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Dapatkah Preeklampsia dicegah?

Noroyono WibowoDivisi Fetomaternal

Departemen Obstetri dan GinekologiFKUI RSCM Jakarta

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• Women with previous pre-eclampsia are at increased risk of cardiovascular diseases

• Women with pre-eclampsia have unfavourablemetabolic profiles in pregnancy

• Cardiovascular risk factors that are present years before pregnancy are associated with a risk of pre-eclampsia

BMJ 2007;335;978-82

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80 – 90% dapat di cegah

Hamil harus dipersiapkan

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HamilHamil Membangun janin - Manusia

InflamasiInflamasi

ROSROS

ResistensiResistensi InsulinInsulin DIS

FUN

GSI

EN

DO

TEL

DIS

FUN

GSI

EN

DO

TEL

PREEKLAMPSIA

Status Nutrisi & Life style

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Trimester 1

1. PF: Gigi + Vagina + Serviks2. DPL + Ferritin + Fibrinogen3. Serum Protein Elektroforesis4. Profil Lipid5. TTGO 75 g Insulin 0/2 jam6. SOD7. Progesteron8. Hs CRP9. Ur/Cr, Cystatin C

Periodontitis Is Associated With Preeclampsia in Pregnant Women

• A total of 83 out of 130 preeclamptic women (63.8%) and 89 out of 243 controls (36.6%) had

chronic periodontitis (OR: 3.0; 95% confidence interval (CI): 1.91 to 4.87; P <0.001).

• Clinical attachment loss increased in the case group (4.0 ± 0.10 mm) compared to the control

group (3.0 ± 0.08 mm) (P <0.001).

• The average newborn birth weight from preeclamptic mothers was 2.453 g, whereas in

controls was 2.981 g (P <0.001).

• Two red complex microorganisms, Porphyromonas gingivalis and Tannerella forsythensis, and

the green complex microorganism Eikenella corrodens were more prevalent in the

preeclamptic group than in controls (P <0.01).

Journal of Periodontology. 2006, Vol. 77, No. 2;182-188

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Association Between Maternal Infections and Preeclampsia: A Systematic Review of Epidemiologic Studies

any infection (bacterial or viral) was associated with a

two-fold higher risk of preeclampsia. This association may provide a potential explanation for preeclampsia-related inflammation.

Maternal and Child Health Journal. 2008;12; 1092-7875

Association between serum ferritin and the insulin resistance syndrome in a representative population

European Journal of Endocrinology,2006; 154;333-340

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Age-adjusted ORs (95% CI) for the 6-year incidence of the IDF-defined metabolic syndrome according to high ferritin and transferrin levels (both above the upper tertiles) (A), lower ferritin and high transferrin levels (B), high ferritin and lower transferrin levels (C), and lower ferritin and lower transferrin levels (D).

Ferritin and Transferrin Are Associated With Metabolic Syndrome Abnormalities and Their Change Over Time in a General Population

Diabetes Care, 2007; 30:1795-1801

Characteristics of Some Plasma ProteinsProtein Fraction Concentration (mg/dL) Molecular Weight (D) Properties

Transthyretin Prealbumin 15-35 55,000 Retinol transport, binds T4

Albumin Albumin 4000-5000 66,000 Colloid osmotic pressure, binding protein

Retinol-binding protein

α1 3-6 21,000 Retinol transport

α1-Antiprotease α1 85-185 54,000 Protease inhibitor

Thyroxine-binding globulin

α1 1-3.5 58,000 Major binding protein for T3 and T4

Transcortin α1 3-3.5 52,000 Binds glucocorticoids

α-Fetoprotein α1 0.002 (adults) Elevated in adults with hepatoma

200-400 (fetus)

Ceruloplasmin α2 20-40 132,000 Contains copper

α2-Macroglobulin α2 150-400 725,000 Protease inhibitor

Haptoglobin α2 100-300 85,000* Binds hemoglobin

Transferrin β 200-400 89,000 Binds iron

Hemopexin β 50-120 60,000 Binds heme

Fibrinogen β 200-400 340,000 Clot formation

C-reactive protein γ 1.0 110,000 Acute phase reactant

Immunoglobulins γ 700-1500 150,000-950,000 Very heterogeneous

* One genetic variant forms higher molecular weight polymers (>200,000 D).T3, triiodothyronine; T4, thyroxine.

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Electrophoretic separation of plasma proteins on cellulose acetatemembrane at pH 8.6, densitometric scan. The electrophoretic patterndepends somewhat on the separation conditions, including supportmedium, pH, and ionic strength. ALB, albumin.

Plasma Contains A Complex Mixture of Proteins

Elsevier Meisenberg & Simmons: Principles of Medical Biochemistry 2e-www.studentconsult.com

Scale

10 nm

Albumin 69.00

Hemoglobin 64.500

1-Globulin 90.000

1-Globulin 156.000

1-lipoprotein 200.000 1-lipoprotein

1.300.000

Fibrinogen 340.000

Figure 50-1. Relative dimensions and approximate molecular masses of protein molecules in the blood (Oncley)

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© 2005 Elsevier

Plasma protein electrophoresis in various disease states. A, Normal. ALB, albumin. B, Immediate response pattern. C, Delayed response pattern. D, Liver cirrhosis. E, Protein-losing conditions (nephrotic syndrome, protein-losing enteropathy). F, Monoclonal gammopathy ("paraprotein").

• 160kDa, a2-globulin• Each molecule of ceruloplasmin binds six atoms of copper.

• carries 90% of the copper present in plasma• Copper is a cofactor for certain enzymes

• Amine oxidase, copper dependent superoxide dismutase, cytochrome oxidase, tyrosinase

Ceruloplasmin Binds Copper

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Theodore A. Kotchen

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63

72

81

90

3,5

4

4,5

5

Gestation (Weeks)

10 20 30 38 10-12

Plas

ma

gluc

ose

(mm

ol/L

)

Plas

ma

gluc

ose

(mm

ol/L

)

Postpartum