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Papers by rima irwinda

Research paper thumbnail of Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta

Journal of Pregnancy, 2021

Introduction. Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1)... more Introduction. Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth. Method. A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection ( fever > 38 ° C , leukocytosis > 18000 / μ L , or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG. Result. A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio ( p...

Research paper thumbnail of Serum zinc, selenium, iron, and copper levels in pregnant women with fetal growth restriction

Clinical and Experimental Obstetrics & Gynecology

Research paper thumbnail of Maternal Amino Acid Status in Severe Preeclampsia: A Cross-Sectional Study

Nutrients

Introduction: Preeclampsia has been one of the leading causes of maternal death in Indonesia. It ... more Introduction: Preeclampsia has been one of the leading causes of maternal death in Indonesia. It is postulated that its relationship with oxidative stress may be the underlying pathology of the disease. Nutrients and amino acids have been suggested as a scavenger for oxygen-free radicals. No previous study regarding the amino acid status in preeclampsia has been conducted in women in Indonesia. Methods: This was a cross-sectional study of a total of 64 pregnant women, 30 with normal pregnancy and 34 with severe preeclampsia. Data were obtained in Cipto Mangunkusumo National Referral Hospital in Jakarta from July to December 2020. Maternal blood samples were taken during or soon after delivery. Amino acid levels were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bivariate analysis was then performed. Results: We identified 19 different levels of amino acids in this study. Four amino acids that were elevated in the preeclampsia group were phenylalanine, ser...

Research paper thumbnail of Intrauterine Infection Predictors among Preterm Premature Rupture of Membrane Patients

Journal of Research in Medical and Dental Science, 2018

Introduction: The preterm premature rupture of membrane (PPROM) complicates pregnancy for 1% to 2... more Introduction: The preterm premature rupture of membrane (PPROM) complicates pregnancy for 1% to 2% of all women and it is associated with 30% to 40% of preterm birth. It is difficult to determine whether infection as the cause or consequence of preterm delivery. Therefore, this study aimed to review several markers to predict intrauterine infection for good management among PPROM patients. Methods: The author searched in PubMed, Cochrane, and Ovid using searching strategy "MeSH". There were 25, 20, and 2 articles found in PubMed, Cochrane, and Ovid; respectively which finally ended to 8 cohort or case control studies and 2 systematic reviews. Critical appraisal was based on validity, importance, and applicability (VIA). Results: In maternal parameters, sensitivity of temperature, heart rate, leucocyte count, and CRP were low without regarding the infection. Besides, biophysical profile score and fetal heart activity were insensitive to predict intrauterine infection. Fetal...

Research paper thumbnail of A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Nutrients

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a ma... more Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable world...

Research paper thumbnail of Remdesivir Treatment for COVID 19 in Pregnant Patients with Moderate to Severe Symptoms: Serial Case Report

Infectious Disease Reports

Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection that causes... more Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection that causes novel Coronavirus Disease 2019 (COVID-19) has become a major health problem worldwide and been declared a pandemic since March 2020 by WHO. One special population that poses a challenge is pregnant women with COVID-19. There have not been many studies related to COVID-19 in pregnancy. In this study, we present five serial cases of Remdesivir treatment for COVID-19 in pregnant women with moderate to severe symptoms. Case Illustration: We briefly describe five serial cases being treated with Remdesivir therapy during hospitalization. Four cases were delivered by cesarean section, and one was delivered vaginally in gestation week 37. All cases showed a shortened duration of hospitalization, rapid improvement in clinical symptoms, and no adverse events were observed in mothers, fetuses, and neonates. Discussion: Remdesivir, an inhibitor RNA Polymerase, has been used in COVID-19 treatment an...

