my dissa present

7/25/2019 My Dissa Present

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Journal Reading

Oleh:

Diska Astarini (I11109083)

Pembimbing:

dr. Luk! "utant#$ "%O&

'e%aniteraan 'linikIlmu Obstetri dan &inek#l#gi

akultas 'ed#kteran ni*ersitas +an,ung%ura

-01


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Effect of Maternal Nutrition and

Dietary Habits on Preeclampsia:

A Case-Control Study

Mulualem Endeshaw, Fekadu Ambaw, Amanu Aragaw, Asrat Ayalew

International Journal of Clinical Medicine, 20!, ", !0"#!$


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INTRODUCTION


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P/LA2P"IA h!%ertensi#n a#m%anied b! %r#teinuria rst deteted

a4ter -0 5eeks #4 gestati#n 5ith #r 5ith#ut generali6ed

edema

#ne #4 the m#st #mm#nl! en#untered h!%ertensi*e

dis#rders #4 %regnan! (7DP)

aets t# 10 #4 all %regnanies gl#ball!.

;7O estimates the inidene #4 %reelam%sia t# be se*en

times higher in de*el#%ing #untries

2aternal m#rbidit! remains great 5ith %reelam%sia$$

a#unting 4#r ab#ut 0$000 deaths 5#rld5ide annuall!

99 deaths #ur in the de*el#%ing 5#rld Ethiopia


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Preelam%sia : < etal m#rbidit! andm#rtalit! ma,#r ause #4 stillbirths and

ne#natal deaths

Onset #4 %reelam%sia :

: -0 =3> 5eeks #4 gestati#n 90 : 3> 5eeks t# lab#r and deli*er!

: %#st %artum 5ithin >8 h#urs a4ter deli*er!


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/isk at#r

Ad*aned 2aternal Age

?ulli%arit!

7igh 2aternal @#d! 2ass Inde

Pre=eisting 7!%ertensi#n

Pre*i#us Preelam%sia

/enal Disease

Diabetes 2ellitus

&um Disease 7ist#r! O4 Ab#rti#n

"eual Partner hange @e4#re #ur 2#nths O4 Pregnan!

/ural /esidene


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Preelam%sia is harateri6ed b! metab#lidisturbanes inluding end#thelial d!s4unti#n$

inBammati#n$ #idati*e stress$ insulin resistaneand d!sli%idemia .

#r man! !ears diet has been suggested t# %la! a

r#le in %reelam%sia (in#nsistent results ar#ssstudies)


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METHODOLOGY


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Study Deign and !eriod

ase=#ntr#l stud!

Cune="e%tember -01>

Lo"ation

@ahir Dar it! Administrati#n$ thi#%ia P#%ulati#n: -$ $ rati# 2:E 0$9-

#ne re4erral h#s%ital and health enters


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!opulation

All %regnant 5#men attending antenatal are 4#ll#5 u%andF#r deli*er! during the stud! %eri#d at %ubli health

4ailities #4 @ahir Dar it! Administrati#n$ and meet theinlusi#n riteria

Cae

%regnant 5#men diagn#sed t# ha*e an! 4#rm #4

%reelam%siaFelam%sia during A? 4#ll#5 u%$ deli*er! are

and %#stnatal 5ithin >8 h#urs b! an #bstetriian

Control#

5#man 5h# ga*e birth during the %reeding - da!s and

5h# did n#t ha*e a diagn#sis #4 %reelam%sia


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Sa$ple Si%e Deter$ination

%i In4# stat al :

akurasi &'(

#ndene le*el)'(

a #ntr#l t# ase rati# #4 -:1

+#tal sam%le: *'* + ,-. #dds rati# : ./,


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Sa$pling Te"hni0ue and !ro"edure

ase=#ntr#l inidene densit! sam%ling

Cae# #nseuti*el! as the! arediagn#sed t# ha*e %reelam%siaFelam%sia

until the reGuired sam%le si6e 5as #btained

Ea"h "ae1 . "ontrol # i$ple rando$ a$pling

4r#m the same health 4ailit! in the same da!


