Tesis

Pengaruh Suplementasi Vitamin D3 5000 IU/hari Terhadap Kadar 25(OH)D, Placental Growth Factor (PlGF) Serum Maternal dan PI A. Uterina pada Wanita Hamil Trimester Pertama dengan Risiko Tinggi Preeklamsia = Effect of Vitamin D3 Supplementation 5000 IU/day on Levels of Maternal Serum 25(OH)D, Placental Growth Factor (PlGF) and Pulsatility Index Uterine Artery in First Trimester Pregnant Women with High Risk of 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 : Menggunakan uji klinis paralel acak tersamar tunggal. Subjek adalah 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 kelompok dan Analisa statistik menggunakan uji T tidak berpasangan. Hasil : Subjek awal berjumlah 92 orang, dieksklusi sebanyak 12 orang dan tersisa 80 subjek yang menyelesaikan penelitian. Karakteristik awal pemeriksaan pada semua kelompok setara. Rerata kadar 25(OH) awal pada semua kelompok merupakan defisiensi vitamin D. Rerata IMT pada kelompok normal 25 kg/m 2 dan kelompok risiko tinggi diatas 29 kg/m 2 (p < 0,05). 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. Kesimpulan : Suplementasi vitamin D 5000 IU/hari bermanfaat dalam memperbaiki proses implantasi dan plasentasi pada awal kehamilan sehingga pemberiannya diharapkan dapat memperbaiki luaran kehamilan.
Kata kunci : 25(OH)D, Placental Growth Factor (PlGF), PI A. Uterina, preeklamsia


Background : Preeclampsia occurs due to interference with the process of implantation and decidualization in early pregnancy. Vitamin D plays an important role in decidualization, implantation and placentation processes. Recent studies have shown that low serum 25(OH)D levels are a risk factor for preeclampsia. Recent evidence supports the role of vitamin D supplementation initiated before, early and during pregnancy in reducing the risk of preeclampsia. The purpose of this study was to determine the role of vitamin D supplementation of 5000 IU/day on implantation and placentation through examination of PI A. Uterine and maternal serum PlGF in first trimester pregnant women. Methods: Using a single-blind randomized parallel clinical trial. Subjects were pregnant women 7-11 week gestation who were divided into 2 groups, namely normal and high risk based on ACOG high risk criteria. Each group was further divided into controls who received only the standard drug and treatment who received 5000 IU of vitamin D/day. All patients were checked for initial 25(OH)D levels, then given intervention for 1 month and rechecked for final 25(OH)D levels, maternal serum PlGF and PI. A. Uterine. Assessing the comparison of the increase in 25(OH)D levels, mean PlGF, and PI A. Uterine among all groups and Statistical analysis using unpaired T test. Results: The initial subjects were 92 people, 12 people were excluded and the remaining 80 subjects completed the study. The baseline characteristics of the examinations in all groups were equal. The mean initial 25(OH) levels in all groups were vitamin D deficiency. The mean BMI in the normal group was 25 kg/m2 and the high-risk group was above 29 kg/m2 (p < 0.05). Compared to control patients, the increase in 25(OH)D levels in the normal treatment group was still higher than in the high risk treatment group, namely 12.33±6.26 ng/mL and 10.45±5.09 ng/mL with p < 0.001. In the normal group, the decrease in PI A. Uterine compared between control and treatment 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 treatment (107,87±31,97) with p 0.005. In the high risk group, the mean ratio of PlGF levels in the kontrol and treatment was significantly different, namely 37.59±9.67 and 70.53±18.32 with p < 0.001. In intervention patients, both normal and high risk groups, the mean decrease in PI A. Uterine (1.08±0.29 vs 043±0.26; p < 0.001) and PlGF levels (107.87±31.97 vs 70.53±18.32; p < 0.001) were significantly different Conclusion: Supplementation of vitamin D 5000 IU/day is useful in improving the process of implantation and placentation in early pregnancy so that its administration is expected to improve pregnancy outcomes.
Keywords: 25(OH)D, Placental Growth Factor (PlGF), PI A. Uterine, preeclampsia