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"Latar Belakang: Prevalensi preeklamsia dalam kehamilan di Indonesia sebesar 7-10%, Asam asetilsalisilat yang mengandung senyawa aktif asam salisilat diketahui dapat mencegah terjadinya preeklamsia awitan dini terutama bila diberikan sebelum usia kehamilan 16 minggu. Tubuh memiliki asam salisilat natural yang didapatkan dari konsumsi sayuran yang mengandung asam salisilat. Asam salisilat merupakan senyawa aktif yang berperan sebagai anti inflamasi. Penelitian ini bertujuan menilai apakah kejadian preeklamsia dipengaruhi oleh kadar asam salisilat natural serum dan urin.Metode: Penelitian ini menggunakan disain case-control berpasangan. Subjek adalah pasien hamil dengan preeklamsia awitan dini (PEAD) dibandingkan dengan hamil normotensi 20-34 minggu terdiri atas 35 pasien/kelompok, preeklamsia awitan lambat (PEAL) dibandingkan dengan hamil normotensi 34-40 minggu terdiri atas 39 pasien/ kelompok. Pemeriksaan kadar asam salisilat (SA) dan asam salisilurat (SUA) dalam serum diperiksa dari sampel darah vena, kadar SA dan SUA urin diperiksa dari sampel urin sewaktu yang terkoreksi dengan kadar kreatinin urin, semuanya diperiksa menggunakan kromatografi. Seluruh subjek dilakukan wawancara FFQ (Food Frequent Questionnaire) untuk mengetahui asupan makanan selama hamil. Analisis statistik yangdigunakan adalah uji Mann Whitney .Hasil: Median usia kehamilan pasien PEAD adalah 31 minggu, kelompok normal adalah 30 minggu. Kadar SUA serum pada PEAD berbeda bermakna dibandingkan hamil normal dengan median 1,43 (min-max 0,001-9,32) vs 0,21 (0,002-15,78) nilai p<0,001. Kadar albumin pada PEAD berbeda bermakna dengan hamil normal median 3 (2,1 – 3,8) vs 3,7 (3,4-4,3) p<0,001. Kadar Asupan protein berbeda bermakna (13% vs 14%,p<0,001)Kadar serat pangan pada PEAD berbeda bermakna dibandingkan hamil normal (8 gram/hari vs 9,6 g/hari, p<0,001). Kadar SA dalam serum dan urin, SUA urin pada kelompok ini tidak berbeda bermakna.Median usia kehamilan PEAL dan normotensi adalah 37 minggu. Kadar SA serum dan urin dan SUA serum tidak berbeda bermakna antara kedua kelompok. Kadar albumin pada PEAL berbeda bermakna dengan median (3 (2,4-3,6) vs 3,4 (2,9-4,1) p<0,001).Simpulan : Tidak terdapat perbedaan bermakna kadar asam salisilat dan asam salisilurat pada serum dan urin pada kehamilan preeklamsia dan normotensi. Kelompok PEAD terdapat kadar SUA serum yang lebih tinggi dan berkorelasi dengan kadar albumin dan asupan protein yang rendah. Asupan serat pangan berhubungan dengan kejadian PEAD, tetapi tidak berhubungan dengan kadar asam salisilat dan asam salisilurat

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Background: The prevalence of preeclampsia in pregnancy in Indonesia is 7-10%. Acetylsalicylate which contains the active compound salicylic acid is known to prevent early onset preeclampsia, especially if given before 16 weeks of gestation. The body has natural salicylic acid which is obtained from the consumption of vegetables that contain salicylic acid. Salicylic acid is an active compound that acts as an anti-inflammatory. This study aims to assess whether the incidence of preeclampsia is influenced by the

levels of natural salicylic acid in the blood and urine.

Methods: : A matched case-control was adopted in this study. Subjects were pregnant patients with early onset preeclampsia (EOP) compared to normotensive pregnancies of 20-34 weeks consisting of 35 patients/group, late onset preeclampsia (LOP) compared with normotensive pregnancies of 34-40 weeks consisting of 39 patients/group. Examination of salicylic acid (SA) and salicylic acid (SUA) levels in serum was examined from venous blood samples, urine SA and SUA levels were examined from urine samples while corrected by urine creatinine levels, all were examined using chromatography. . To measure food intake during pregnancy, all subject were interviewed using the FFQ (Food Frequent Questionnaire). The Mann Whitney test was utilized in the statistical analysis.

Objective: The goal of this study is to see if natural blood and urine levels of salicylic acid affect the risk of preeclampsia.

Result :EOP subject had a median gestational age of 31 weeks, while normal group 30 wga. Serum SUA levels in EOP were considerably different from normal pregnant women, with a median of 1.43 (min-max 0.001-9.32) versus 0.21 (0.002-15.78) p value <0.001, while albumin levels in EOP were significantly different from normal pregnant women, with a median of 3 (2.1-3.8) vs. 3.7 (3.4-4.3) p<0.001, and protein intake significantly lower than normal (13 vs 14%, p<0,001).. Dietary fiber in EOP was significantly

different compared to normal pregnancy (8 g/day vs 9.6 g/day, p<0.001) SA levels in serum and urin, as well as urine SUA, were not substantially different in this group.

LOP and normotensive gestational age were both 37 weeks. The levels of SA and SUA in the serum and urine were not substantially different between the two groups. With a median of 3 (2.4-3.6) vs. 3.4, albumin levels in PEAL were substantially different (2.9-4.1).

