<![CDATA[Anemia remains a major global public health problem, particularly among pregnant women, where it contributes to adverse maternal and fetal outcomes. Its etiology is multifactorial, involving nutritional, biological, and healthcare-related determinants. Objective: This study aimed to analyze the determinants of anemia among pregnant women in Tarakan City, focusing on maternal age, parity, pregnancy spacing, chronic energy deficiency (CED), and timing of the first antenatal care (ANC) visit. Methods: A retrospective cohort study was conducted using medical record data from 187 pregnant women who attended their first antenatal care (K1) visit at the Pantai Amal Community Health Center between January and December 2025. Data were analyzed using chi-square tests for bivariate analysis and multiple logistic regression to identify dominant risk factors, with a significance level of p ≤ 0.05. Results: The prevalence of anemia was 28.9%. Bivariate analysis showed significant associations between anemia and pregnancy spacing (p=0.05), chronic energy deficiency (p=0.007), and timing of the first ANC visit (p<0.001). Multivariate analysis identified pregnancy spacing (aOR=0.45; 95% CI: 0.21–0.94; p=0.033), CED (aOR=3.24; 95% CI: 1.26–8.30; p=0.014), and timing of the first ANC visit (aOR=8.06; 95% CI: 3.73–17.41; p<0.001) as significant determinants. The timing of the first ANC visit emerged as the most dominant factor, with late initiation associated with an approximately eightfold increased risk of anemia. Conclusion: Anemia among pregnant women in Tarakan City is significantly influenced by pregnancy spacing, nutritional status, and particularly the timing of antenatal care initiation. Early ANC attendance and improved maternal nutritional status are critical strategies for reducing anemia prevalence. Targeted interventions focusing on optimal birth spacing and early pregnancy monitoring are strongly recommended.]]>
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