Research paper thumbnail of ILSI Southeast Asia symposium: prevalence, risk factors, and actions to address gestational diabetes in selected Southeast Asian countries

European Journal of Clinical Nutrition

Research paper thumbnail of Lower placental 25-hydroxyvitamin D3 (25(OH)D3) and higher placental CYP27B1 and 25(OH)D3 ratio in preterm birth

Journal of Nutritional Science

Neonatal mortality rates in Indonesia are still at an alarming rate, with preterm birth as one of... more Neonatal mortality rates in Indonesia are still at an alarming rate, with preterm birth as one of the causes. Nutritional deficiencies such as low level of vitamin D is suspected to be the risk factors of preterm birth but still a little knowledge about it. Vitamin D metabolism includes 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), as the inactive and active form, with the help of 1α-hydroxylase (CYP27B1) enzyme. Our study aims to determine the differences of 25(OH)D3, 1,25(OH)2D3 and CYP27B1 enzyme in term and preterm birth. A cross-sectional study was performed in Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, in January–June 2017. The blood sample was taken soon after delivery, to examine maternal 25(OH)D3 and 1,25(OH)2D3 in serum and tissue placenta, as well as placental CYP27B1 enzyme. Statistical analysis using SPPS version 20 was used to find significances. There were a total of sixty subjects in this study, with term-preterm b...

Research paper thumbnail of The effect of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women

Medical Journal of Indonesia, 2015

Latar belakang: Keuntungan suplementasi multi mikronutrien semakin mendapat perhatian melihat ban... more Latar belakang: Keuntungan suplementasi multi mikronutrien semakin mendapat perhatian melihat banyaknya ibu hamil dengan status nutrisi yang suboptimal, namun rendahnya kepatuhan mengurangi efektivitas dari program suplementasi besi-asam folat yang dicanangkan pemerintah. Tujuan studi ini adalah untuk menilai efektivitas suplementasi multimikronutrien dan protein pada status besi dan mikronutrien wanita hamil. Metode: Studi eksploratif dilakukan pada 100 wanita hamil selama ≤ 12 minggu yang melakukan asuhan antenatal di Rumah Sakit Budi Kemuliaan, Jakarta. Susu formula yang mengandung multi-mikronutrien dan protein diberikan setiap bulan hingga persalinan. Pemeriksaan antropometri, darah maternal dan tali pusat, ultrasonografi (USG), dan dietary recall merupakan variabel yang dinilai. Data dianalisis menggunakan uji korelasi. Korelasi antar variabel diuji menggunakan uji Pearson atau Spearman.

Research paper thumbnail of The status of probiotics supplementation during pregnancy

Medical Journal of Indonesia, 2015

Probiotics have been known for their use in medical field for quite a long time. Strong evidences... more 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.

Research paper thumbnail of Impact of pregnancy-induced hypertension on fetal growth

American Journal of Obstetrics and Gynecology, 1999

The purpose of this study was to evaluate the effect of different types of pregnancy-induced hype... more The purpose of this study was to evaluate the effect of different types of pregnancy-induced hypertension on fetal growth. STUDY DESIGN: A retrospective cohort study was conducted on the basis of 16,936 births from January 1, 1989, through December 31, 1990, by means of data from a population-based perinatal database in Suzhou, China. Pregnancy-induced hypertension was classified as gestational hypertension, preeclampsia, or severe preeclampsia-eclampsia. Univariate and multivariate regression analyses were performed to examine the effect of the various types of pregnancy-induced hypertension on gestational age, preterm birth, birth weight, low birth weight, and intrauterine growth restriction. RESULTS: Gestation was 0.6 week shorter in women with severe preeclampsia than in normotensive women (P < .01). However, the risk of preterm birth was not increased with any classification of pregnancyinduced hypertension (for severe preeclampsia: adjusted odds ratio 1.75; 95% confidence interval, 0.88-3.47). After adjustment for duration of gestation and other confounders, preeclampsia and severe preeclampsia increased the risk of intrauterine growth restriction and low birth weight. The adjusted odds ratios of low birth weight were 2.65 (1.73-4.39) for preeclampsia and 2.53 (1.19-4.93) for severe preeclampsia. However, the risk of low birth weight was not increased significantly for gestational hypertension (adjusted odds ratio 1.56 [1.00-2.41]).

Research paper thumbnail of Assessment of the nutrient intake and micronutrient status in the first trimester of pregnant women in Jakarta

Medical Journal of Indonesia

Tujuan dari penelitian ini adalah untuk mengetahui asupan nutrisi dan status mikronutrien dalam s... more Tujuan dari penelitian ini adalah untuk mengetahui asupan nutrisi dan status mikronutrien dalam serum wanita hamil di Jakarta pada trimester pertama. Metode: Studi deskriptif dilakukan pada 234 wanita hamil pada trimester pertama (<14 minggu). Asupan nutrisi didapat dari konversi frequency food questionnaire (FFQ) semi kuantitatif menggunakan Nutrisurvey. Serum maternal diperiksa untuk menilai kadar nutrisi.