Conclusion: In preeclampsia and normotensive pregnancies, there was no significant difference in salicylic acid and salicyluric acid levels in blood and urine. The serum SUA levels in the EOP group were greater and associated with low albumin levels and low protein intake. Fiber intake was linked to the development of EOP, but not to salicylic acid levels or salicyluric acid levels."

"Preeklamsia merupakan salah satu penyebab kematian utama ibu dan perinatal di dunia. Inflamasi disertai tingginya indeks apoptosis di syncytiotrophoblast dan ekspresi Cyclophilin A diduga berperan pada preeklamsia. Faktor tersebut diasumsikan menyebabkan jejas jantung/pembuluh darah yang meningkatkan risiko morbiditas dan mortalitas ibu dan perinatal. Tujuan penelitan ini adalah menganalisis peran inflamasi, indeks apoptosis dan Cyclophilin A terhadap jejas jantung/pembuluh darah pada preeklamsia awitan dini, lanjut dan kehamilan normal. Sebanyak 47 wanita hamil yang terpilih dilakukan pemeriksaan hematologi, ekokardiografi dan ultrasonografi Doppler. Plasenta diperiksa secara histopatologis untuk mengukur ekspresi NF-KB dan PARP-1, indeks apoptosis berdasarkan pemeriksan TUNEL, ekspresi Cyclophilin A dan pemeriksaan ultrastruktur mikroskopik pada syncytiotrophoblast. Analisis Anova digunakan untuk mengidentifikasi perbedaan antara ketiga kelompok, sedangkan regresi linier digunakan untuk mengetahui korelasi faktor yang diduga terhadap jejas jantung/pembuluh darah menggunakan SPSS 20. Usia ibu, indeks massa tubuh (IMT), hitung trombosit, NF- KB dan indeks apoptosis lebih tinggi disertai Cyclophilin A lebih rendah pada preeklamsia awitan dini dibandingkan preeklamsia awitan lanjut dan kehamilan normal. Hitung leukosit lebih tinggi pada preeklamsia awitan lanjut dibandingkan awitan dini dan normal. Total peripheral resistance (TPR) paling tinggi pada kelompok awitan dini dibandingkan awitan lanjut dan kehamilan normal, sedangkan cardiac index (CI) tidak berbeda bermakna pada ketiga kelompok. Resistensi indeks (RI) lebih tinggi pada preeklamsia awitan dini dibandingkan awitan lanjut dan kehamilan normal. Berdasarkan analisis regresi linier multivariat, membuktikan indeks apoptosis dan Cyclophilin A memiliki hubungan dengan jejas jantung/pembuluh darah. Hal tersebut menunjukkan inflamasi, indeks apoptosis, Cyclophilin A disertai pemeriksan ekokardiografi dan ultrasonografi Doppler merupakan metode yang cepat, tepat dan noninvasif faktor risiko terhadap jejas jantung/pembuluh darah pada preeklamsia. Penelitian yang dianjurkan di masa datang adalah menilai geometri jantung dengan ekokardiografi dan volumetri plasenta dengan ultrasonografi.

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Preeclampsia is one of the leading cause of maternal and perinatal death in the world. Inflammation accompanied by a high apototic index of syncytiotrophoblast and Cyclophilin A were speculated to play a role in preeclampsia. Those response were assumed to cause cardiovascular injury which lead to the risk of maternal and perinatal morbidity and mortality in preeclampsia. The objective of the study was to investigate the role of inflammation, apoptotic index and Cyclophilin A in cardiovascular injury in early and late onset preeclampsia compared to normal pregnancy.

A total of 47 pregnant women were selected, consisting almost the same size of each group (30%) and assessed for maternal hematology, echocardiography and Doppler ultrasound. Placentae were assessed histopathologically by measuring nuclear factor kappa-light-chain-enhancer of activated B cells (NF- KB) and Poly (ADP-ribose) polymerase 1 (PARP-1) expression for inflammation marker, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay for apoptotic index and Cyclophilin A. Confirmation by transmission electron microscopy (TEM) was done. Anova analysis was used to identify the differences between the three groups while linier regression was employed to assess the correlation between factors on cardiovascular injury using SPSS 20.

Maternal age, body mass index (BMI), platelet count, NF- KB and apoptotic index, resistance index (RI) were higher supported by low Cyclophilin A in early onset preeclampsia (EOP) than in late onset preeclampsia (LOP) and normal pregnancy. Leukocyte count was higher in late onset preeeclampsia than in early and normal pregnancy. Total peripheral resistance (TPR) was highest in the EOP compared to LOP and normal pregnancy, while the cardiac index (CI) was not significantly different in all groups.

Based on multivariate linear regression analysis, the apoptotic index and Cyclophilin A correlated to cardiovascular injury. Assesing inflammation, apoptotic index, Cyclophilin A, echocardiography examination and Doppler ultrasound examination might indicated timely and non-invasive detection as an alarm entry point for cardiovascular injury in both early and late onset preeclampsia. Cardiac geometry by echocardiography and placental volumetry by Doppler ultrasound should be performed in future research."

