PREEKLAMSIA

:
PERAN KALSIUM & ANTIOKSIDAN

Agus Sulistyono

Dan Teman-teman

PREECLAMPSIA
Clinical (pregnancy specic syndrome)
Hypertension
Proteinuria

Impact
Leading cause of maternal mortality
5 fold increase in perinatal mortality
15% of preterm births

TREATMENT OF PREECLAMPSIA
Delivery! Delivery! Delivery!
Usually prevents maternal mortality.
Does not prevent maternal morbidity.
Can result in iatrogenic prematurity.

TREATMENT OF PREECLAMPSIA

The best treatment

is prevenDon!
ProphylacDc treatment may
actually be early therapy.

PREECLAMPSIA PROPHYLAXIS
HISTORY

Salt restricDon
Salt supplementaDon
Protein restricDon
Protein supplementaDon
Eat less
Eat more
Rest less
Rest more
etc., etc., etc. ...

CALCIUM SUPPLEMENTATION
RATIONALE

Epidemiology
low calcium diets => more preeclampsia
(South and Central America and Africa)

MEKANISME TERJADINYA
PREEKLAMPSIA

Wanita hamil kekurangan kalsium

SImulasi hormon paraIroid (PTH)

Peningkatan kalsium intraselular

Otot polos


Pembuluh darah Rahim
Vasokontriksi

Kontraksi

Referensi:
1. Hofmeyr GJ et al.; Calcium supplementation during pregnancy for preventing hypertensive disorders
and related problems; Cochrane Database of Systematic Reviews; 2010

Women with Hypertensive Disorders

Of Pregnancy (%)

PERBANDINGAN KEJADIAN HIPERTENSI KEHAMILAN PADA

IBU HAMIL YANG DIBERIKAN KALSIUM DAN YANG TIDAK

Week of Gestation

Resiko gangguan hipertensi pada kehamilan secara signifikan

lebih rendah pada ibu hamil yang diberikan suplementasi
kalsium daripada yang tidak(3)
Referensi:
1. Nitkowski J; The Real Calcium Problem and Solution; NutritionReallyWorks.net; 2011
2. Hofmeyr GJ et al.; Calcium supplementation during pregnancy for preventing hypertensive disorders and related
problems; Cochrane Database of Systematic Reviews; 2010
3. Belizan et al.; Calcium Supplementation to Prevent Hypertensive Disorders of Pregnancy; The New England Journal
of Medicine;1991.

CALCIUM SUPPLEMENTATION

CLINICAL TRIALS AND META-ANALYSIS

Favors Control

Favors Calcium
Marya 1987
Villar 1987
Lopez-Jaramillo 1989
Lopez-Jaramillo 1989
Montanaro 1990
Villar 1990
Beilzan 1991
Cong 1993
Sanchez- Ramos 1994
Pooled Estimate

0.001

OR for developing preeclampsia

0.01

0.1

10

CALCIUM SUPPLEMENTATION
CLINICAL TRIALS AND META-ANALYSIS

Summary:
Preeclampsia reduced (OR = 0.38)
PIH reduced (OR = 0.3)
Blood pressure reduced
The minimal expense and negligible
risk ... may jus6fy administra6on of
calcium to even the low risk cohort.

98

95

100

Ionic
Cora
is the l Ca
HIGH
absro EST
pIon

90
80
70

50

60
50

40

40

40

37

40

33

39

21

30

10

10

20
10
0

Ionic Coral
Calcium

Coral Calcium Ca Carbonate

Ca Citrat

% Kandungan Ca Elemental

Ca Lactate

Ca Phospate

% Absorbsi

Nitkowski J; The Real Calcium Problem and SoluKon; NutriKon Really Works.net; 2011

SELENIUM ~ PREECLAMPSIA

SELENIUM ~ PREECLAMPSIA

TERIMAKASIH