Research paper thumbnail of Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta

Journal of Pregnancy, 2021

Introduction Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) ... more Introduction Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth. Method A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection (fever > 38°C, leukocytosis > 18000/μL, or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG. Result A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio (p = 0.181), H...

Research paper thumbnail of Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta

PLoS ONE, 2020

Background The prevalence of gestational hypertension and diabetes in pregnancy is increasing wor... more Background The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project. Methods Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose...

Research paper thumbnail of A Significant Increase in Maternal Blood Uric Acid Levels Accompanies the Severity of Hypertensive Disorders in Pregnancy

Indonesian Journal of Obstetrics and Gynecology, 2021

Objective: To asses the relationship between maternal serum uric acid level and severity of hyper... more Objective: To asses the relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes.Methods: A cross sectional study was conducted at Persahabatan Hospital from January 2014 to December 2018. Subject were pregnant women with hypertensive disorder. Serum uric acid levels were taken from a venous blood sample at the time the patient came for delivery. The severity of hypertensive disorders in pregnancy were grouped into chronic hypertension, gestational hypertension, preeclampsia without severe feature, preeclampsia with severe feature, and preeclampsia with severe feature and organ involvement. The perinatal outcomes were the gestational age at birth, birth weight, and the first minute APGAR score. The relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes were analyzed using Mann Whitney and Kruskall Wallis test.Result: A total of 704 out of 880 ...

Research paper thumbnail of Long-chain polyunsaturated fatty acid (LC-PUFA) status in severe preeclampsia and preterm birth: a cross sectional study

Scientific Reports

Long-Chain Polyunsaturated Fatty Acid (LCPUFA) is essential throughout pregnancy, since deficienc... more Long-Chain Polyunsaturated Fatty Acid (LCPUFA) is essential throughout pregnancy, since deficiency of LPUFA may linked to obstetrical complications. This study aimed to investigate LCPUFA status in severe preeclampsia and preterm birth. A cross sectional study was conducted in 104 pregnant women, which divided into normal pregnancy, severe preeclampsia and preterm birth groups. Serum percentage and concentration of total LCPUFA, omega-3, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), omega-6, linoleic acid (LA), and arachidonic acid (AA) were measured using gas chromatography/mass spectrometry. Receiver operating characteristic (ROC), bivariate and multivariate analysis were performed. Severe preeclampsia showed the highest concentration of total PUFA and the lowest DHA percentage, with significantly higher Omega-6/Omega-3 ratio (p = 0.004) and lower omega-3 index (p

Research paper thumbnail of Maternal Characteristics, Pregnancy, and Neonatal Outome in Preeclampsia and HELLP Syndrome: a Comparative Study

HELLP syndrome is a complication in pregnancy which may increase maternal morbidity and mortality... more HELLP syndrome is a complication in pregnancy which may increase maternal morbidity and mortality risk. This study aims to compare maternal characteristics, pregnancy and neonatal outcome between preeclampsia and HELLP syndrome. All preeclampsia without or with severe features and HELLP syndrome using ACOG criteria coming to dr. Cipto Mangunkusumo Hospital from January 2015 to December 2017 were recruited into this cross-sectional study. Demographic, clinical, laboratories parameters, and neonatal outcomes were compared between HELLP and preeclampsia patients. The SPSS 20 for Windows was used for all analyses. There were 676 deliveries which was complicated by preeclampsia without or with severe features and 113 patients with HELLP syndrome. Gestational age, history of hypertension systolic and diastolic blood pressure, hemoglobin, hematocrit, urea, creatinine, uric acid, and albumin are different significantly between HELLP and preeclampsia patients. History of hypertension in prev...