"Latar Belakang: Asam lemak rantai panjang Omega-3 dan Omega-6 selain pentinguntuk perkembangan otak janin, diketahui juga dapat mempengaruhi kejadianpreeklamsia. Derivat omega-3 seperti DHA dapat membantu stimulasi VascularEndothelial Growth Factor (VEGF) yang berperan dalam angiogenesis saat implantasitrofoblas. Belum tersedianya data pengaruh asam lemak rantai panjang terhadap kejadianpreeklamsia mendorong untuk dilakukannya penelitian ini.Tujuan: Mengetahui perbedaan kadar Omega-3 dan Omega-6 pada ibu hamil denganpreeklamsia dan normalMetode: Penelitian dilakukan dengan uji potong-lintang menggunakan sampel ibu hamilpreeklamsia dan tidak preeklamsia yang telah dikumpulkan sebelumnya pada tahun 2018di RSUPN Dr. Cipto Mangunkusumo dan RSU Budi Kemuliaan dan RSUD Koja,kemudian dilakukan pengolahan pada Januari 2020.Hasil: Diperoleh 60 subjek penelitian dengan 30 subjek pada masing – masing kelompok.Pada kelompok preeklamsia didapatkan hasil Omega-3 lebih rendah dengan mediankadar ALA 39 μmol/L dan EPA 9 μmol/L dengan perbedaan yang bermakna (p=0,01).Sedangkan kadar Omega-6 ditemukan lebih tinggi pada preeklamsia, dengan kadar LA4726 μmol/L dan AA 558 μmol/L. Indeks omega-3 pada kelompok preeklamsia jugarendah yaitu 2%, begitu pula rasio Omega-6/Omega-3 yang tinggi (17 μmol/L) dan rasioAA/EPA 61 μmol/L.Kesimpulan: Ketidakseimbangan antara Omega-3 dan Omega-6, indeks Omega-3rendah, rasio Omega-6/Omega-3 dan rasio AA/EPA yang tinggi didapatkan padapreeklamsia.

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Background: Omega-3 and Omega-6 long-chain fatty acids, besides being important for

fetal brain development, are also known to influence the incidence of preeclampsia.

Omega-3 derivatives such as DHA can help stimulate Vascular Endothelial Growth

Factor (VEGF) which plays a role in angiogenesis during trophoblast implantation. The

unavailability of data on the effect of long-chain fatty acids on the incidence of

preeclampsia is encouraging this study.

Objective: To determine differences in levels of Omega-3 and Omega-6 in pregnant

women with preeclampsia and normal

Methods: The study was carried out by cross-sectional testing using samples of

preeclampsia and non-preeclampsia pregnant women that had been collected earlier in

2018 at Dr. RSUPN. Cipto Mangunkusumo and Budi Kemuliaan Hospital and Koja

District General Hospital then processed in January 2020.

Results: Obtained 60 research subjects with 30 subjects in each group. Results with low

category were obtained in the preeclampsia group with median levels of Omega-3, ALA

39 μmol / L, EPA 9 μmol / L with significant differences (p = 0.01). While high levels of

Omega-6 in preeclampsia, LA 4726 μmol / L and AA 558 μmol / L. The omega-3 index

in the preeclampsia group was also low at 2%, as was the high Omega-6 / Omega-3 ratio

(17 μmol / L) and the 61 μmol / L AA / EPA ratio in the preeclampsia group.

Conclusion: An imbalance between Omega-3 and Omega-6, low index of Omega-3, a

ratio of Omega-6 / Omega-3, and ratio of high AA / EPA is found in preeclampsia."

"Latar Belakang : Preeklamsia terjadi akibat adanya gangguan pada proses implantasi dan desidualisasi pada awal kehamilan. Vitamin D memainkan peranan penting pada proses desidualisasi, implantasi dan plasentasi. Penelitian terbaru menunjukkan bahwa kadar 25(OH)D yang rendah dalam serum merupakan faktor risiko preeklamsia. Bukti terbaru mendukung peran suplementasi vitamin D yang dimulai pada saat sebelum, awal dan selama kehamilan dalam mengurangi risiko preeklamsia. Tujuan penelitian ini adalah untuk mengetahui peranan suplementasi vitamin D 5000 IU/hari pada implantasi dan plasentasi melalui pemeriksaan PI A. Uterina dan PlGF serum maternal pada wanita hamil trimester pertama.Metode : Uji klinis paralel acak tersamar tunggal. Subjek wanita hamil usia 7-11 minggu yang dibagi 2 kelompok, yaitu normal dan risiko tinggi berdasarkan kriteria risiko tinggi ACOG. Tiap kelompok dibagi lagi menjadi kontrol yang hanya mendapat obat standar dan perlakuan yang mendapat vitamin D 5000 IU/hari. Semua pasien diperiksa kadar 25(OH)D awal, kemudian diberikan intervensi selama 1 bulan dan diperiksa ulang kadar 25(OH)D akhir, PlGF serum maternal dan PI. A. Uterina. Menilai perbandingan kenaikan kadar 25(OH)D, PlGF, dan PI A. Uterina diantara semua kelompokHasil : Subjek awal berjumlah 92 orang, dieksklusi sebanyak 12 orang dan tersisa 80 subjek yang menyelesaikan penelitian. Semua subjek mengalami defisiensi vitamin D. Dibandingkan pasien kontrol kenaikan kadar 25(OH)D pada kelompok perlakuan normal masih lebih tinggi dibandingkan dengan kelompok perlakuan risiko tinggi yaitu 12,33±6,26 ng/mL dan 10,45±5,09 ng/mL dengan nilai p<0,001. Kelompok normal, penurunan PI A. Uterina dibandingkan antara kontrol dan perlakuan bermakna sebesar 0,57±0,36 dan 1,08±0,29 (p<0,001) sedangkan kadar PlGF juga berbeda bermakna antara kontrol (84,27±10,02) dan perlakuan (107,87±31,97) dengan nilai p 0,005. Pada kelompok risiko tinggi, perbadingan rerata kadar PlGF pada kontrol dan perlakuan berbeda bermakna yaitu 37,59±9,67 dan 70,53±18,32) nilai p<0,001. Pada pasien intervensi baik kelompok normal dan risiko tinggi rerata penurunan PI A. Uterina (1,08±0,29 vs 0,43±0,26; nilai p<0,001) dan kadar PlGF (107,87±31,97 vs 70,53±18,32; nilai p<0,001) berbeda bermakna.

