Pengaruh Kadar Vitamin D dan Tumor Necrosis Factor Alpha terhadap Kehamilan Normal Trimester 1 dan Abortus Spontan
(1) Departemen Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Andalas, Rumah Sakit Umum Pusat Dr. M. Djamil Padang, Sumatera Barat, Indonesia
(2) Divisi Uroginekologi, Departemen Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Andalas, Rumah Sakit Umum Pusat Dr. M. Djamil Padang, Sumatera Barat, Indonesia
(*) Corresponding Author
DOI: https://doi.org/10.25077/aoj.7.2.391-404.2023
Abstract
Latar Belakang: Abortus masih merupakan masalah besar dalam pelayanan obstetri karena merupakan salah satu penyebab kematian ibu dan janin sampai saat ini. Kekurangan vitamin D mempengaruhi kehamilan dan dapat berdampak terhadap risiko komplikasi pada ibu hamil dan pada pertumbuhan janin. Tumor necrosis factor-alpha (TNF-α) adalah sitokin Th1 multifungsi dan sangat penting untuk kontrol awal kejadian abortus. Tujuan penelitian ini melihat apakah terdapat perbedaan kadar vitamin D, dan TNF-α pada pasien kehamilan normal trimester 1 dan pasien dengan kejadian abortus.
Metode: Desain penelitian adalah potong-lintang. Penelitian ini dilakukan pada Maret 2022 hingga selesai penelitian di Poliklinik Obstetri dan Ginekologi, PONEK RSUP Dr. M. Djamil Padang, Rumah Sakit Universitas Andalas, Rumah Sakit dr. Reksodiwiryo Padang, RSUD M Zein Painan, RSUD Pariaman untuk pengambilan sampel darah. Pemeriksaan kadar 1,25 dihidroksi vitamin D3, TNF-α serum maternal dilakukan di Laboratorium Biomedik Universitas Andalas Padang. Sampel penelitian ini adalah seluruh ibu hamil trimester 1 dan ibu dengan abortus berjumlah 44 orang. Teknik pengambilan sampel dengan consecutive sampling. Analisis data univariat dan bivariat dengan menggunakan uji T-independen (p<0,05) pada taraf signifikansi dan uji Mann-whitney berdasarkan distribusi data.
Hasil: primipara lebih banyak pada kehamilan normal yaitu 19 orang (86,4%) dan abortus paritas multipara lebih banyak yaitu 12 orang (54,5%). Rerata kadar serum 1,25 dihidroksi vitamin D3 sebesar 52,81 ng/ml dan rerata kadar TNF-α sebesar 351,07 ng/ml. Terdapat perbedaan bermakna pada kadar 1,25 dihidroksi vitamin D3 antara kehamilan normal dengan kehamilan abortus dengan p value 0,047. Perbedaan kadar TNF-α antara abortus dan kehamilan normal didapatkan p value 0,108.
Kesimpulan: Terdapat perbedaan bermakna pada kadar vitamin D antara kehamilan normal dengan kehamilan abortus. Tidak terdapat perbedaan bermakna pada kadar TNF-α antara kehamilan abortus dengan kehamilan normal.
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Sari YN, Herfanda E, Putri IM. Gambaran Faktor Risiko Kejadian Abortus Spontan pada Ibu Hamil di RSUD Panembahan Senopati Bantul Tahun 2017- 2018. J Sehat Mandiri. 2022;17(1):135-145.
Amalia M. FAKTOR RISIKO KEJADIAN ABORTUS (STUDI DI RUMAH SAKIT ISLAM SULTAN AGUNG SEMARANG). J Kesehat Masy Indones. 2015;10(1):23-29.
Prahesti R. Analisis faktor-faktor yang berhubungan dengan kejadian anemia pada ibu hamil di Puskesmas Prambanan, Sleman, Yogyakarta. Published online 2017.
Purwaningrum ED, Fibriyana AI. Faktor risiko kejadian abortus spontan. HIGEIA (Journal Public Heal Res Dev. 2017;1(3):84-94.
Singh S, Maddow‐Zimet I. Facility‐based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG An Int J Obstet Gynaecol. 2016;123(9):1489-1498.
Camuci MB, Martins JT, Cardeli AAM, Robazzi ML do CC. Nursing Activities Score: nursing work load in a burns Intensive Care Unit. Rev Lat Am Enfermagem. 2014;22:325-331.
Ganatra B, Gerdts C, Rossier C, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372-2381.
Kuntari T, Wilopo SA, Emilia O. Determinan abortus di Indonesia. Kesmas J Kesehat Masy Nas (National Public Heal Journal). 2010;4(5):223-229.
