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Determinants of low APGAR score among preeclamptic deliveries in Cipto Mangunkusumo Hospital: a retrospective cohort study in 2014 Susilo, Sulaeman A.; Pratiwi, Karina N.; Fattah, Adly N.A.; Irwinda, Rima; Wibowo, Noroyono
Medical Journal of Indonesia Vol 24, No 3 (2015): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: Preeclampsia has great implication on adverse neonatal outcome. Appearance, pulse, grimace, activity, respiration (APGAR) score at 1 or 5 minutes is one of the indicators of physiologic maturity of the infant. Therefore, the aim of this study was to know the correlation of APGAR score in preeclamptic deliveries with its risk factors. Methods: This study was a retrospective cohort. Data were collected from January to December 2013 including all preeclamptic women with singleton live pregnancies who delivered their babies in Cipto Mangunkusumo Hospital, Jakarta. The primary outcome was APGAR score. There were some determinants conducted in this study. Binary logistic was used as multivariate analysis to analyze the correlation between APGAR score and risk factors of preeclampsia, data were analyzed using chi square test. Results: Out of 450 preeclamptic women, 446 of them met the inclusion criteria. Low APGAR scores at 1 and 5 minutes were found in 19% (86/446) and 5.4% (24/446) of neonates respectively. Early onset of preeclampsia (adjusted OR = 4.577; 95% CI = 2.147 - 9.757), white blood cell â¥ 15,000/Î¼L (adjusted OR = 3.315; 95% CI = 1.738 â 6.324), HELLP syndrome (adjusted OR = 2.00; 95% CI = 1.38 â 2.91) were independent risk factors for having infant with low APGAR score at 1 minute. Meanwhile, there was no significant risk factors at 5 minutes APGAR score after adjustment.Conclusion: Leukocytosis, early onset preeclampsia, preterm birth, and thrombocytopenia, severity of preeclampsia, and HELLP syndrome are independent risks of having infant born with low APGAR score at 1 minute in preeclamptic deliveries.

The effect of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women Wibowo, Noroyono; Irwinda, Rima
Medical Journal of Indonesia Vol 24, No 3 (2015): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: Potential benefits of multiple micronutrient supplements has become an increasing interest seeing as the high rate of pregnant women with suboptimal nutritional status, but low compliance often reduces effectiveness of large-scale iron and folic acid supplementation program. The aim of this study was to investigate the efficacy of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women. Methods: An exploratory study was conducted to 100 pregnant women â¤ 12 weeks, who underwent antenatal care in Budi Kemuliaan Hospital, Jakarta. The subjects received formulated powder milk containing multi-micronutrient and protein supplement monthly until delivery. Anthropometric measurement, maternal and cord blood exam, ultrasound and dietary recall were done. The data was analyzed by correlation test. Correlation between variables was tested using Pearson or Spearman correlation test.Results: The mean maternal hemoglobin level significantly decreased during study (p < 0.001), being the lowest in second trimester. The levels on the first, second, and third trimester respectively was 12.16 Â± 1.03 g/d; 12 anemic subjects and 17 had low ferritin level, 10.85 Â± 0.95 g/dL; 58 anemic subjects and 69 had low ferritin level, and 11.02 Â± 0.35 g/dL; 50 anemic subjects and 51 had low level of ferritin). Ferritin and serum iron levels were decreased at trimester one and two (p < 0.001), also the zinc and vitamin D level declined. Anemia did not correlate with pregnancy outcomes such as preterm delivery, preeclampsia, or low birth weight.Conclusion: The levels of maternal hemoglobin, ferritin, iron, zinc, and vitamin D during pregnancy could not be maintained or increased by multi-micronutrient and protein supplementation.

The status of probiotics supplementation during pregnancy Wibowo, Noroyono; Mose, Johanes C.; Karkata, Made K.; Purwaka, Bangun T.; Kristanto, Herman; Chalid, Maisuri T.; Yusrawati, Yusrawati; Sitepu, Makmur; Kaeng, Juneke J.; Bernolian, Nuswil; Prasmusinto, Damar; Irwinda, Rima
Medical Journal of Indonesia Vol 24, No 2 (2015): June
Publisher : Faculty of Medicine Universitas Indonesia

Probiotics have been known for their use in medical field for quite a long time. Strong evidences are now available for the use of probiotics in clinical setting. One of the current issues on this topic is the use of probiotics in pregnancy. Recent studies showed that probiotics may be safe and beneficial for prenatal supplementation. In this review, we highlighted several proven use of probiotics supplementation in pregnant women. A few selected strains of probiotics showed promising outcome to prevent preterm labor and preeclampsia, and to reduce atopic eczema but not asthma and wheezing, in offspring of women who had prenatal probiotics supplementation. The mechanism of action responsible for this effect is closely related to the regulation of T cells, although the exact pathways are not defined yet.