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Background : Preeclampsia occurs due to disruption of the implantation and decidualization in early pregnancy. Vitamin D plays an important role in decidualization, implantation, and placentation. Recent evidence supports the role of vitamin D supplementation initiated before, early and during pregnancy in reducing the risk of preeclampsia. The study aim is to determine the effect of vitamin D supplementation of 5000 IU/day on implantation and placentation through examination of Uterine Artery PI (UtA-PI) and maternal serum PlGF in first trimester pregnant women.

Methods: Using a single-blind, randomized parallel clinical trial. Subjects were pregnant women 7-11 weeks gestation and divided into 2 groups, normal and high risk, based on ACOG preeclampsia high risk criteria. Each group was further divided into controls who received the standard drug and interventions who received 5000 IU of vitamin D/day. Subjects were examined for 25(OH)D levels before and after the 1 month intervention, including maternal serum PlGF and UtA-PI levels. Both groups were compared for the difference of 25(OH)D levels, mean PlGF, and UtA-PI.

Results: We have 80 subjects who have vitamin D deficiency. The normal and high-risk intervention group showed the increase of 25(OH)D levels, 12.33±6.26 ng/mL and 10.45±5.09 ng/mL with p<0.001 accordingly. For the normal group, the decrease of UtA-PI compared between control and intervention was significant 0,57±0,36 and 1,08±0,29 (p<0.001) while PlGF levels were also significantly different between control (84,27±10,02) and intervention (107,87±31,97) with p<0.05. While in high-risk group, the PlGF levels of control and intervention were significantly different, 37.59±9.67 and 70.53±18.32 with p<0.001. In intervention patients, both normal and high-risk groups, the decrease of UtA-PI (1.08±0.29 vs 0.43±0.26; p<0.001) and PlGF levels (107.87±31.97 vs 70.53±18.32; p<0.001) were significantly different."

"Latar belakang. Prevalensi preeklampsia masih tinggi pada ibu hamil dan janin di negara berkembang. Patofisiologi preeklampsia masih belum dapat dipahami sepenuhnya. Stres oksidatif, inflamasi dan malnutrisi masih menjadi hipotesis utama yang dihubungkan dengan kejadian preeklampsia. Koenzim Q10 merupakan komponen penting dalam tubuh sebagai antioksidan.Tujuan. Studi ini merupakan studi potong lintang komparatif pertama di Indonesia. Subjek penelitian diambil dari dua rumah sakit di Jakarta. Studi untuk menilai status gizi ibu hamil di Indonesia, asupan koenzim Q10, dan kadar koenzim Q10 plasma pada ibu hamil yang dihubungkan dengan kejadian preeklampsia.Metode. Sebanyak 72 subjek preeklampsia dan non-preeklampsia direkrut dari RS Cipto Mangunkusumo dan Koja, Jakarta pada bulan September 2018 sampai November 2018. Kriteria inklusi meliputi subjek usia >18 tahun, usia kehamilan >34 minggu dan in partu, kehamilan tunggal, intrauterin, hidup, dan kriteria ekslusi meliputi riwayat penyakit kronik misalnya hipertensi kronik, diabetes mellitus, dan penyakit ginjal sebelum dan saat hamil. Data karakteristik, data klinis, sampel plasma darah, kuesioner food recall 1x24 jam dan FFQ semikuantitatif diambil pada peneltian ini. Data dianalisis statistik menggunakan SPSS versi 20.0.Hasil. Kejadian preeklampsia lebih banyak terjadi pada usia yang lebih tua yaitu >35 tahun (p = 0,001). Tingkat pendidikan, pekerjaan, usia kehamilan, riwayat obstetri yaitu paritas, dan status gizi antara perempuan hamil dengan preeklampsia dan non-preeklampsia secara statistik tidak berbeda bermakna. Semua subjek pada kelompok preeklampsia dan non-preeklampsia (termasuk hamil normal) memiliki kadar koenzim Q10 plasma yang rendah. Kadar koenzim Q10 di plasma pada kelompok preeklampsia cenderung lebih rendah daripada non-preeklampsia tetapi secara statistik tidak berbeda bermakna.Kesimpulan. Semua subjek pada kelompok preeklampsia dan non-preeklampsia (termasuk hamil normal) memiliki kadar koenzim Q10 plasma yang rendah, walaupun asupan koenzim Q10 adalah kategori cukup namun kualitasnya rendah pada sebagian besar subjek preeklampsia dan non-preeklampsia.

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Background: Preeclampsia remains a major issue in developing countries. Studies on this disease have yet to clearly elucidate the precise mechanism of its pathogenesis. Oxidative stress, inflammation, and malnutrition have been correlated with preeclampsia. Coenzyme Q10 (CoQ10) is a vital nutrient for pregnant women as an antioxidant.

Aim: This was the first comparative cross-sectional study in two hospitals in Jakarta to investigate the nutrition status of pregnant women in Indonesia, CoQ10 intake and plasma levels during pregnancy, and correlation with the incidence of preeclampsia.

Methods: Seventy-two preeclamptic and non-preeclamptic pregnant mothers were enrolled in this study. We included patients above 18 years old, gestational age >34 weeks, singleton pregnancy, and excluded patients with history of chronic hypertension, diabetes mellitus, and renal diseases before or during current pregnancy. Clinical data and 24-hour food recall and semi-quantitative food frequency questionnaire were collected. Plasma CoQ10 levels were also obtained. Data was statistically analyzed using SPSS version 20.0.