Research paper thumbnail of Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women

Women's Health

Introduction: Cesarean section is one of the most common obstetrical interventions that has been ... more Introduction: Cesarean section is one of the most common obstetrical interventions that has been performed at an increasing rate globally, due to both medical and non-medical reasons. This study aims to develop a prediction tool for pregnant women potentially needing c-section, such that necessary preparations from the mothers, families, and health providers can be made. Methods: A total of 603 pregnant women were recruited in the first phase of c-section prediction tool development. The association between the maternal and fetal factors on the risk of c-section were analyzed, followed by a stepwise multivariate regression analysis. In the next phase, 61 pregnant women were enrolled for external validation. Discrimination was assessed using area under the curve. The calibration plot was then made and assessed using the Hosmer–Lemeshow test. Results: There were 251 (41.6%) cases of vaginal delivery and 352 (58.4%) of c-section assessed. Multivariate analysis showed that gestational age

Research paper thumbnail of Preeclampsia: From Cellular Wellness to Inappropriate Cell Death, and the Roles of Nutrition

Frontiers in Cell and Developmental Biology

Preeclampsia is one of the most common obstetrical complications worldwide. The pathomechanism of... more Preeclampsia is one of the most common obstetrical complications worldwide. The pathomechanism of this disease begins with abnormal placentation in early pregnancy, which is associated with inappropriate decidualization, vasculogenesis, angiogenesis, and spiral artery remodeling, leading to endothelial dysfunction. In these processes, appropriate cellular deaths have been proposed to play a pivotal role, including apoptosis and autophagy. The proper functioning of these physiological cell deaths for placentation depends on the wellbeing of the trophoblasts, affected by the structural and functional integrity of each cellular component including the cell membrane, mitochondria, endoplasmic reticulum, genetics, and epigenetics. This cellular wellness, which includes optimal cellular integrity and function, is heavily influenced by nutritional adequacy. In contrast, nutritional deficiencies may result in the alteration of plasma membrane, mitochondrial dysfunction, endoplasmic reticulu...

Research paper thumbnail of What is the Best Predictor for Diagnosis of Placenta Accreta? An Evidence-Based Review

Obstetrics & Gynecology International Journal, 2016

Background: Antenatal diagnosis of placenta accreta is important because it could possibly reduce... more Background: Antenatal diagnosis of placenta accreta is important because it could possibly reduce the morbidities. Several attempts including ultrasound, magnetic resonance imaging (MRI), multi-parameter prediction, and cell-free placental mRNA had been studied to establish a good predictor for diagnosis of placenta accreta. We aim to appraise several studies finding at the accuracy value of these predictors. Methods: The search was conducted on the Cochrane Library®, PubMed® and EMBASE® with the keywords of “ultrasound”, “accreta”, and “predict” or “predictor” or “predicting”. We used diagnostic appraisal questions developed by Centre of Evidence-Based Medicine (CEBM), University of Oxford. Result: Appraisal of 8 diagnostic studies involving 1324 patients underwent ultrasound, MRI, cell-free mRNA examination, or their combination for predicting placenta accreta was conducted finding at the diagnostic values. The overall rate of placenta accreta found on these studies were ranging from 8.4% to 31.8%. Accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of ultrasound in this study in diagnosing placenta accreta were respectively 64.8% – 95.3%, 17% - 100%, 78.9%-100%, 56%-100%, and 64,8% - 100%. The Se, Sp, PPV, and NPV of MRI in predicting placenta accreta derived from 3 studies were respectively 88.89%-100%, 100%, 100%, 92.86%-100%. Se, Sp, PPV, and NPV of cell-free placental mRNA for placenta accreta prediction were respectively. 91.7%, 78.9%, 57.9% and 96.8% using the multiple of median (MoM) of 3.325 as the cut-off point. Conclusion: Ultrasound has a wide range of diagnostic accuracy in predicting placenta accreta. MRI had better diagnostic accuracy for predicting the stage of invasion of placenta. Free-placental mRNA is an objective and promising predictor for diagnosis of placenta accreta.

Research paper thumbnail of Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta

Journal of Pregnancy, 2021

Introduction. Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1)... more Introduction. Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth. Method. A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection ( fever > 38 ° C , leukocytosis > 18000 / μ L , or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG. Result. A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio ( p...

