
before
treatment
and
after
treatment.
The
effect
is
defined
by
comparing
the
mean
value
of
the
variable
before
and
after
treatment.
This
pre-experimental
research
is
intended
to
find
the
mean
differences
on
the
group
before
and
after
treatment
in
order
to
see
the
changes
on
the
amount
of
prolactin
hormones
and
infant’s
weight.
This
research
is
done
at
two
midwife
clinics
in
Tangerang
on
February
to
July
2019.
The
population
of
this
research
is
27
working
mothers
that
have
6---24
months
baby.
From
the
total
of
27
mothers,
only
13
of
them
agreed
to
become
a
respondent,
and
from
13
mothers,
3
of
them
were
excluded
because
they
cannot
keep
up
the
process
until
done.
The
inclusion
criteria
of
this
research
are
working
mother
(before
and
after
having
babies),
that
have
a
0 --- 6
months
baby,
which
have
a
problem
of
the
insufficient
amount
of
breastfeed.
This
research
is
conducted
when
the
respondent
agreed
to
participate,
the
respondents
then
will
be
taken
blood
sample
to
be
checked
the
amount
of
prolactin
hormone
and
weigh
their
infants.
Then,
some
papaya
juice
was
sent
to
the
respondent’s
home
and
they
were
asked
to
consume
it
two
times
a
day
for
seven
days.
On
the
eighth
day,
a
blood
sam-
ple
were
taken
again
from
each
respondent
to
be
checked
the
amount
of
prolactin
hormone
and
weigh
their
infants
again.
The
papaya
leaf
juice
was
made
by
blending
the
papaya
leaf
which
has
a
bitter
flavor.
In
order
to
neutralize
and
relieve
the
smell
of
the
papaya
leaf,
star
fruit
water
and
honey
were
added.
The
procedure
to
made
it
is:
The
mod-
erate
papaya
leaf
is
selected
and
then
washed
with
boiled
water.
The
papaya
leaf
is
chopped
and
then
blended
with
80
cc
of
boiled
water,
20
cc
of
star
fruit
water
and
two
table-
spoons
of
honey
were
added.
While
the
treatment
is
occurring,
the
respondents
are
allowed
to
draw
back
if
they
are
feeling
uncomfortable
on
this
research.
In
order
to
keep
the
confounding
variable,
the

204
M.
Ikhlasiah
et
al.
Table
1
Respondent’s
characteristics
(n
=
10).
Characteristics
Amount
Percentage
Ages
20---35
years
old
9
90
>35
years
old 1
10
Labor
type
Spontaneous
7
70
SC
(Seksio
Caesarea)
3
30
Education
level
Junior
high
4
40
Senior
high
3
30
College
3
30
Parity
Primipara
3
30
Multipara
7
70
researcher
suggested
the
respondents
to
breastfeed
their
babies
as
often
as
possible
and
stop
giving
the
formula
milk,
respondents
are
also
asked
to
sleep
earlier
and
breastfeed
at
night.
Respondents
are
also
asked
to
minimize
their
activ-
ities
and
stressful
thoughts
on
these
seven
days
period
to
help
this
research
to
gain
a
good
result.
The
data
collection
is
done
while
the
research
still
takes
place.
Then,
coding,
data
analysis,
and
interpretation
are
conducted.
Research
ethics
that
has
been
used
is
respect
for
person,
where
respondents
are
free
to
accept
or
refuse
the
treatment
on
this
research.
Justice,
where
all
of
the
respondents
are
equally
treated
without
any
differences.
Beneficence
and
Nonmaleficence,
where
the
role
of
each
respondent
is
useful
to
this
research.
Table
1
shows
that
90%
of
the
respondents
aged
between
20
and
35
years
old,
70%
deliver
spontaneously,
40%
of
them
have
Junior
high
education,
and
70%
of
them
are
multipara.
Table
2
shows
that
90%
of
respondent
have
increased
prolactin
hormone
levels
after
consuming
papaya
leaf
juice.
The
average
increase
of
prolactin
hormone
is
19.59
ng/ml.
The
increase
of
prolactin
hormone
can
be
occurred
in
just
several
minutes
after
breastfeeding,16
infant’s
suction
reflex
help
to
stimulate
the
production
of
prolactin
hormone.