Results: Age (above 35 years old) was significant when comparing preeclampsia and non-preeclampsia group (p = 0.001). Education, work status, gestational age, pregnancy history, BMI, dietary intake, and nutrition status were not statistically significant between both groups. The plasma CoQ10 levels in preeclampsia group were lower than non-preeclampsia group, albeit not statistically significant. The main results show all subjects were patients with severe late-onset preeclampsia with decreased plasma CoQ10 level.

Conclusions: Both preeclamptic and non-preeclamptic subjects in Indonesia show reduced plasma CoQ10 levels. Despite adequate intake, plasma CoQ10 levels in pregnant women remain low."

"Salah satu penyebab tingginya angka kematian ibu di Indonesia adalah adanya hipertensi pada kehamilan yang disebabkan oleh preeklampsia. Hingga saat ini, penyebab preeklampsia masih belum diketahui secara pasti, namun teori yang berkembang menyebutkan adanya iskemia plasenta. Iskemia plasenta disebabkan adanya kegagalan pada proses angiogenesis. Penelitian yang menggunakan desain potong lintang ini bertujuan untuk melihat perbedaan protein yang mempengaruhi proses angiogenesis pada plasenta normal dan preeklampsia serta melihat interaksinya. Sampel yang digunakan adalah 34 plasenta kehamilan normal dan 34 plasenta kehamilan preeklampsia. Kadar protein TGF- , TGF- Reseptor dan SMAD2 diperiksa menggunakan metode ELISA dan ekspresi relatif mRNA SMAD2 dan TSP-1 diperiksa menggunakan metode RT-qPCR.Kadar protein TGF- , TGF- Reseptor 1, TGF- Reseptor 2 dan protein SMAD2 meningkat pada preeklampsia p=0,0001, p=0,004, p=0,0001, p=0,0001 . Ekspresi mRNA SMAD2 dan TSP-1 pada preeklampsia juga mengalami peningkatan p=0,033, p=0,002 . Didapatkan korelasi positif kuat antara kadar protein TGF- Reseptor 1 dan TGF- Reseptor 2 pada plasenta normal p=0,0001 R=0,799 dan preeklampsia p=0,0001 R=0,783 . Korelasi positif sedang pada korelasi TGF- dan protein SMAD2 pada plasenta normal p=0,0001 R=0,672 dan korelasi positif ringan pada plasenta preeklampsia p=0,028 R=0,331 . Ada korelasi positif kuat antara TGF- Reseptor 1 dan protein SMAD2 0,0001 R=0,704 pada plasenta normal dan korelasi positif sedang pada plasenta preeklampsia p=0,0001 R=0,675 . Pada korelasi antara TGF- Reseptor 2 dengan protein SMAD2 plasenta normal diperoleh korelasi sedang p=0,0001 R=0,650 begitu juga pada plasenta preeklampsia 0,0001 R=0,675 . Kemudian pada uji korelasi antara protein TGF- dengan mRNA SMAD2 diperoleh korelasi positif ringan pada plasenta normal p=0,022 R=0,347 dan tidak ada korelasi pada plasenta preeklampsia. Pada uji korelasi antara protein TGF- Reseptor 1 dengan mRNA SMAD2 diperoleh korelasi positif ringan pada plasenta normal p=0,016 R=0,370 dan tidak ada korelasi pada plasenta preeklampsia. Tidak ditemukan korelasi antara TGF- Reseptor 2 dengan mRNA SMAD2 pada kedua kelompok. Kemudian tidak ditemukan korelasi protein SMAD2 dengan mRNA TSP-1 pada plasenta normal namun terdapat korelasi positif kuat pada plasenta preeklampsia p=0,0001 R=0,774 . Dari penelitian ini disimpulkan bahwa ada pengaruh peningkatan kadar TGF- , TGF- Reseptor, dan protein SMAD2 dengan ekspresi relatif TSP-1 pada proses angiogenesis.

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One of the causes of high maternal mortality in Indonesia is the presence of hypertension in pregnancy caused by preeclampsia. Until now, the cause of preeclampsia is still not known, but the theory suggests the presence of placental ischemia. Placental ischemia is caused by failure of angiogenesis. This cross sectional study aims to examine the differences in proteins that affect angiogenesis in normal placenta and preeclampsia and see their interactions. The sample used was 34 placentas of normal pregnancy and 34 placental preeclampsia pregnancy. TGF protein levels, TGF receptors and SMAD2 were examined using the ELISA method and the relative expression of SMAD2 and TSP 1 mRNA was examined using the RT qPCR method.Levels of TGF protein, TGF Receptor 1, TGF Receptor 2 and protein SMAD2 increased in preeclampsia p 0.0001, p 0.004, p 0.0001, p 0.0001 . SMAD2 and TSP 1 mRNA expression in preeclampsia also increased p 0.033, p 0.002 . There was a strong positive correlation between protein content of TGF receptor 1 and TGF receptor 2 in normal placenta p 0.0001 R 0,799 and preeclampsia p 0.0001 R 0,783 . Moderate positive correlations in TGF and SMAD2 protein correla tion on normal placenta p 0.0001 R 0.672 and mild positive correlation of placenta preeclampsia p 0.028 R 0.331 . There was a strong positive correlation between TGF receptor 1 and the SMAD2 protein 0.0001 R 0.704 in normal placenta and moderately positive correlation in the preeclampsia placenta p 0.0001 R 0.675 . In the correlation between TGF Receptor 2 with normal placental SMAD2 protein obtained moderate correlation p 0.0001 R 0.650 as well as on preeclampsia placenta 0.0001 R 0.675 . Then the correlation test between TGF protein and SMAD2 mRNA obtained a mild positive correlation on normal placenta p 0,022 R 0,347 and no correlation on placenta preeclampsia. In the correlation test between TGF protein Receptor 1 and SMAD2 mRNA obtained a mild positive correlation on normal placenta p 0.016 R 0.370 and no correlation in placenta preeclampsia. No correlation was found between TGF receptor 2 and SMAD2 mRNA in both groups. Then there was no correlation of SMAD2 protein with TSP 1 mRNA in normal placenta but there was a strong positive correlation in placenta preeclampsia p 0.0001 R 0.774 . From this study it was concluded that there was an effect of increased levels of TGF , TGF receptor, and SMAD2 protein with relative expression of TSP 1 in angiogenesis process."