Research paper thumbnail of Serum zinc, selenium, iron, and copper levels in pregnant women with fetal growth restriction

Clinical and Experimental Obstetrics & Gynecology

Research paper thumbnail of Maternal Amino Acid Status in Severe Preeclampsia: A Cross-Sectional Study

Nutrients

Introduction: Preeclampsia has been one of the leading causes of maternal death in Indonesia. It ... more Introduction: Preeclampsia has been one of the leading causes of maternal death in Indonesia. It is postulated that its relationship with oxidative stress may be the underlying pathology of the disease. Nutrients and amino acids have been suggested as a scavenger for oxygen-free radicals. No previous study regarding the amino acid status in preeclampsia has been conducted in women in Indonesia. Methods: This was a cross-sectional study of a total of 64 pregnant women, 30 with normal pregnancy and 34 with severe preeclampsia. Data were obtained in Cipto Mangunkusumo National Referral Hospital in Jakarta from July to December 2020. Maternal blood samples were taken during or soon after delivery. Amino acid levels were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bivariate analysis was then performed. Results: We identified 19 different levels of amino acids in this study. Four amino acids that were elevated in the preeclampsia group were phenylalanine, ser...

Research paper thumbnail of Intrauterine Infection Predictors among Preterm Premature Rupture of Membrane Patients

Journal of Research in Medical and Dental Science, 2018

Introduction: The preterm premature rupture of membrane (PPROM) complicates pregnancy for 1% to 2... more Introduction: The preterm premature rupture of membrane (PPROM) complicates pregnancy for 1% to 2% of all women and it is associated with 30% to 40% of preterm birth. It is difficult to determine whether infection as the cause or consequence of preterm delivery. Therefore, this study aimed to review several markers to predict intrauterine infection for good management among PPROM patients. Methods: The author searched in PubMed, Cochrane, and Ovid using searching strategy "MeSH". There were 25, 20, and 2 articles found in PubMed, Cochrane, and Ovid; respectively which finally ended to 8 cohort or case control studies and 2 systematic reviews. Critical appraisal was based on validity, importance, and applicability (VIA). Results: In maternal parameters, sensitivity of temperature, heart rate, leucocyte count, and CRP were low without regarding the infection. Besides, biophysical profile score and fetal heart activity were insensitive to predict intrauterine infection. Fetal...

Research paper thumbnail of A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Nutrients

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a ma... more Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable world...

Research paper thumbnail of Remdesivir Treatment for COVID 19 in Pregnant Patients with Moderate to Severe Symptoms: Serial Case Report

Infectious Disease Reports

Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection that causes... more Introduction: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection that causes novel Coronavirus Disease 2019 (COVID-19) has become a major health problem worldwide and been declared a pandemic since March 2020 by WHO. One special population that poses a challenge is pregnant women with COVID-19. There have not been many studies related to COVID-19 in pregnancy. In this study, we present five serial cases of Remdesivir treatment for COVID-19 in pregnant women with moderate to severe symptoms. Case Illustration: We briefly describe five serial cases being treated with Remdesivir therapy during hospitalization. Four cases were delivered by cesarean section, and one was delivered vaginally in gestation week 37. All cases showed a shortened duration of hospitalization, rapid improvement in clinical symptoms, and no adverse events were observed in mothers, fetuses, and neonates. Discussion: Remdesivir, an inhibitor RNA Polymerase, has been used in COVID-19 treatment an...

Research paper thumbnail of ILSI Southeast Asia symposium: prevalence, risk factors, and actions to address gestational diabetes in selected Southeast Asian countries

European Journal of Clinical Nutrition

Research paper thumbnail of Lower placental 25-hydroxyvitamin D3 (25(OH)D3) and higher placental CYP27B1 and 25(OH)D3 ratio in preterm birth

Journal of Nutritional Science

Neonatal mortality rates in Indonesia are still at an alarming rate, with preterm birth as one of... more Neonatal mortality rates in Indonesia are still at an alarming rate, with preterm birth as one of the causes. Nutritional deficiencies such as low level of vitamin D is suspected to be the risk factors of preterm birth but still a little knowledge about it. Vitamin D metabolism includes 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), as the inactive and active form, with the help of 1α-hydroxylase (CYP27B1) enzyme. Our study aims to determine the differences of 25(OH)D3, 1,25(OH)2D3 and CYP27B1 enzyme in term and preterm birth. A cross-sectional study was performed in Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, in January–June 2017. The blood sample was taken soon after delivery, to examine maternal 25(OH)D3 and 1,25(OH)2D3 in serum and tissue placenta, as well as placental CYP27B1 enzyme. Statistical analysis using SPPS version 20 was used to find significances. There were a total of sixty subjects in this study, with term-preterm b...

