OVERVIEW OF REPRODUCTIVE HEALTH IN WOMEN IN AGRICULTURAL AREAS DUE TO EXPOSURE TO PESTICIDES

Exposure to pesticides during pregnancy can affect the incidence of developmental disorders in children and reproductive disorders in mothers. Exposure to pesticides during pregnancy can increase the incidence of Low Birth Weight (LBW) and mothers who are exposed will also be at risk of experiencing anemia during pregnancy and can even cause miscarriage to death in the mother and fetus. This study was conducted to identify potential associations between pesticide exposure during pregnancy and adverse maternal and fetal outcomes. The literature search process carried out in this literature review uses databases such as Google Scholar, PubMed, and ScienceDirect with a publication year range of 2016 to 2023. Some of the keywords used are "Exposure", "Pesticide", "Pregnancy", "Agriculture", and "Reproductive Health". The evidence uncovered in this study suggests a potential link between pesticide exposure during pregnancy and adverse maternal and fetal health outcomes including preterm delivery, LBW, congenital malformations, gestational diabetes, preeclampsia, and impaired fetal growth. In addition, exposure to pesticides is also associated with potential long-term health consequences for mothers and their children, such as an increased risk of obesity and neurodevelopmental disorders. After knowing the impact caused by exposure to pesticides on pregnant women, then as a nurse can provide education or counseling to the public, especially pregnant women regarding the use of Personal Protective Equipment (PPE) when participating in spraying pesticides. To reduce exposure to pesticides in pregnant women, nurses can also teach them how to wash fruits and vegetables that they buy cleanly to avoid pesticide residues sticking to them.


INTRODUCTION
Agronursing is a comprehensive client-focused service and service management in the agricultural sector (Afandi et al., 2023).Agronursing is client-centered (individuals, families, groups, and communities) nursing and service management that is comprehensive and holistic in the field of agriculture.
Agronursing is very suitable in Indonesia as an agricultural country because most of the Indonesian population works in the agricultural sector (Kurniyawan et l., 2023).
Pesticides are toxic substances that have the potential to have a negative impact on the environment and biodiversity, causing resistance, resurgence, emergence of new pests, and health problems for humans and other living things (Peraturan Menteri Pertanian, 2019).Pesticides are widely used by farmers to control pests, weeds, insects, and other diseases or animals that damage agricultural products to obtain optimal agricultural products (Kurniyawan et al., 2023).In recent years the use of pesticides Health problems that arise due to the use of pesticides that are not appropriate can endanger the health of farmers and consumers, non-target microorganisms, and have an impact on the digestion of the environment, both soil and water, some farmers do not feel the effects of pesticides in their bodies (Yushananta et al., 2020).
However, this can be even more dangerous when it happens continuously, which is where signs of health problems due to pesticide poisoning begin to appear.
Exposure to pesticides that have high concentrations can cause various health problems, mild acute poisoning can cause dizziness, headache, and skin irritation, while severe acute poisoning can cause nausea, chills, difficulty breathing, and increased pulse which can even cause death (Yushananta et al., 2020).
Pregnancy is the period starting from conception until the birth of the fetus, the normal length of pregnancy is 280 days (40 weeks / 9 months 7 days) calculated from the first trimester which starts from conception until 3 months, the 2nd trimester from the 4th month to 6 months, and the 3rd trimester from the 7th to the 9th month (Retnaningtyaset al., 2022).
Exposure to pesticides during pregnancy can affect the incidence of developmental disorders in children and reproductive disorders in mothers.Exposure to pesticides during pregnancy can increase the incidence of LBW and mothers who are exposed will also be at risk of experiencing anemia during pregnancy and can even cause miscarriage to death in the mother and fetus (Yushananta et al., 2021).
Pesticides that enter the body can inhibit The 20 articles were re-selected according to the language, research design, output, and other predetermined criteria.Finally, 10 articles were determined that matched the research criteria and could proceed to the analysis stage.

RESULTS
Pregnant women who are continuously exposed to pesticides can be at risk of developing anemia and hypertension during pregnancy.Research conducted by (Sulistyawati et al, 2019) showed that 73.2% of pregnant women who were exposed to pesticides experienced anemia.This proves that there is a relationship between a history of exposure to pesticides and the incidence of anemia in pregnant women.In addition, pregnant women who are exposed to pesticides can also be at risk of developing hypertension as evidenced by research conducted by Septiana, et al (2021) which shows there is a significant relationship between work related to pesticide exposure and the incidence of hypertension in pregnant women.The incidence of hypertension in pregnant women due to exposure to pesticides is due to the lack of awareness of exposure to pesticides and not using PPE.Apart from being at risk during the mother's pregnancy, continuous exposure to pesticides can also have an impact on the baby being born.There is a significant difference between exposure to pesticides and the incidence of LBW pregnant women who are exposed to pesticides are more likely or two times more likely to give birth to babies with low birth weight than pregnant women who are not exposed to pesticides.(Rahmawati et al., 2023).The incidence of LBW is influenced by levels of umbilical serum IGF-1 due to exposure to pesticides during pregnancy (Widyawati et al., 2020).
Research conducted by (Ehrenstein et al., 2019)demonstrated that the risk of offspring with autism spectrum disorders increased after prenatal exposure to ambient pesticides within 2000 m of their mother's residence during pregnancy.
Pesticide exposure in pregnant women can attack the fetus through the mechanism of metabolism from the mother's body to the fetus through the umbilical cord and placenta.The results showed that there were 28 (43.1%)children who experienced developmental delays due to exposure to pesticides (Zakiyah et al., 2017).Research results (Winnoto et al., 2016) showed that 64% of respondents experienced developmental disorders in pre-school children aged 4-5 years due to exposure to pesticides during pregnancy.There is a significant relationship between work related to pesticide exposure and the incidence of hypertension in pregnant women, the period of exposure to pesticides and the incidence of hypertension in pregnant women, the duration of exposure to pesticides and the incidence of hypertension in pregnant women, the frequency of exposure to pesticides and the incidence of hypertension in pregnant women, practice mixing pesticides with the incidence of hypertension in pregnant women and the use of personal protective equipment with the incidence of hypertension in pregnant women.