"Latar Belakang: Sepsis neonatarum awitan dini (SNAD) mempunyai gejala klinis dan hasil laboratorium yang tidak spesifik sehingga diagnosisnya sulit ditegakkan, perlunya penelitian tentang faktor-faktor risiko ibu dan bayi yang mempengaruhi kejadian SNAD untuk diterapkan di fasilitas-fasilitas kesehatan terbatas. Tujuan: Mengetahui insiden pada sepsis neonatarum awitan dini,dan faktor-faktor risiko ibu dan bayi yang berpengaruh terhadap kejadian sepsis neonatarum awitan dini. Metode: Penelitian ini merupakan studi prognostik dengan desain kohort prospektif menggunakan data primer dari observasi dan data sekunder dari rekam medik pada bulan Juli-Oktober 2019 di Unit Perinatologi, Departemen Ilmu Kesehatan Anak Rumah Sakit Umum Cipto Mangunkusumo Jakarta, Indonesia. Bayi dengan gejala klinis, disertai faktor risiko ibu (suhu ibu, leukosit darah ibu, ketuban pecah dini, karakteristik ketuban, dan antibiotik intrapartum), dan faktor risiko bayi (skor APGAR, usia gestasi, berat badan lahir) dengan hasil positif SNAD (Proven: kultur darah +, Probable: >2 septic marker + dan kultur darah-). Sebanyak 120 subyek tersangka SNAD yang dilakukan analisis. Hasil: Hasil analisis multivariat faktor risiko ibu dan bayi dengan regresi logistik ganda adalah ketuban berwarna hijau, kental dan berbau (P=0,009, RR=839,9, IK 95% 0,000-1094,9), skor APGAR <7 (P=<0,001, RR=13,06, IK 95% 3,837-44,486), usia gestasi <37 minggu (P=0,002, RR=9,47, IK 95% 2,29-39,06), serta leukosit darah ibu >15000/µL (P=0,010, RR=4,44, IK 95% 1,420-13,915). Insidens SNAD pada penelitian ini adalah 87 dari 495 kelahiran (probable sepsis 86 per 495 dan proven sepsis 1 per 495). Kesimpulan: Faktor risiko ibu dan bayi terhadap kejadian sepsis neonatarum awitan dini berdasarkan hasil analisis multivariat adalah ketuban berwarna hijau, kental dan berbau, skor APGAR <7, usia gestasi <37 minggu, serta leukosit darah ibu >15.000/µL.

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Background: Early-onset neonatal sepsis (EONS) has non-specific clinical symptoms and laboratory results, thus the diagnosis is difficult to establish. It is important to evaluate maternal and infant risk factors for EONS, for prediction of sepsis in limited healthcare facilities.

Objective: To evaluate the incidence of early-onset neonatal sepsis, and maternal and infants risk factor of early-onset neonatal sepsis.

Method: This is a prognostic study with prospective cohort design using primary data obtained from observations and secondary data from the Perinatology Division medical record in July-October 2019, Cipto Mangunkusumo Hospital Jakarta, Indonesia. Data of infants with clinical symptoms, accompanied by maternal risk factors (maternal temperature, maternal leukocytes, premature rupture of the membranes, amniotic characteristics, and intrapartum antibiotics), and infant risk factors (APGAR score, gestational age, birth weight,) with positive EONS results (Proven: blood culture +, Probable: >2 septic marker + and blood culture -) were taken. A total of 120 subjects with EONS events were analyzed.

Results: Multivariate analysis with multiple logistic regression, significant maternal and infant risk factors were green, thick and foul odor of amniotic fluid (P=0.009, RR=839.90, CI 95% 0.000-1094.9), APGAR score <7 (P=<0.001, RR=13.06, CI 95% 3.83-44.486), gestational age <37 weeks (P=0.002, RR=9.47, CI 95% 2.29-39.06), and maternal leukocytes >15000/µL (P=0.010, RR=4.44, CI 95% 1.420-13.915). The incidence of SNAD in this study was 87 of 495 births (probable sepsis 86 per 495 and proven sepsis 1 per 495).

Conclusion: Significant maternal and infant risk factors for the occurrence of early-onset neonatal sepsis are gestational age <37 weeks, APGAR score <7, green, thick and foul odor of amniotic fluid, and maternal leukocytes>15,000/µL."

