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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.

Effect of the Feeding of Formula Milk Enriched with Pro-Antioxidants for the Prevention of Preeclampsia; Study of High Sensitivity C-Reactive Protein (hs-CRP) and Cell-Free mRNA of Plasminogen Activator Inhibitor-1 (PAI-1) in Plasma Wibowo, Noroyono
Indonesian Journal of Obstetrics and Gynecology Volume. 35, No. 4, October 2011
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Objective: To evaluate the effect of the feeding of formula milk enriched with pro-antioxidants to high sensitivity C-reactive protein (hs-CRP) and cell-free mRNA of Plasminogen Activator Inhibitor-1 (PAI-1) in the first trimester, second trimester, and post labor for the prevention of preeclampsia. Method: This is double-blinded randomized clinical trial in 8-12 weeks pregnant woman with low (below 900 Î¼mol/l) Ferric Reducing Ability of Plasma (FRAP), as a marker of low systemic antioxidant. A total of 104 samples were collected from patients who had antenatal care in Bunda Hospital Jakarta, Budi Kemuliaan Hospital, and Dr.Cipto Mangunkusumo General Hospital from January 2007 until December 2009. From block randomization, 49 samples were allocated in the case group, and 55 samples to the control group. A formula milk enriched with pro-antioxidants was fed to the case group throughout their pregnancy, and a regular pregnancy formula milk was fed to the control group. Hs-CRP and cell-free mRNA PAI-1 test in the two groups at first trimester, second, and post labour was conducted. The incidence of preeclampsia was then compared in the two groups. Result: Significant difference (p

The Level of Zinc is Increasing, while the Serum Folat Level is Decreasing, after Multi-Micronutrient Supplementation in Pregnant Woman Wibowo, Noroyono
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 4, October 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (102.758 KB)

Objective: To measure the changes of serum iron, folic acid, zinc and selenium level on pregnant woman after multi-micronutrient supplementation. Method: First trimester pregnant woman whom attended Maternal- Fetal Policlinic at Dr. Cipto Mangunkusumo Hospital from July 2011 till October 2011 was considered into the study. The intervention was consumption of multi-micronutrient tablet once a day for three months period. The outcomes were the measurements of serum level of iron, folic acid, zinc and selenium before and after supplementation. We used paired T Test and Wilcoxon test for statistical analysis. Results: Twenty-eight pregnant women in their first trimester participated in the study. The micronutrient serum level was measured before and after supplementation during the time period. Before supplementation, serum iron and zinc level were below normal. Serum selenium level was normal with higher than normal serum folic acid level. After supplementation, serum zinc level was found to be below normal. Both level of serum iron and selenium increased to normal. Serum folic level was higher than normal. We found a decrease in serum zinc level with an increase in serum folic acid level that was statistically significant (p 0.009; p 0.003 respectively). We also found a slight decrease of serum iron level and an increase of serum selenium level that were not statistically significant (p 0.295; p 0.333). Conclusion: There is a decreased level of serum zinc with an increase in serum folic acid level after multi-micronutrient supplementation. [Indones J Obstet Gynecol 2012; 36-4: 171-5] Keywords: multi-micronutrient, supplementation

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.

The Level of Zinc is Increasing, while the Serum Folat Level is Decreasing, after Multi-Micronutrient Supplementation in Pregnant Woman Wibowo, Noroyono
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 4, October 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To measure the changes of serum iron, folic acid, zinc and selenium level on pregnant woman after multi-micronutrient supplementation. Method: First trimester pregnant woman whom attended Maternal- Fetal Policlinic at Dr. Cipto Mangunkusumo Hospital from July 2011 till October 2011 was considered into the study. The intervention was consumption of multi-micronutrient tablet once a day for three months period. The outcomes were the measurements of serum level of iron, folic acid, zinc and selenium before and after supplementation. We used paired T Test and Wilcoxon test for statistical analysis. Results: Twenty-eight pregnant women in their first trimester participated in the study. The micronutrient serum level was measured before and after supplementation during the time period. Before supplementation, serum iron and zinc level were below normal. Serum selenium level was normal with higher than normal serum folic acid level. After supplementation, serum zinc level was found to be below normal. Both level of serum iron and selenium increased to normal. Serum folic level was higher than normal. We found a decrease in serum zinc level with an increase in serum folic acid level that was statistically significant (p 0.009; p 0.003 respectively). We also found a slight decrease of serum iron level and an increase of serum selenium level that were not statistically significant (p 0.295; p 0.333). Conclusion: There is a decreased level of serum zinc with an increase in serum folic acid level after multi-micronutrient supplementation. [Indones J Obstet Gynecol 2012; 36-4: 171-5] Keywords: multi-micronutrient, supplementation