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Method and MaterialStudy

2aria3le Out#me *ariable: Presene #4

%reelam%siaFelam%siaduring %regnan! #r deli*er!

Inde%endent Hariable: 2aternal s#i#=dem#gra%hi

harateristis dietar! habits (4ruit$

*egetable$ meat$ al#h#l$#ee and 4#late intake)

nutriti#nal status 2A and

anemia (J11 gFdL)K


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measurement of MUAC and document reie!Data Collection Procedure

face to face interie!


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RESULT


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DISCUSSION


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"#e main findin$ :

!omen !#o reported eatin$ e$etables or fruit #adlo!er ris% of deelopin$ preeclampsia t#an !omen!#o reported not consumin$ e$etables or fruit&

"#is findin$ is consistent !it# t#e study conducted inNor!ay!#ic# reealed a reduced ris% of preeclampsia

!it# or$anic e$etable consumption&


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folic acid supplementation durin$ pre$nancy !as

associated !it# a lower risk of preeclampsia& 'esideits crucial adanta$e of preentin$ neural tube defect in babies( folic

acid supplementation durin$ pre$nancy #as been t#ou$#t to

decreases plasma #omocysteine concentrations&


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an amino acid released as t#e body di$ests dietary proteinincreases durin$ preeclampsia and elderlyan amino acid released as t#e body di$ests dietary proteinincreases durin$ preeclampsia and elderly


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As maternal Mid-Upper Arm Circumference (MUAC) isconsidered to be relatively stable during pregnancyamon$ !omen of

deelopin$ countries !e used MUAC measurement instead& "#ere !ere

linear trends in ris% of preeclampsia !it# increasin$ mid-arm

circumference in t#is study& )omen !#o #ad a MUAC value

above the average (2!" cm) had two foldincreased risk of preeclampsiacompared to !omen in t#elo!er alue MUAC (A#$ % 2!&' ' C* % +!, !'&)!

"#is findin$ is consistent!it# studies conducted in *imbab!e


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Ho!eer( usin$ MUAC and 'M+ as an independent mar%er for

predictin$ preeclampsia #as been critici,ed as fairly !ea% met#ods

in recent studies&

t#er studies also propose t#e use of body fat mass and total body!ater measurement as reliable met#ods to predict ris% of

preeclampsia in pre$nancy t#an MUAC or 'M+ indices&


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!omen #ain$

anemiadurin$ t#e first trimester !ere almost

.times more li%ely t#an !#o did not to #ae increased

incidence of preeclampsia&

"#e susceptibility of !omen !it# anemia to preeclampsia

could be e/plained by a deficiency of micronutrientsand antio/idants&

0ecent results also indicate t#at reduction in serum leels of

calcium( ma$nesium and ,inc durin$ pre$nancy mi$#t be possible

contributors to t#e deelopment of preeclampsia&


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"#e occurrence of anemia in t#is study mi$#t be related

to a reduced inta%e of fruit and e$etables and ot#er

micronutrient deficiency&

Stri%in$ly( #o!eer( ot#er studies demonstrated t#e ris%

of #i$#est #emo$lobin concentration to predispose to

preeclampsia1 a reduced plasma olume mi$#t attribute

to t#e obsered result&


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coffee inta%e durin$ pre$nancy #as statistically si$nificant

association !it# incidence of preeclampsia& "#e study in Nor!ay reealed t#at higher caffeine2coffee( tea3 inta%e