"Latar belakang: Preeklampsia mengakibatkan 225 kematian dari 100.000 kelahiran di Indonesia. Salah satu teori terjadinya preeklampsia adalah peningkatan antioksidan yang tidak adekuat, contohnya glutation peroksidase GPx , untuk mengimbangi peningkatan stres oksidatif yang terjadi selama kehamilan. GPx adalah antioksidan enzimatik yang mengubah peroksida menjadi tidak berbahaya, sehingga mengurangi stres oksidatif. Beberapa penelitian yang menyelidiki GPx menghasilkan hasil yang bertentangan, dan belum ada yang dilakukan di Indonesia. Penelitian ini bertujuan untuk membandingkan aktivitas spesifik GPx pada kehamilan normal, preeklampsia onset awal, dan preeklampsia onset akhir. Metode: Studi ini adalah penelitian observasional dengan menggunakan desain potong lintang komparatif. Jaringan plasenta diperoleh dari Rumah Sakit Ibu dan Anak Budi Kemuliaan dan RSUPN Cipto Mangunkusumo pada tahun 2015. Aktivitas umum U/mL GPx diukur dengan menggunakan GPx Randox Ransel Kit berdasarkan metode Paglia dan Valentine, yang kemudian dibagi dengan determinan protein mg/mL untuk mendapatkan aktivitas spesifik U/mg . Data kemudian dianalisis dengan menggunakan SPSS 20 dengan uji Kruskal-Wallis. Hasil: Kehamilan normal memiliki aktivitas spesifik tertinggi 8.562 3.93320.00 , diikuti oleh preeklamsia onset akhir 6.655 2.646-32.93 dan preeklampsia onset dini 6.328 5.873-13.17. Namun, perbedaan ini tidak signifikan menurut uji Kruskal-Wallis p = 0,399. Kesimpulan: Tidak ada perbedaan yang signifikan antara aktivitas spesifik GPx antara kehamilan normal, preeklampsia onset awal, dan preeklampsia onset akhir.

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Background: Preeclampsia is responsible for the mortality rate of 225 out of 100,000 deliveries in Indonesia. It is theorized that preeclampsia is caused by inadequate increase of antioxidant, one of which is glutathione peroxidase GPx, to compensate with increasing oxidative stress during pregnancy. GPx is an enzymatic antioxidant which converts peroxides to its harmless counterparts, thus limiting oxidative stress. Several studies investigating GPx produced conflicting results, and none of them were done in Indonesia. This study aimed to compare GPx specific activity in normal pregnancy, early onset, and late onset preeclampsia.

Methods: This was an observational study using comparative cross sectional design. The placental tissues were obtained from Budi Kemuliaan Hospital and Cipto Mangunkusumo Hospital in 2015. General activity U mL was measured using GPx Randox Ransel Kit based on Paglia and Valentine method, which was then divided by protein determinant mg ml to find out the specific activity U mg. The data was then analyzed using SPSS 20 with Kruskal Wallis test.

Results: Normal pregnancy had the highest specific activity 8.562 3.93320.00, followed by late onset preeclampsia 6.655 2.646 32.93 and earlyonset preeclampsia 6.328 5.873 13.17 . However, these differences were ruled insignificant using Kruskal Wallis test p 0.399 .

Conclusion There was no significant difference of GPx specific activity between normal pregnancy, early onset preeclampsia, and late onset preeclampsia."

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Latar Belakang: Preeklamsia merupakan gangguan hipertensi dalam kehamilan yang disebabkan oleh plasentasi abnormal dengan penyebab pasti yang belum diketahui. Perubahan pola makan dan pola makanan berubah drastis selama dekade terakhir baik di negara maju maupun berkembang terutama peningkatan konsumsi gula tambahan diantaranya fruktosa. Fruktosa memegang peranan penting pertumbuhan janin pada trimester pertama. Namun, konsumsi berlebih fruktosa dapat menyebabkan disfungsi endotel yang dapat mengakibatkan hipoksia plasenta sehingga terjadi preeklamsia. PRPP sebagai metabolit antara pada metabolisme fruktosa diduga meningkat pada kondisi preeklamsia yang diakibatkan oleh konsumsi fruktosa berlebih. Penelitian ini bertujuan untuk mengetahui peningkatan kadar PRPP pada kondisi preeklamsia dan korelasinya dengan konsumsi fruktosa meternal serta jumlah leukosit.

Metode: Penelitian potong lintang pada 60 perempuan hamil yang dibagi menjadi dua kelompok. Kelompok preeklamsia dan hamil normal, masing-masing sebanyak 30 subjek yang dilakukan pemeriksaan kadar PRPP pada leukosit dan jumlah leukosit dari darah vena. Seluruh subjek dilakukan wawancara sFFQ (semiquantitative Food Frequent Questionnaire)konsumsi gula maternal.

Hasil: Kadar PRPP leukosit pasien preeklamsia lebih tinggi bermakna pada kelompok preeklamsia (7.015,67 vs 5.577,63, p=0,003). Jumlah leukosit pada kelompok preeklamsia lebih tinggi dibandingkan kelompok normal (15.905 (5.014,10) vs 8.078,33 (1.141,74) /mm³, p=0,000). Konsumsi fruktosa kelompok preeklamsia lebih tinggi dibandingkan kelompok normal namun tidak bermakna secara statistik (6,25 (0,6 – 10,54) vs 4,65(0,60 – 19,4) g/hari, p=0,32). Korelasi positif lemah kadar PRPP dengan jumlah leukosit (r=0,327, p=0,035). Tidak ada korelasi kadar PRPP dengan konsumsi fruktosa maternal (r=-0.013, p=0.923). Tidak ada korelasi jumlah leukosit dengan konsumsi fruktosa maternal (r=0.122, p=0.352).

Kesimpulan: Terdapat perbedaan bermakna kadar PRPP leukosit kelompok preeklamsia dibandingkan kelompok normal. Terdapat korelasi positif lemah kadar PRPP leukosit dengan jumlah leukosit. Tidak terdapat korelasi kadar PRPP leukosit dengan konsumsi fruktosa maternal dan jumlah leukosit dengan konsumsi fruktosa maternal.