Sitilonga JM, Sitorus RJ, Yeni Y. CAUSAL FACTORS OF ABORTUS SPONTANEOUS OCCURENCE IN DR. MOHAMMAD HOESIN GENERAL STATE HOSPITAL PALEMBANG. J Ilmu Kesehat Masy. 2017;8(2):100-108.
World Health Organization (WHO). Abortion.; 2014. https://www.who.int/news-room/fact-sheets/detail/abortion
World Health Organization (WHO). Maternal Mortality Fact Sheet.; 2016.
Kementerian Kesehatan RI. Riset Kesehatan Dasar Di Indonesia Tahun 2010.; 2010.
Kementrian Kesehatan RI. Profil Kesehatan Indonesia Tahun 2015.; 2015.
Vitoratos N, Economou E, Iavazzo C, Panoulis K, Creatsas G. Maternal serum levels of TNF-alpha and IL-6 long after delivery in preeclamptic and normotensive pregnant women. Mediators Inflamm. 2010;2010.
Bhattacharya S, Townend J, Shetty A, Campbell D, Bhattacharya S. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy? BJOG An Int J Obstet Gynaecol. 2008;115(13):1623-1629.
Hou W, Yan XT, Bai CM, Zhang XW, Hui LY, Yu XW. Decreased serum vitamin D levels in early spontaneous pregnancy loss. Eur J Clin Nutr. 2016;70(9):1004-1008.
Urrutia-Pereira M, Solé D. Vitamin D deficiency in pregnancy and its impact on the fetus, the newborn and in childhood. Rev Paul Pediatr. 2015;33:104-113.
Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull. 2018;126(1):57-77.
Miliku K, Vinkhuyzen A, Blanken LME, et al. Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes. Am J Clin Nutr. 2016;103(6):1514-1522.
Wagner CL, Taylor SN, Johnson DD, Hollis BW. The role of vitamin D in pregnancy and lactation: emerging concepts. Women’s Heal. 2012;8(3):323- 340.
Wagner CL, Hollis BW. The implications of vitamin D status during pregnancy on mother and her developing child. Front Endocrinol (Lausanne). Published online 2018:500.
Suryana H, Kampono N, Hestiantoro A. Perbandingan kadar interleukin-10 serum antara wanita hamil normal dan hamil dengan ancaman persalinan preterm. Indones J Obstet Gynecol. Published online 2006.
Ji J, Muyayalo KP, Zhang Y, Hu X, Liao A. Immunological function of vitamin D during human pregnancy. Am J Reprod Immunol. 2017;78(2):e12716.
Hollis BW, Wagner CL. New insights into the vitamin D requirements during pregnancy. Bone Res. 2017;5(1):1-16.
Sheiner EK. Bleeding during Pregnancy: A Comprehensive Guide. Springer Science & Business Media; 2011.
Aji AS, Erwinda E, Yusrawati Y, Malik SG, Lipoeto NI. Vitamin D deficiency status and its related risk factors during early pregnancy: a cross-sectional study of pregnant Minangkabau women, Indonesia. BMC Pregnancy Childbirth. 2019;19(1):1-10.
Koch Y, Wimberger P, Grümmer R. Human chorionic gonadotropin induces decidualization of ectopic human endometrium more effectively than forskolin in an in-vivo endometriosis model. Exp Biol Med. 2018;243(11):953-962.
Ng S-W, Norwitz GA, Pavlicev M, Tilburgs T, Simón C, Norwitz ER. Endometrial decidualization: the primary driver of pregnancy health. Int J Mol Sci. 2020;21(11):4092.
Tamblyn JA, Hewison M, Wagner CL, Bulmer JN, Kilby MD. Immunological role of vitamin D at the maternal–fetal interface. J Endocrinol. 2015;224(3):R107-R121.
Greer LL NJ. Buku Acuan Persalinan Kurang Bulan (Prematur) 1.; 2005.
Zygmunt M, Lang U, Katz N, Künzel W. Maternal plasma fibronectin: a predictor of preterm delivery. Eur J Obstet Gynecol Reprod Biol. 1997;72(2):121-126.
Romanowska-Próchnicka K, Felis-Giemza A, Olesińska M, Wojdasiewicz P, Paradowska-Gorycka A, Szukiewicz D. The role of TNF-α and anti-TNF-α agents during preconception, pregnancy, and breastfeeding. Int J Mol Sci. 2021;22(6):2922.
McLoughlin RM, Jenkins BJ, Grail D, et al. IL-6 trans-signaling via STAT3 directs T cell infiltration in acute inflammation. Proc Natl Acad Sci. 2005;102(27):9589-9594.
Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss III JF, Petraglia F. Inflammation and pregnancy. Reprod Sci. 2009;16(2):206-215.