Research paper thumbnail of The effect of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women

Medical Journal of Indonesia, 2015

Latar belakang: Keuntungan suplementasi multi mikronutrien semakin mendapat perhatian melihat ban... more Latar belakang: Keuntungan suplementasi multi mikronutrien semakin mendapat perhatian melihat banyaknya ibu hamil dengan status nutrisi yang suboptimal, namun rendahnya kepatuhan mengurangi efektivitas dari program suplementasi besi-asam folat yang dicanangkan pemerintah. Tujuan studi ini adalah untuk menilai efektivitas suplementasi multimikronutrien dan protein pada status besi dan mikronutrien wanita hamil. Metode: Studi eksploratif dilakukan pada 100 wanita hamil selama ≤ 12 minggu yang melakukan asuhan antenatal di Rumah Sakit Budi Kemuliaan, Jakarta. Susu formula yang mengandung multi-mikronutrien dan protein diberikan setiap bulan hingga persalinan. Pemeriksaan antropometri, darah maternal dan tali pusat, ultrasonografi (USG), dan dietary recall merupakan variabel yang dinilai. Data dianalisis menggunakan uji korelasi. Korelasi antar variabel diuji menggunakan uji Pearson atau Spearman.

Research paper thumbnail of The status of probiotics supplementation during pregnancy

Medical Journal of Indonesia, 2015

Probiotics have been known for their use in medical field for quite a long time. Strong evidences... more 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.

Research paper thumbnail of Impact of pregnancy-induced hypertension on fetal growth

American Journal of Obstetrics and Gynecology, 1999

The purpose of this study was to evaluate the effect of different types of pregnancy-induced hype... more The purpose of this study was to evaluate the effect of different types of pregnancy-induced hypertension on fetal growth. STUDY DESIGN: A retrospective cohort study was conducted on the basis of 16,936 births from January 1, 1989, through December 31, 1990, by means of data from a population-based perinatal database in Suzhou, China. Pregnancy-induced hypertension was classified as gestational hypertension, preeclampsia, or severe preeclampsia-eclampsia. Univariate and multivariate regression analyses were performed to examine the effect of the various types of pregnancy-induced hypertension on gestational age, preterm birth, birth weight, low birth weight, and intrauterine growth restriction. RESULTS: Gestation was 0.6 week shorter in women with severe preeclampsia than in normotensive women (P < .01). However, the risk of preterm birth was not increased with any classification of pregnancyinduced hypertension (for severe preeclampsia: adjusted odds ratio 1.75; 95% confidence interval, 0.88-3.47). After adjustment for duration of gestation and other confounders, preeclampsia and severe preeclampsia increased the risk of intrauterine growth restriction and low birth weight. The adjusted odds ratios of low birth weight were 2.65 (1.73-4.39) for preeclampsia and 2.53 (1.19-4.93) for severe preeclampsia. However, the risk of low birth weight was not increased significantly for gestational hypertension (adjusted odds ratio 1.56 [1.00-2.41]).

Research paper thumbnail of Assessment of the nutrient intake and micronutrient status in the first trimester of pregnant women in Jakarta

Medical Journal of Indonesia

Tujuan dari penelitian ini adalah untuk mengetahui asupan nutrisi dan status mikronutrien dalam s... more Tujuan dari penelitian ini adalah untuk mengetahui asupan nutrisi dan status mikronutrien dalam serum wanita hamil di Jakarta pada trimester pertama. Metode: Studi deskriptif dilakukan pada 234 wanita hamil pada trimester pertama (<14 minggu). Asupan nutrisi didapat dari konversi frequency food questionnaire (FFQ) semi kuantitatif menggunakan Nutrisurvey. Serum maternal diperiksa untuk menilai kadar nutrisi.