Assessment of the nutrient intake and micronutrient status in the first trimester of pregnant women in Jakarta Wibowo, Noroyono; Bardosono, Saptawati; Irwinda, Rima; Syafitri, Inayah; Putri, Atikah S.; Prameswari, Natasya
Medical Journal of Indonesia Vol 26, No 2 (2017): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Maternal nutrition before and during pregnancy is important for a healthy pregnancy outcome. According to National Basic Health Research (Riskesdas) 2013, 24.2% of pregnant women are at risk of chronic malnutrition and 37.1% of them suffer from anemia. The aim of this study was to obtain information about the nutrient intake and serum micronutrient status in the first trimester of pregnant women in Jakarta.Methods: A descriptive study was conducted towards 234 pregnant women with gestational age no more than 14 weeks. The nutrient intake data was obtained from the conversion of frequency food questionnaire (FFQ) which was semi quantitative data using a Nutrisurvey application. The maternal serum was examined to obtain data about nutrient level.Results: The mean of daily maternal energy intake was 1,256.1 kcal. Most subjects had nutrient intake below the recommendations of Institute of Medicine (IOM) and recommended dietary allowances (RDA), i.e. energy (88.9%), protein (80.8%), iron (85%), folic acid (74.8%), calcium (90.6%), and zinc (94.9%). However, they showed a high intake level of vitamin A (70.5%). Most subjects had deficiency in vitamin A (69.7%), vitamin D (99.6%), and zinc (81.2). No correlation was found between the maternal nutrient intake and nutritional status.Conclusion: Most of the first-trimester-pregnant-women in Jakarta had low maternal energy and nutrient intake, except for vitamin A, as well as low serum vitamin A, vitamin D, and zinc level.

Long-chain polyunsaturated fatty acid status in first-trimester pregnant women Wibowo, Noroyono; Irwinda, Rima; Bardosono, Saptawati; Prameswari, Natasya; Putri, Atikah S.; Syafitri, Inayah
Medical Journal of Indonesia Vol 27, No 3 (2018): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: The beneficial effects of long-chain polyunsaturated fatty acid (LCPUFA) on maternal health have been widely investigated in pregnant women. First-trimester supplementation of LCPUFA has been reported to play a role in the inflammatory response, thus reducing a preterm birth and preeclampsia. However, there is a lack of studies investigating the blood concentration of LCPUFA in pregnant women in Indonesia. This study was conducted to evaluate the status of LCPUFA in first-trimester pregnant women in Jakarta, Indonesia.Methods: A descriptive study was conducted using the secondary data of 197 pregnant women in their first trimester who received antenatal care in Budi Kemuliaan Hospital during February 2012 to April 2015. Nutrient intake data were collected through interviews conducted using a semi-quantitative frequency food questionnaire (SQ-FFQ). Total concentrations of linoleic acid (LA), arachidonic acid (AA), alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were measured using gas-chromatography/mass spectrometry (GC-MS). Statistical analysis of the data was conducted using SPSS 20.0.Results: Most subjects had deficient blood concentrations of LA (74.1%), AA (85.3%), ALA (76.6%), and DHA (73.1%). The median total concentrations of LA, AA, ALA, EPA, and DHA were as follows: 76.08%, 14.97%, 2.64%, 6.36%, and 1.18%, respectively. The median EPA+DHA level was 7.98%. A total of 38 women (19.3%) were classified as high-risk subjects based on the omega-3 index. No correlation was observed between total DHA+EPA concentration and birth weight (r=0.027, p=0.709). However, a significant difference was detected between the concentrations of LA, AA, and ALA and the maternal body mass index (p<0.05).Conclusion: Most subjects had low intake and blood concentrations of LA, AA, ALA, EPA, and DHA in the first trimester of pregnancy.