Based
on
Suksesty’s
study,
green
bean
juice
and
fennel
can
increase
the
prolactin
hormone
amount,11 including
papaya
leaf,
Pratiwi’s
study
explain
that
the
800
mg
papaya
leaf
extract
can
increase
the
amount
of
prolactin
amount
on
mothers
(Table
3).
Discussion
Setyono’s
study
in
developing
papaya
leaf
powder
drink
and
red
ginger
with
brown
sugar,
cinnamon
powder,
salt,
pan-
dan
leaves,
and
water
that
processed
to
become
powder
which
is
given
to
breastfeeding
mothers
and
then
the
color,
smell,
and
texture
are
examined,14 while
Turlina’s15 study
that
gave
papaya
leaf
powder
to
breastfeeding
mother
and
gave
positive
impacts
to
the
continuity
of
breastfeeding.
Papaya
leaves
are
a
part
of
papaya
plant
with
Latin
name
Carica
papaya.
This
plant
is
a
small
tree
with
2---10
m
height.
Perpendicular
hollow
trunk
without
branches,
but
branches
can
be
made.
Single
shaped
5 --- 9
fingers
leaves.
Hol-
low
petiole
with
50---100
cm
length.
Usually
papaya
leaves
appear
on
the
mid
of
the
branches.17 The
papaya
leaves
contain
carpain
alkaloid,
carpinine,
pseudocarpaine,
dehy-
drocarpaine
I,
dehydrocarpaine
II,
vitamin
B,
C,
E,
and
mineral
Zn,
Ca,
Fe,
K,
Na,
and
Mg.18,19 Phytochemical
profile
of
the
carica
papaya
reveals
the
presence
of
phytocom-
pounds
that
active
with
pharmacological,
alkaloid,
phenolic,
and
amino
acid.20 A
moreover
study
can
be
conducted
to
identify
and
isolate
the
most
active
bioconstituents
that
connected
the
compounds
in
increasing
the
prolactin
hor-
mone.
Table
2
Prolactin
hormone
frequency
distribution
before
and
after
treatment.
Respondent
Prolactin
amount
before
treatment
Prolactin
amount
after
treatment
Infant’s
weight
before
treatment
Infant’s
weight
after
treatment
R1
28
36
5300
5500
R2
90
125
5000
5200
R3
102
135
4200
4100
R4
75
78.1
6200
6400
R5
62.5
112
8300
8500
R6
146
110
3600
4000
R7
104
134
3700
3900
R8
98.7
108
4000
4100
R9
99
122
3800
3850
R10
86
127
3900
4100
Mean
89.12
108.71
4800
4965
Table
3
Differences
between
the
mean
of
prolactin
hormones
before
and
after
treatment.
Differences
of
prolactin
hormones
Differences
of
infant’s
weight
Z
score
prolactin
amount
Z
score
infant’s
weight
19.59
165
0.047
0.009

The
effects
of
papaya
leaf
juice
for
breastfeeding
and
working
mothers
205
Some
studies
explained
that
papaya
leaves
have
medical
properties,
such
as
antibacterial,
accelerate
wound
healing,
diuretic,
increasing
uterine
contrac-
tions,
anti-fungus,
contraception,
anti-tumor,
and
anti-
coagulant.18,19
The
increasing
amount
of
breastfeeding
mother
that
consumes
papaya
leaf
juice
offset
by
reduced
breastmilk
vis-
cosity.
The
breastmilk
becomes
thinner
and
clear
(foremilk)
on
day
9
until
day
12
post
consuming.
The
research
assumed
that
papaya
leaves
can
decrease
the
amount
of
fats
that
con-
sumed
by
mothers.
Thick
breastmilk
(hindmilk)
have
a
high
amount
of
fats,
while
thin
breastmilk
contains
more
protein
and
lactose,16 both
breastmilk
is
allowed
to
be
given
to
their
infants.
Table
2
explains
that
10%
of
the
respondents
have
decreasing
amount
of
prolactin
hormone.
This
can
be
caused
by
the
decreasing
frequency
of
breastfeeding.