Research paper thumbnail of Oxidative Stress Induced Damage and Early Senescence in Preterm Placenta

Journal of Pregnancy, 2021

Introduction Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) ... more Introduction Senescent cells have been demonstrated to release High Mobility Group Box 1 (HMGB1) which induces labor through an inflammatory pathway. This research is aimed at demonstrating whether telomere shortening, proinflammatory HMGB1, and oxidative damage marker 8-OHdG play a role in the placenta of preterm birth in comparison to term birth. Method A cross-sectional study on 67 full thickness of the placenta obtained from mothers with term and preterm birth. Mothers with clinical signs of infection (fever > 38°C, leukocytosis > 18000/μL, or abnormal vaginal discharge) and other pregnancy complications were excluded. Real-time polymerase chain reaction was performed to measure T/S ratio and ELISA quantification to measure the amount of HMGB1 and 8-OHdG. Result A total of 34 placentas from preterm and 33 placentas from term birth were examined. Maternal characteristics were comparable between the two groups. There were no statistical difference of T/S ratio (p = 0.181), H...

Research paper thumbnail of Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta

PLoS ONE, 2020

Background The prevalence of gestational hypertension and diabetes in pregnancy is increasing wor... more Background The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project. Methods Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose...

Research paper thumbnail of A Significant Increase in Maternal Blood Uric Acid Levels Accompanies the Severity of Hypertensive Disorders in Pregnancy

Indonesian Journal of Obstetrics and Gynecology, 2021

Objective: To asses the relationship between maternal serum uric acid level and severity of hyper... more Objective: To asses the relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes.Methods: A cross sectional study was conducted at Persahabatan Hospital from January 2014 to December 2018. Subject were pregnant women with hypertensive disorder. Serum uric acid levels were taken from a venous blood sample at the time the patient came for delivery. The severity of hypertensive disorders in pregnancy were grouped into chronic hypertension, gestational hypertension, preeclampsia without severe feature, preeclampsia with severe feature, and preeclampsia with severe feature and organ involvement. The perinatal outcomes were the gestational age at birth, birth weight, and the first minute APGAR score. The relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes were analyzed using Mann Whitney and Kruskall Wallis test.Result: A total of 704 out of 880 ...

Research paper thumbnail of Long-chain polyunsaturated fatty acid (LC-PUFA) status in severe preeclampsia and preterm birth: a cross sectional study

Scientific Reports

Long-Chain Polyunsaturated Fatty Acid (LCPUFA) is essential throughout pregnancy, since deficienc... more Long-Chain Polyunsaturated Fatty Acid (LCPUFA) is essential throughout pregnancy, since deficiency of LPUFA may linked to obstetrical complications. This study aimed to investigate LCPUFA status in severe preeclampsia and preterm birth. A cross sectional study was conducted in 104 pregnant women, which divided into normal pregnancy, severe preeclampsia and preterm birth groups. Serum percentage and concentration of total LCPUFA, omega-3, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), omega-6, linoleic acid (LA), and arachidonic acid (AA) were measured using gas chromatography/mass spectrometry. Receiver operating characteristic (ROC), bivariate and multivariate analysis were performed. Severe preeclampsia showed the highest concentration of total PUFA and the lowest DHA percentage, with significantly higher Omega-6/Omega-3 ratio (p = 0.004) and lower omega-3 index (p

Research paper thumbnail of Maternal Characteristics, Pregnancy, and Neonatal Outome in Preeclampsia and HELLP Syndrome: a Comparative Study

HELLP syndrome is a complication in pregnancy which may increase maternal morbidity and mortality... more HELLP syndrome is a complication in pregnancy which may increase maternal morbidity and mortality risk. This study aims to compare maternal characteristics, pregnancy and neonatal outcome between preeclampsia and HELLP syndrome. All preeclampsia without or with severe features and HELLP syndrome using ACOG criteria coming to dr. Cipto Mangunkusumo Hospital from January 2015 to December 2017 were recruited into this cross-sectional study. Demographic, clinical, laboratories parameters, and neonatal outcomes were compared between HELLP and preeclampsia patients. The SPSS 20 for Windows was used for all analyses. There were 676 deliveries which was complicated by preeclampsia without or with severe features and 113 patients with HELLP syndrome. Gestational age, history of hypertension systolic and diastolic blood pressure, hemoglobin, hematocrit, urea, creatinine, uric acid, and albumin are different significantly between HELLP and preeclampsia patients. History of hypertension in prev...