durin$ pre$nancy seems to be associated !it# elevated systolic blood

pressure levelsin first and t#ird trimester pre$nancy&

Caffeine inta%e acutely increases blood pressure leels& Habitual

caffeine consumption may be associated !it# c#ronic blood pressure

leels or t#e ris% of #ypertension in non-pre$nant adults& "#e

mec#anisms by !#ic# caffeine e.posure affect heart rate and blood

pressure levels might include increases of catecholamine levels

which might subse/uently lead to vasoconstriction&


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Diferences in blood pressure leels associated !it# caffeine inta%e

durin$ pre$nancy mi$#t be mar%ers of subclinical cardioascular

adaptation mec#anisms and t#e subse4uent ris% of #ypertensie

complications( suc# as pre$nancy-induced #ypertension and

preeclampsia

n t#e ot#er #and( ot#er studies reported t#at caffeine inta%e

preent incidence of #ypertension durin$ pre$nancy & Ho!eer(

ot#ers did not find any eidence !#et#er caffeine inta%e affects

blood pressure durin$ pre$nancy or not


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+n a$reement !it# t#e results of preious studies t#ere !as no

significant relationship between maternal age and

preeclampsiain t#is study&

Ho!eer( it !as different from t#e results obsered by ot#er study

t#at obsered t#e relations#ip bet!een adanced maternal a$e and

occurrence of preeclampsia&

Suc# difference could be due to t#e ariation of study desi$ns andstudy settin$s& 0ural residence #as been identified as a ris% factor

for preeclampsia in seeral studies &

Ho!eer1 !e obsered only a weak positive association of

preeclampsia risk with this covariate in the bivariate analysis


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t#e result of t#is study s#o!ed no statistically significantassociation between alcohol intake durin$ pre$nancy and

incidence of preeclampsia&

"#is possible e/planation for t#is ariation may be t#e difference in

t#e type of alco#ol bein$ ta%en( t#e amount and t#e fre4uency ofdrin%in$&


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Preious studies #ae reported se/ual partner c#an$e as a ris%

factor for preeclampsia& "#is current study did not findchange of partner to be a strong risk factor

for preeclampsia& 5arious studies proposed t#at currently( t#ere is no sure !ay to

preent preeclampsia& 6or many years diet #as been su$$ested toplay a role in preeclampsia& "#e #ypot#eses #ae been dierse and

often mutually inconsistent&


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Most of t#e recommendation proposed by many studies are: increase t#e amount of fruit and e$etables and decrease t#e amount of fried

foods and 7un% food

$et enou$# rest

e/ercise re$ularly

aoid drin%in$ alco#ol

aoid beera$es containin$ caffeine and ta%in$ folate and iron re$ularly


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CONCLUSION


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preeclampsia8eclampsia needs to be identified as a

priority area in reducin$ maternal mortality in deelopin$

countries& "#ere are seeral preentie and ris% factors

for preeclampsia&

5e$etable and fruit consumption and folate inta%e durin$

pre$nancy are independent protectie factors of

preeclampsia& n t#e ot#er #and( #i$#er mid upper arm

circumference( anemia and coffee inta%e durin$

pre$nancy are ris% factors for t#e deelopment of

preeclampsia&

a screenin$ tool for preeclampsia prediction and early

dia$noses minimi,e deat#s associated !it# seere

preeclampsia8eclampsia&

6urt#er researc# is needed to understand t#e effect of

dosa$e and fre4uency of nutrient( alco#ol and caffeine

inta%e on incidence of preeclampsia&


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"#e findin$s of t#is study s#ould be ie!ed in li$#t of

t#e follo!in$ limitations& )e mi$#t #ae introduced

selection bias since cases !ere selected consecutielyas t#ey appear for dia$nosis&

"#e random and systematic measurement error in self-

reported dietary inta%e mi$#t attenuate t#e association

obsered in t#is study&

Dietary assessment !as made at dia$nosis #ence(

recall bias is ineitable& )e did not also assess t#e

effect of !ide ran$e of dietary factors on preeclampsia1

t#erefore( causal relations#ip cannot be inferred fromt#is case-control study&


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THANK YOU

my dissa present

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