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 Preeclampsia is a hypertensive disorder in pregnancy caused by abnormal placentation with an unknown exact cause. Changes in diet pattern and diet composition have changed dramatically over the past decade, in both developed and developing countries, especially the increase in consumption of added sugars including fructose. Fructose plays an important role in fetal growth in the first trimester. However, excessive consumption of fructose can cause endothelial dysfunction which can result in placental hypoxia resulting in preeclampsia. PRPP as an intermediate metabolite in fructose metabolism is thought to increase in preeclampsia conditions caused by excess fructose consumption. This study aims to determine the increase in PRPP levels in preeclampsia conditions and its correlation with meternal fructose consumption and leukocyte count.

Method: Cross-sectional observational study on 60 pregnant women divided into two groups. The preeclampsia and normal pregnancy groups, each as many as 30 subjects were examined for PRPP levels in leukocyte and leukocyte counts from venous blood. All subjects were interviewed with sFFQ (semiquantitative Food Frequent Questionnaire) on maternal sugar consumption.

Results: Leukocyte’s PRPP levels in preeclampsia patients were significantly higher in the preeclampsia group (7,015.67 vs 5,577.63, p=0.003). The number of leukocyte in the preeclampsia group was higher than in the normal group (15,905 (5,014.10) vs 8,078.33 (1,141.74) /mm3, p=0.000). The fructose consumption of the preeclampsia group was higher than in the normal group but not statistically significant (6.25 (0.6 - 10.54) vs 4.65 (0.60 - 19.4) g / day, p=0.32). Weak positive correlation of PRPP levels with leukocyte count (r=0.327, p=0.035). There was no correlation between PRPP levels and maternal fructose consumption (r =-0.013, p=0.923). There was no correlation between leukocyte count and maternal fructose consumption (r=0.122, p=0.352).

Conclusion: There was a significant difference in PRPP leukocyte levels in the preeclampsia group compared to the normal group. There is a weak positive correlation of leukocyte PRPP levels with leukocyte count. There was no correlation between leukocyte PRPP levels with maternal fructose consumption and leukocyte counts with maternal fructose consumption.

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"Ketidakseimbangan trace elemen dan asam lemak berperan dalam terjadinya preeklamsia. Penelitian ini bertujuan untuk mengetahui status trace elemen serum dan eritrosit serta asam lemak pada preeklamsia berat. Desain potong lintang dilakukan pada 40 ibu hamil dalam 2 kelompok, preeklamsia berat dan normotensi. Pengukuran trace elemen dan asam lemak dalam serum dan eritrosit dilakukan dengan menggunakan Inductively Coupled Plasma and Gas Chromatography Mass Spectrometry. Receiver Operating Characteristic (ROC), analisis bivariat dan multivariat dilakukan. Trace elemen yang ditemukan berbeda nyata baik dalam serum maupun dalam eritrosit adalah selenium, besi, cadmium dan timbal (p<0,05). Hampir semua asam lemak eritrosit, ALA, EPA, DHA, omega-3, LA, GLA, DGLA, AA, omega-6 dan asam oleat ditemukan berbeda bermakna. Nilai tertinggi prediksi preeklamsia berat dengan AUC 0,77(IK95%:0,625-0,912) dan sensitifitas 90% serta spesifitas 50% terdapat pada ALA dengan cut off 0,16 amol/RBC yang mewakili asam lemak omega3 dan untuk golongan omega6 terdapat pada LA dengan cut off 54,25 amol/RBC (sensitifitas 85%; spesifitas 75%). Peningkatan risiko preeklamsia tertinggi terdapat pada EPA yang rendah(OR 14,53; IK95% 2,21-95,41) dan AA yang tinggi(OR 7,37; IK95% 1,37-39,7). Pengukuran trace elemen dan asam lemak diperlukan untuk menentukan status nutrisi dan terutama sebagai prediktor preeklamsia. Pengukuran asam lemak pada eritrosit dinilai lebih baik dibandingkan serum.

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Imbalance of trace elements and fatty acids plays a role in the occurrence of preeclampsia. The aim of the study was to determine the status of serum and erythrocyte trace elements and fatty acids in severe preeclampsia. Cross-sectional design was performed on 40 pregnant women in 2 groups, severe preeclampsia and normotensive. Measurement of trace elements and fatty acids in serum and erythrocyte was performed using Inductively Coupled Plasma and Gas Chromatography Mass Spectrometry. Receiver Operating Characteristic (ROC), bivariate and multivariate analysis were performed. Trace elements found to be significantly different both in serum and in erythrocyte were Selenium, Iron, Cadmium and Lead (p<0.05). Almost all erythrocyte fatty acids, ALA, EPA, DHA, omega-3, LA, GLA, DGLA, AA, omega-6 and oleic were found to be significantly different. The highest predictive value of severe preeclampsia with an AUC of 0.77(95% CI: 0.625-0.912); a sensitivity of 90% and specificity of 50% was found in ALA with a cut off of 0.16 amol/RBC representing omega3 fatty acids and for the omega6 group in LA with a cut off of 54.25 amol/RBC (85% sensitivity; 75% specificity). The highest increased risk of preeclampsia was found in low EPA (OR 14.53; 95% CI 2.21-95.41) and high AA (OR 7.37; 95% CI 1.37-39.7). Measurement of trace elements and fatty acids is needed to determine nutritional status especially as a predictor of preeclampsia. Erythrocyte fatty acids measurement is considered better than serum. "