Research paper thumbnail of Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women

Women's Health

Introduction: Cesarean section is one of the most common obstetrical interventions that has been ... more Introduction: Cesarean section is one of the most common obstetrical interventions that has been performed at an increasing rate globally, due to both medical and non-medical reasons. This study aims to develop a prediction tool for pregnant women potentially needing c-section, such that necessary preparations from the mothers, families, and health providers can be made. Methods: A total of 603 pregnant women were recruited in the first phase of c-section prediction tool development. The association between the maternal and fetal factors on the risk of c-section were analyzed, followed by a stepwise multivariate regression analysis. In the next phase, 61 pregnant women were enrolled for external validation. Discrimination was assessed using area under the curve. The calibration plot was then made and assessed using the Hosmer–Lemeshow test. Results: There were 251 (41.6%) cases of vaginal delivery and 352 (58.4%) of c-section assessed. Multivariate analysis showed that gestational age

Research paper thumbnail of Preeclampsia: From Cellular Wellness to Inappropriate Cell Death, and the Roles of Nutrition

Frontiers in Cell and Developmental Biology

Preeclampsia is one of the most common obstetrical complications worldwide. The pathomechanism of... more Preeclampsia is one of the most common obstetrical complications worldwide. The pathomechanism of this disease begins with abnormal placentation in early pregnancy, which is associated with inappropriate decidualization, vasculogenesis, angiogenesis, and spiral artery remodeling, leading to endothelial dysfunction. In these processes, appropriate cellular deaths have been proposed to play a pivotal role, including apoptosis and autophagy. The proper functioning of these physiological cell deaths for placentation depends on the wellbeing of the trophoblasts, affected by the structural and functional integrity of each cellular component including the cell membrane, mitochondria, endoplasmic reticulum, genetics, and epigenetics. This cellular wellness, which includes optimal cellular integrity and function, is heavily influenced by nutritional adequacy. In contrast, nutritional deficiencies may result in the alteration of plasma membrane, mitochondrial dysfunction, endoplasmic reticulu...

Research paper thumbnail of What is the Best Predictor for Diagnosis of Placenta Accreta? An Evidence-Based Review

Obstetrics & Gynecology International Journal, 2016

Background: Antenatal diagnosis of placenta accreta is important because it could possibly reduce... more Background: Antenatal diagnosis of placenta accreta is important because it could possibly reduce the morbidities. Several attempts including ultrasound, magnetic resonance imaging (MRI), multi-parameter prediction, and cell-free placental mRNA had been studied to establish a good predictor for diagnosis of placenta accreta. We aim to appraise several studies finding at the accuracy value of these predictors. Methods: The search was conducted on the Cochrane Library®, PubMed® and EMBASE® with the keywords of “ultrasound”, “accreta”, and “predict” or “predictor” or “predicting”. We used diagnostic appraisal questions developed by Centre of Evidence-Based Medicine (CEBM), University of Oxford. Result: Appraisal of 8 diagnostic studies involving 1324 patients underwent ultrasound, MRI, cell-free mRNA examination, or their combination for predicting placenta accreta was conducted finding at the diagnostic values. The overall rate of placenta accreta found on these studies were ranging from 8.4% to 31.8%. Accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of ultrasound in this study in diagnosing placenta accreta were respectively 64.8% – 95.3%, 17% - 100%, 78.9%-100%, 56%-100%, and 64,8% - 100%. The Se, Sp, PPV, and NPV of MRI in predicting placenta accreta derived from 3 studies were respectively 88.89%-100%, 100%, 100%, 92.86%-100%. Se, Sp, PPV, and NPV of cell-free placental mRNA for placenta accreta prediction were respectively. 91.7%, 78.9%, 57.9% and 96.8% using the multiple of median (MoM) of 3.325 as the cut-off point. Conclusion: Ultrasound has a wide range of diagnostic accuracy in predicting placenta accreta. MRI had better diagnostic accuracy for predicting the stage of invasion of placenta. Free-placental mRNA is an objective and promising predictor for diagnosis of placenta accreta.