Ragsdale HB, Kuzawa C, Borja J, McDade TW. Inflammatory cytokines in pregnancy and birth outcomes in the Philippines. In: AMERICAN JOURNAL OF HUMAN BIOLOGY. Vol 30. WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA; 2018.
Sulistyorini D, Putri SS. Analisis faktor-faktor yang mempengaruhi kejadian BBLR di Puskesmas Pedesaan Kabupaten Banjarnegara tahun 2014. J Ilm Medsains. 2015;1(1):23-29.
Tafti FD, Zare F, Miresmaeili SM, Fesahat F. Evaluating Vitamin D and foxp3 mRNA levels in women with recurrent spontaneous abortion. JBRA Assist Reprod. 2022;26(2):232.
Li N, Wu H, Hang F, Zhang YS, Li MJ. Women with recurrent spontaneous abortion have decreased 25 (OH) vitamin D and VDR at the fetal-maternal interface. Brazilian J Med Biol Res. 2017;50.
Lee SM, Meyer MB, Benkusky NA, O’Brien CA, Pike JW. The impact of VDR expression and regulation in vivo. J Steroid Biochem Mol Biol. 2018;177:36-45.
Hamzaoui A, Berraïes A, Hamdi B, Kaabachi W, Ammar J, Hamzaoui K. Vitamin D reduces the differentiation and expansion of Th17 cells in young asthmatic children. Immunobiology. 2014;219(11):873-879.
Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 2016;96(1):365-408.
Adhi KC, Sulistywati S, Respati SH. KADAR HUMAN LEUKOCYTE ANTIGEN-G (HLAG) DAN TUMOR NERCROSIS FAKTOR ALPHA (TNFa) PADA ABORTUS DAN KEHAMILAN NORMAL. J Kesehat Reproduksi. 2016;2(2).
Mahadevan U, Martin CF, Sandler RS, et al. 865 PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy. Gastroenterology. 2012;5(142):S149.
Yang S-L, Tan H-X, Niu T-T, Li D-J, Wang H-Y, Li M-Q. Kynurenine promotes the cytotoxicity of NK cells through aryl hydrocarbon receptor in early pregnancy. J Reprod Immunol. 2021;143:103270.
Dai F, Hu M, Zhang Y, et al. TNF-α/Anti-TNF-α drugs and its effect onpregnancy outcomes. Expert Rev Mol Med. 2022;24:e26.
Cantorna MT. Diet, immunity and inflammation: 9. Vitamin D and the immune system. Elsevier Inc Chapters. Published online 2013.
Gil Á, Plaza-Diaz J, Mesa MD. Vitamin D: classic and novel actions. Ann Nutr Metab. 2018;72(2):87-95.
Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta. 2010;31(12):1027-1034.
Akoh CC, Pressman EK, Cooper E, Queenan RA, Pillittere J, O’Brien KO. Low vitamin D is associated with infections and proinflammatory cytokines during pregnancy. Reprod Sci. 2018;25:414-423.
Rasud R. Hubungan Kadar Serum 25 (OH) Vitamin D Ibu Hamil Trimester III Dengan Luaran Maternal. Published online 2020.
Dovnik A, Mujezinović F. The association of vitamin D levels with common pregnancy complications. Nutrients. 2018;10(7):867.
Jang HG, Choi Y, Kim JO, et al. Polymorphisms in tumor necrosis factor-alpha (− 863C> A,− 857C> T and+ 488G> A) are associated with idiopathic recurrent pregnancy loss in Korean women. Hum Immunol. 2016;77(6):506-511.
Pietrowski D, Bettendorf H, Keck C, et al. Lack of association of TNFα gene polymorphisms and recurrent pregnancy loss in Caucasian women. J Reprod Immunol. 2004;61(1):51-58.
Kwiatek M, Gęca T, Kwaśniewska A. Pro-and Anti-Inflammatory Cytokines in the First Trimester—Comparison of Missed Miscarriage and Normal Pregnancy. Int J Environ Res Public Health. 2021;18(16):8538.
Pérez-Roque L, Núñez-Gómez E, Rodríguez-Barbero A, Bernabéu C, LópezNovoa JM, Pericacho M. Pregnancy-induced high plasma levels of soluble endoglin in mice lead to preeclampsia symptoms and placental abnormalities. Int J Mol Sci. 2021;22(1):1-20. doi:10.3390/ijms22010165
Yu X-W, Li X, Ren Y-H, Li X-C. Tumour necrosis factor-α receptor 1 polymorphisms and serum soluble TNFR1 in early spontaneous miscarriage. Cell Biol Int. 2007;31(11):1396-1399.
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