Kamis, 13 Juni 2013

Morbiditas infeksi terkait lainnya di Ibu, Janin dan neonatus

Infection-Related Morbidities in the Mother, Fetus and Neonate
  1. Staffan Bergström2

Only partially understood host defense mechanisms operate against infections affecting maternal and fetal morbidity. Subclinical ascending infections through the lower female genital tract are predominant worldwide. Important micronutrient deficiencies may prevail in low-income countries where these infections are much more common than in high-income countries. Important morbidities related to poor perinatal outcome both for the mother and for the fetus and newborn comprise preterm birth, prelabor rupture of membranes, placental abruption (predelivery detachment of the placenta), postpartum sepsis and maternal anemia. In the fetus, sepsis and intrauterine growth retardation are suspected to be consequences of ascending maternal infections. In the newborn, septicemia and respiratory disorders as well as some neurological disorders seem to be consequences of such ascending genital infections in the pregnant woman. It is concluded that much more attention should be given to efforts to elucidate the host defense mechanisms and antimicrobial barriers from the vagina through the cervix, fetal membranes and amniotic fluid including the early fetal immunocompetence in the second and the third trimester of pregnancy. 

(Fania Anjela)

Nutrisi Transisi dan Obesitas di Dunia Berkembang

The Nutrition Transition and Obesity in the Developing World
  1. Barry M. Popkin2
Changes in diet and activity patterns are fueling the obesity epidemic. These rapid changes in the levels and composition of dietary and activity/inactivity patterns in transitional societies are related to a number of socioeconomic and demographic changes. Using data mainly from large nationally representative and nationwide surveys, such as the 1989, 1991, 1993 and 1997 China Health and Nutrition Surveys, in combination with comparative analysis across the regions of the world, we examine these factors. First, we show the shifts in diet and activity are consistent with the rapid changes in child and adult obesity and in some cases have been causally linked. We then provide a few examples of the rapid changes in the structure of diet and activity, in particular associated with increased income. Cross-country and in-depth analysis of the China study are used to explore these relationships. People living in urban areas consume diets distinctly different from those of their rural counterparts. One of the more profound effects is the accelerated change in the structure of diet, only partially explained by economic factors. A second is the emergence of a large proportion of families with both currently malnourished and overweight members as is shown by comparative analysis of a number of Asian and Latin American countries. 
 (Fania Anjela)

Analisis Anemia dan Kehamilan-Terkait Kematian Ibu

An Analysis of Anemia and Pregnancy-Related Maternal Mortality
  1. Bernard J. Brabin3,
  2. Mohammad Hakimi*, and
  3. David Pelletier
The relationship of anemia as a risk factor for maternal mortality was analyzed by using cross-sectional, longitudinal and case-control studies because randomized trials were not available for analysis. The following six methods of estimation of mortality risk were adopted: 1) the correlation of maternal mortality rates with maternal anemia prevalence derived from national statistics; 2) the proportion of maternal deaths attributable to anemia; 3) the proportion of anemic women who die; 4) population-attributable risk of maternal mortality due to anemia; 5) adolescence as a risk factor for anemia-related mortality; and 6) causes of anemia associated with maternal mortality. The average estimates for all-cause anemia attributable mortality (both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia and Latin America, respectively. Case fatality rates, mainly for hospital studies, varied from <1% to >50%. The relative risk of mortality associated with moderate anemia (hemoglobin 40–80 g/L) was 1.35 [95% confidence interval (CI): 0.92–2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI: 2.05–6.00). Population-attributable risk estimates can be defended on the basis of the strong association between severe anemia and maternal mortality but not for mild or moderate anemia. In holoendemic malarious areas with a 5% severe anemia prevalence (hemoglobin <70 g/L), it was estimated that in primigravidae, there would be 9 severe-malaria anemia-related deaths and 41 nonmalarial anemia-related deaths (mostly nutritional) per 100,000 live births. The iron deficiency component of these is unknown. 
(Fania Anjela)

Pola Diet Ditandai dengan Asupan tinggi Sayuran, Buah, dan Minyak Nabati Apakah Terkait dengan Risiko Mengurangi Preeklamsia di nulipara Ibu Hamil Norwegia

A Dietary Pattern Characterized by High Intake of Vegetables, Fruits, and Vegetable Oils Is Associated with Reduced Risk of Preeclampsia in Nulliparous Pregnant Norwegian Women
  1. Anne Lise Brantsæter 4 , * ,
  2. Margaretha Haugen 4 ,
  3. Sven Ove Samuelsen 5 , 6 ,
  4. Hanne Torjusen 4 , 7 ,
  5. Lill Trogstad 5 ,
  6. Jan Alexander 4 ,
  7. Per Magnus 5 , and
  8. Helle Margrete Meltzer 4
Several dietary substances have been hypothesized to influence the risk of preeclampsia. Our aim in this study was to estimate the association between dietary patterns during pregnancy and the risk of preeclampsia in 23,423 nulliparous pregnant women taking part in the Norwegian Mother and Child Cohort Study (MoBa). Women participating in MoBa answered questionnaires at gestational wk 15 (a general health questionnaire) and 17–22 (a FFQ). The pregnancy outcomes were obtained from the Medical Birth Registry of Norway. Exploratory factor analysis was used to assess the associations among food variables. Principal component factor analysis identified 4 primary dietary patterns that were labeled: vegetable, processed food, potato and fish, and cakes and sweets. Relative risks of preeclampsia were estimated as odds ratios (OR) and confounder control was performed with multiple logistic regression. Women with high scores on a pattern characterized by vegetables, plant foods, and vegetable oils were at decreased risk [relative risk (OR) for tertile 3 vs. tertile 1: 0.72; 95% CI: 0.62, 0.85]. Women with high scores on a pattern characterized by processed meat, salty snacks, and sweet drinks were at increased risk [OR for tertile 3 vs. tertile 1: 1.21; 95% CI: 1.03, 1.42]. These findings suggest that a dietary pattern characterized by high intake of vegetables, plant foods, and vegetable oils decreases the risk of preeclampsia, whereas a dietary pattern characterized by high consumption of processed meat, sweet drinks, and salty snacks increases the risk. 
(Fania Anjela)

Potensi Biaya-Efektivitas Intervensi Gizi untuk Mencegah Hasil Kehamilan Merugikan di Dunia Berkembang

Potential Cost-Effectiveness of Nutrition Interventions to Prevent Adverse Pregnancy Outcomes in the Developing World
  1. Dwight J. Rouse3 
The potential cost-effectiveness of antenatal nutrition interventions to improve pregnancy outcomes in the developing world has not undergone formal evaluation. Furthermore, the effectiveness of antenatal care in improving maternal or fetal and neonatal health has been questioned. However, reasonably compelling evidence from randomized trials shows that nutrition interventions can prevent both infant (iodine supplementation) and maternal (vitamin A and β-carotene supplementation) deaths, and informal analysis suggests that the cost-effectiveness of nutrition interventions would be comparable and, in some cases, markedly superior to several standard antenatal interventions. Future efforts to establish the cost-effectiveness of nutrition interventions in developing countries will depend on conducting large, pragmatic clinical trials that use region- and resource-appropriate interventions with mortality or valid, incontrovertibly severe morbidity endpoints. If such trials establish effectiveness, credible cost-effectiveness analyses can then be performed. 
(Fania Anjela)