In
this
research,
respondents
that
have
a
decreasing
amount
of
pro-
lactin
hormone
experienced
pain
while
breastfeeding,
this
has
caused
stress
to
the
respondents
while
breastfeeding.
This
condition
then
obstruct
the
breastmilk
production
on
mothers
and
resulting
in
decreased
confidence
on
mothers
because
their
breastmilk
is
decreasing.
Table
2
also
shows
that
90%
of
the
infant’s
weight
is
increasing
by
the
mean
of
165
g.
The
increasing
of
weight
for
0 --- 6
months
baby
can
be
affected
by
mother’s
weight
dur-
ing
pregnancy,
parent’s
genetic,
nutrition
during
pregnancy
and
puerperium,
and
baby’s
intake.21 The
papaya
leaf
juice
gave
a
positive
impact
on
infant’s
weight
to
the
mother
who
consumed
it
2
times
a
day.
The
increasing
of
baby’s
weight
is
one
of
a
baby’s
growth
indicator
whether
if
it
goes
on
well
or
not.
Besides,
weighing
the
baby
also
defined
the
baby’s
nutritional
status.22
Based
on
this
research,
it
shows
that
every
baby
weight
normally,
which
means
that
the
babies
grow
well.
This
will
help
their
growth
in
the
future,
gross
motor
and
fine
motor
development,
and
academic
achievement
in
15
years
in
the
future.23
There
is
an
effect
on
giving
papaya
leaf
juice
to
breast-
feeding
and
working
mothers
in
increasing
the
amount
of
prolactin
hormone
and
infant’s
weight
in
Tangerang.
Papaya
leaf
juice
can
be
used
as
galactogogues
to
help
breastfeed-
ing
mother.
A
further
research
can
be
conducted
by
including
control
group.
Conflict
of
interest
The
authors
declare
no
conflict
of
interest.
References
1.
Lyell
GJ.
WHA
Global
Nutrition
Targets
2025:
breastfeed-
ing
policy
brief;
2012.
Available
at:
https://www.who.int/
nutrition/topics/globaltargets
breastfeeding
policybrief.pdf
[Internet].
2.
Lee
S,
Kelleher
SL.
Biological
underpinnings
of
breastfeed-
ing
challenges:
the
role
of
genetics,
diet,
and
environment
on
lactation
physiology.
Am
J
Physiol
Endocrinol
Metab.
2016;311:E405---22.
Available
at:
https://www.ncbi.nlm.nih.
gov/pubmed/27354238
[Internet].
3.
Kementerian
Kesehatan
Republik
Indonesia.
Data
dan
Informasi,
Profil
Kesehatan
Indonesia
2017.
Jakarta:
Kementerian
Kese-
hatan
Republik
Indonesi;
2018.
p.
1---184.
4.
Sultana
A,
Rahman
KU,
Ms
MS.
Clinical
update
and
treat-
ment
of
lactation
insufficiency.
Med
J
Islam
World
Acad
Sci.
2013;21:19---28.
5.
Stuebe
A.
The
risks
of
not
breastfeeding.
Rev
Obstet
Gynecol.
2009;2:222---31.
6.
Mathur
GP,
Chitranshi
S,
Mathur
S,
Singh
SB,
Bhalla
M.
Lactation
failure.
Indian
Pediatr.
1992;29:1541---4.
7.
Sim
TF,
Hattingh
HL,
Sherriff
J,
Te e
LBG.
The
use,
perceived
effectiveness
and
safety
of
herbal
galactagogues
during
breast-
feeding:
a
qualitative
study.
Int
J
Environ
Res
Public
Health.
2015:11050---71.
8.
Hillervik-Lindquist
C.
Studies
on
perceived
breast
milk
insuffi-
ciency.
A
prospective
study
in
a
group
of
Swedish
women.
Acta
Paediatr
Scand
Suppl.
1991;376:1---27.
9.
Schwarz
EB,
McClure
CK,
Tepper
PG.
Lactation
and
maternal
measures
of
subclinical
cardiovascular
disease.
Am
Coll
Obstet
Gynecol.
2010;115:41---8.
10.
Asi
K,
Ibu
P,
Di
M.