The Levels of Zinc, Selenium, Iron and Copper in Preterm Pregnancy do not Differ with those of Healthy Pregnancy Wibowo, Noroyono; fitriana, Fitriana
Indonesian Journal of Obstetrics and Gynecology Volume 7 No. 2 April 2019
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: to compare zinc, selenium, iron and copper levels in maternal serum of normal and preterm pregnancy. Methods: It is a cross sectional study with preterm and normal pregnant woman who will carry delivery in Dr. Cipto Mangunkusumo National Hospital and Budi Kemuliaan Hospital Jakarta from January to April 2017. This study was conducted by comparing the levels of each micronutrient in both groups of subjects. Result: From January until April 2017, there were 53 subjects divided into 30 normal pregnant women and 23 preterm pregnant women. The levels of zinc, selenium iron and copper in preterm pregnancy were 42 µg/dL, 72,39 µg/L, 74 µg/L, and 2144,52 µg/dL. Levels of zinc, selenium, iron and copper in normal pregnancy were 42 µg/dL, 67,27 µg/L, 70,5 µg/L, and 2221 µg/dL. There was no difference in micronutrients level in both groups. Conclusion: This study concluded that there was no difference in zinc, selenium, iron and copper levels in normal and preterm pregnancy. Keywords: pregnancy, zinc, selenium, iron, copper   LatarBelakang:Persalinan preterm adalahpersalinansebelumusiakehamilan 37 minggulengkap. Persalinan preterm inimasihmenjadimasalah di seluruhdunia.Padalaporan World Health Organization (WHO), Indonesia mendudukiperingkatkelimanegaradenganpersalinan preterm terbanyakyakni 675.700 persalinanpadatahun 2010.Berbagaifaktordihubungkandenganpenyebabterjadinyapersalinan preterm, termasuksalahsatunyaadalahgangguannutrisiselamakehamilan, terutamaseng, selenium, besidantembaga. Tujuan:Penelitianinimembandingkankadarseng, selenium, besidantembagapada serum maternal ibuhamil normal dan preterm. Metode:Penelitiandilakukandenganujipotong-lintangdengansubjekpenelitianibuhamilbaik preterm maupunaterm yang akanmelaksanakanpersalinan di RSUPN Dr. CiptoMangunkusumodan RS Budi Kemuliaan Jakarta padaJanuarihingga April 2017. Penelitiandilakukandenganmembandingkankadarmasing-masingmikronutrienpadakeduakelompoksubjek. Hasil:DalamjangkawaktuJanuarihingga April 2017 didapatkan 53 subjekpenelitianyakni 30 ibuhamil normal dan 23 ibudengankehamilan preterm. Seluruhsubjekdimasukkandalamanalisis data.Kadar seng, selenium, besidantembagapadaibudengankehamilan preterm secaraberurutanadalah 42 µg/dL, 72,39 µg/L, 74 µg/L, dan 2144,52 µg/dL.Sedangkankadarseng, selenium, besidantembagapadaibuhamil normal secaraberurutanadalah 42 µg/dL, 67,27 µg/L, 70,5 µg/L, dan 2221 µg/dL. Tidakadaperbedaanbermaknakadarmikronutrienpadakeduakelompoksubjek. Kesimpulan: Penelitianinimenyimpulkanbahwatidakadaperbedaankadarseng, selenium, besidantembagapadaibuhamil normal danibudengankehamilan preterm. Kata kunci:kehamilan, seng, selenium, besi, tembaga

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