Indonesian local fetal-weight standard: a better predictive ability for low Apgar score of SGA neonates Fattah, Adly N.A.; Pratiwi, Karina N.; Susilo, Sulaeman A.; Berguna, Jimmy S.N.; Irwinda, Rima; Wibowo, Noroyono; Santoso, Budi I.; Zhang, Jun
Medical Journal of Indonesia Vol 25, No 4 (2016): December
Publisher : Faculty of Medicine Universitas Indonesia

Background: Accurate assessment of fetal growth is one of crucial components of antenatal care. A generic reference for fetal-weight and birthweight percentiles that can be easily adapted to local populations have been developed by Mikolajczyk and colleagues. This study aimed to validate our own local percentile standard by evaluating the odds ratio (OR) of low 1st and 5th minute Apgar score for small-for-gestational age (SGA) versus those not SGA.Methods: We used the generic reference tools for fetal-weight and birthweight percentiles developed by Mikolajczyk and colleagues to create our own local standard and then defined the SGA neonates. For validation, we used the database of singleton live deliveries (2,139 birth) during January 1st to December 31st 2013 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We compared our reference with that of Hadlock and colleagues. For every reference, the OR of Apgar score <7 at 1st and 5th minutes for infants who were SGA versus those not estimated with bivariate and multivariate analyses.Results: SGA found in 35% (748/2,139) and 13% (278/2,139) of neonates using the definition derived from Indonesian standard and Hadlock’s. OR of Apgar score <7 at 1st and 5th minutes were 3.45 (95% CI=2.56–4.65) and 3.05 (95% CI=1.92–4.83) for the Indonesian local fetal-weight standard compared with respectively 2.14 (95% CI=1.65–2.76) and 1.83 (95% CI=1.21–2.77) for Hadlock and collegues’ reference.Conclusion: Indonesian local fetal-weight standard has a better ability to predict low 1st and 5th minutes Apgar scores of SGA neonates than has the Hadlock and collegues’ reference.

Impact of pregnancy-induced hypertension on fetal growth Irwinda, Rima; Surya, Raymond; Nembo, Lidia F.
Medical Journal of Indonesia Vol 25, No 2 (2016): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Pregnancy-induced hypertension (PIH) is still a major cause of maternal and infant morbidity and mortality worldwide. The aim of this study to investigate the impact of PIH on fetal growth.Methods: A longitudinal cross-sectional study was conducted by 2,076 obstetric patients registered in the book of delivery emergency room BLUD RSUD Ende/ Ende hospital from September 1st 2014 to August 31st 2015. Pregnancy-induced hypertension was classified into gestational hypertension, preeclampsia, and severe preeclampsia. Categorical comparative chi-square continued by logistic regression analysis were performed to examine the effect of PIH to infants’ growth outcome.Results: Women with preeclampsia had higher number of preterm delivery (26.7%). Infants born from preeclamptic women had lower birth weight (median 2,575 gram; p<0.001), birth length (median 49 cm; p<0.001), and also head circumference (median 32 cm; p<0.001). Severe preeclampsia contributed statistically significance to SGA (OR=1.90; 95% CI=1.20-3.01; adjusted OR=1.91; 95% CI=1.20-3.01) and LGA (OR=2.70; 95% CI=1.00-7.29; adjusted OR=2.92; 95% CI=1.07-8.00). Based on birth weight independent of gestational age, severe preeclampsia had an impact to VLBW (OR=11.45; 95% CI=2.77-47.38; adjusted OR=8.68; 95% CI=1.57-48.04) and LBW (OR=6.57; 95% CI=4.01-10.79; adjusted OR=5.71; 95% CI=3.33-9.78) where it showed statistical significance.Conclusion: PIH women who had SGA or VLBL or LBW infants were caused by the hypoperfusion model as the pathogenesis of preeclampsia. Meanwhile, LGA infants born by preeclamptic women were due to the compensation of the decrease from uteroplacental perfusion or other diseases such as obese mother or gestational.diabetes mellitus.