Pengaruh
Konsumsi
Ekstrak
Daun
Katuk
Terhadap
Kecukupan
Asi
Pada
Ibu
Menyusui
Di
Klaten
Endang
Suwanti,
Kuswati.
J
Terpadu
Ilmu
Kesehat.
2015;52:132---5.
11.
Suksesty
CE,
Ikhlasiah
M.
Pengaruh
Jus
Campuran
Kacang
Hijau
Terhadap
Peningkatan
Hormon
Prolaktin
dan
Berat
Badan
Bayi.
J
Ilm
Bidan.
2017;2:32---40.
12.
Kharisma
Y,
Ariyoga
A,
Sastramihardja
HS.
Efek
Ekstrak
Air
Buah
Pepaya
(Carica
papaya
L.)
Muda
terhadap
Gambaran
Histologi
Kelenjar
Mamma
Mencit
Laktasi
[Effect
of
unripe
papaya
(Carica
papaya
L.)
aqueous
extract
on
histological
feature
of
mice
lac-
tating
mammary
glands].
Maj
Kedokt
Bandung.
2009;43:160---5.
13.
Pratiwi
TE,
Suwondo
A.
Exclusive
breastfeeding
improvement
program
using
Carica
papaya
leaf
extract
on
the
levels
of
pro-
lactin
hormones.
Int
J
Sci.
2018;7:2016---9.
14.
Setyono
FS,
Adi
AC,
Ismawati
R.
Galactogogue
instant
powder
combination
of
papaya
leaves
and
red
ginger
for
breastfeeding
mother.
Int
J
Prev
Public
Health
Sci.
2016;2:32---6.
15.
Turlina
L,
Wijayanti
R.
Pengaruh
Pemberian
Serbuk
Daun
Pepaya
Terhadap
Kelancaran
Asi
Pada
Ibu
Nifas
Di
Bpm
Ny.
Hanik
Dasiyem.
Amd.Keb
Di
Kedungpring
Kabupaten
Lamongan.
Surya.
2015;7.
16.
WHO.
Infant
and
young
child
feeding.
Model
chapter
for
text-
books
for
medical
students
and
allied
health
professional;
2009.
p.
1---112.
17.
Qurrota
A,
Laily
AN.
Analisis
Fitokimia
Daun
Pepaya
(Carica
papaya
L.)
Di
Balai
Penelitian
Tanaman
Aneka
Kacang
dan
Umbi,
Kendalpayak,
Malang
[The
phytochemical
analysis
of
papaya
leaf
(Carica
papaya
L.)
at
The
Research
Center
of
Various
Bean
and
Tuber
Crops
Kendalpayak].
Malang.
2011:134---7.
18.
Yogiraj
V,
Goyal
PK,
Chauhan
CS.
Carica
papaya
Linn:
an
overview.
Int
J
Herb
Med.
2015;2:1---8.
19.
Anitha
B,
Raghu
N,
Ts
G,
Karthikeyan
M,
Gk
C,
Km
B.
Medicinal
uses
of
Carica
papaya.
J
Nat
Ayurvedic
Med.
2018:1---11.
20.
Akhila
S.
Phytochemical
studies
on
Carica
papaya
leaf
juice.
Int
J
Pharm
Sci
Res.
2015;6:880---3.
21.
Metgud
CS,
Naik
VA,
Mallapur
MD.
Factors
affecting
birth
weight
of
a
newborn
---
a
community
based
study
in
rural
Karnataka,
India.
PLoS
ONE.
2012;7:e40040.
Available
at:https://www.ncbi.nlm.nih.gov/pubmed/22792210[Internet].
22.
Kementerian
Kesehatan
Republik
Indonesia.
Pedoman
pelak-
sanaan
Stimulasi,
Deteksi
dan
Intervensi
Dini
Tumbuh
Kembang
Anak
di
Tingkat
Pelayanan
Dasae;
2016.
p.
1---59.
23.
Nakamuro
M,
Uzuki
Y,
Inui
T.
The
effects
of
birth
weight:
does
fetal
origin
really
matter
for
long-run
outcomes.
Econ
Lett.
2013;121:53---8.
Available
at:
http://www.sciencedirect.com/
science/article/pii/S0165176513003273
[Internet].