DISCUSSION
has increased because they are considered the most effective way to control plantdisturbing organisms at the agricultural level.The use of highly toxic pesticides is mostly used in developing countries, including Indonesia.Globally, WHO estimates that poisoning caused by pesticides causes 300,000 deaths per year mostly from low to middle-income countries (Peraturan Menteri Pertanian, 2019).Inappropriate use of pesticides by farmers is caused by the use of pesticides that are not following the recommended dosage, and the principle of using pesticides that are not appropriate, such as the use of Personal Protective Equipment (PPE).The use of incomplete Personal Protective Equipment (PPE) is very vulnerable to pesticides entering the body, pesticides can enter the body through unprotected body parts when spraying pesticides using long clothes, head coverings, boots, mouth guards, eye protection, and gloves hand.Pathways of pesticide exposure to farmers' bodies are through hands and nose or direct contact when applying pesticides and direct contact with pesticides which will disrupt levels of the cholinesterase enzyme in the liver (Rahmasari & Musfirah, 2020).
Pregnant women are a vulnerable population with unique considerations when it comes to pesticide exposure.Pesticides, which are commonly used in agricultural and residential settings, may pose risks to both maternal and fetal health.Exposure to pesticides can hurt the nervous system, neurodegenerative, cognitive, and psychomotor disorders, growth and development, and disruption of nerve cell development during pregnancy, and early life in children and adults.Pesticide exposure can hurt the reproductive system such as changes in hormones, ovaries, damage to fertility, premature birth, LBW, defects, and spontaneous abortion(Kurniyawan et al.,   2023).This paper aims to explore the potential health effects of pesticide exposure on pregnant women and discuss strategies to mitigate these risks.Understanding the impact of pesticides on this population is crucial for the development of effective public health policies and Interventions.Mitigation strategies should focus on minimizing pesticide exposure among pregnant women.(Yushananta et al., 2021) This can be achieved through improved education and awareness programs, regulatory measures to restrict pesticide use near residential areas and during sensitive periods of pregnancy, and promoting the adoption of safer alternative pest control methods in agricultural practices.(Kurniyawan et al., 2023).Additionally, healthcare providers play a vital role in counseling pregnant women about potential risks and offering guidance on reducing exposure.The review identified several potential health effects of pesticide exposure on pregnant women.impaired fetal growth.Maternal pesticide exposure has also been linked to potential long-term health consequences for both mothers and their offspring, such as an increased risk of childhood obesity and neurodevelopmental disorders.(Ehrenstein et al., 2019).To minimize the potential risks associated with pesticide exposure during pregnancy, several strategies can be considered.Implementing strict regulations on pesticide use, promoting the use of alternative pest management approaches, and providing education and training for farmers and agricultural workers on safe handling and application of pesticides are important steps.Furthermore, healthcare providers should be aware of the potential risks and provide appropriate counseling and support to pregnant women regarding pesticide exposure.(Septiana et al., 2021).CONCLUSION Exposure to pesticides in pregnant women has a very influential impact on their health.Health problems that can occur as a result of exposure to pesticides include hypertension, anemia, low birth weight babies, developmental disorders of preschool children, and autism problems.Pregnant women exposed to pesticides are more likely or 2 times more likely to give birth to children with LBW when compared to pregnant women who are not exposed to pesticides.Factors for the occurrence of these health problems can result from incomplete use of PPE in spraying pesticides and consuming fruit or vegetables that are not washed clean from exposure to pesticides.To reduce this problem, health workers can conduct counseling regarding the handling of pesticide exposure to pregnant women in agricultural areas.In addition, to reduce exposure to pesticides, pregnant women are expected to wash fruits or vegetables that have been purchased cleanly to avoid consuming the remaining pesticides, use complete PPE when participating in spraying pesticides, which consists of using gloves, masks, wearing special clothes, boots, glasses, and hats, as well as being able to avoid things related to pesticides in advance so that health problems do not occur that can affect pregnant women and the fetus they contain.