Risk of small for gestational age babies in preterm delivery due to pregnancy-induced hypertension Irwinda, Rima; Santoso, Budi Iman; Surya, Raymond; Nembo, Lidia Firmiaty
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

BACKGROUND Pregnancy-induced hypertension (PIH) causes high maternal morbidity and mortality worldwide. This study aims to assess the impact of PIH on fetal growth according to gestational age in preterm deliveries.METHODS A prospective cohort study using secondary data was undertaken in Ende District, East Nusa Tenggara, Indonesia from September 2014 to August 2015. The t-test was performed to compare mean birth weight based on gestational week between normotensive and PIH women, continued by linear regression. The chi-square or Fisher exact test was also conducted to determine the probability of birthing small for the gestational age (SGA) and large for gestational age (LGA) babies between normotensive and PIH women.RESULTS A total of 1,673 deliveries were recorded in Ende Hospital over the 1-year study period, among which 182 cases involved preterm births. The PIH group had lower birth weight than normotensive women at each gestational age starting from 32–35 weeks (p=0.004; 95% CI 150.84–771.36). Normotensive women at gestational ages of 32 (p=0.05; 95% CI 0.01–0.83), 34 (p=0.37; 95% CI 0.01–4.12), and 36 (p=0.31; 95% CI 0.02–2.95) weeks had a lower risk of birthing SGA babies than PIH women; LGA babies were recorded at gestational ages of 33 (p=1.00; 95% CI 0.07–37.73) and 35 (p=0.31; 95% CI 0.34–63.07) weeks.CONCLUSIONS Poor perfusion of the uteroplacental is one of the reasons behind intrauterine growth restriction, which results in SGA babies born to PIH women.

Preeklamsia: Pencegahan hingga Pengelolaan Berbasis Bukti Surya, Raymond; Irwinda, Rima; Sungkar, Ali
Cermin Dunia Kedokteran Vol 46, No 1 (2019): Obstetri - Ginekologi
Publisher : PT. Kalbe Farma Tbk.

Mekanisme pasti preeklamsia masih tidak diketahui, sering dikaitkan dengan faktor imunologi, genetik, kerentanan terhadap sindrom metabolik, inflamasi/infeksi kronik, hipertensi sebelumnya, penyakit ginjal kronik. Uji prediksi preeklamsia dapat dilakukan dengan melihat faktor risiko demografi, penemuan biofisik, ataupun kombinasi keduanya. Pencegahan preeklamsia di antaranya aspirin dosis rendah pada populasi risiko tinggi dan suplementasi kalsium pada populasi rendah asupan kalsium. Penatalaksanaan preeklamsia yang baik terdiri dari antihipertensi, magnesium sulfat, kortikosteroid, penentuan saat terminasi kehamilan, hingga metode persalinan.The exact mechanism of preeclampsia is unknown; it is associated with immunological, genetic factor, susceptibility to metabolic syndrome, chronic inflammation/infection, history of previous hypertension, and chronic renal disease. Preeclampsia prediction test can be conducted through demographic risk factors, biophysical findings, or both. The prevention measures include low dose aspirin in high risk population and calcium supplementation in low calcium intake population. Good management of preeclampsia consists of antihypertensive, magnesium sulphate, corticosteroid, pregnancy termination, and delivery methods.

Trace elements in maternal serum and their relationships with preterm birth and fetal growth restriction Irwinda, Rima; Sungkar, Ali; Surya, Raymond; Guinto, Valerie Tiempo
Makara Journal of Health Research Vol. 24, No. 1
Publisher : UI Scholars Hub

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Background: Preterm birth (PTB) and fetal growth restriction (FGR) contribute to high hospital costs. An imbalance in the concentration of the four trace elements (i.e., copper, zinc, iron, and calcium) was shown to be associated with complications during pregnancy. This study aimed to analyze the role of these trace elements in the occurrence of PTB and FGR. Methods: A search was conducted in PubMed, Cochrane Library, and Ovid. The articles were filtered based on the inclusion and exclusion criteria, and further screening was based on the association of articles with the clinical question. The risk of bias in each of the studies was assessed using the Cochrane risk of bias table. Forrest plots were created and analyzed using Review Manager 5.3e. Results: Three studies were included in the risk of bias assessment and meta-analysis. Maternal serum levels of copper and iron were lower in the FGR group (p < 0.05), while copper, zinc, iron, and calcium were lower in the PTB group (p < 0.05). The included studies had a low degree of homogeneity (I2 < 50%). Conclusion: Maternal iron deficiency was associated with FGR, while low levels of the trace elements copper, zinc, iron, and calcium were associated with PTB.

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