Pemerintah di dunia sedang berkembang memberi semua ibu hamil mendapat antenatal care, memberi tablet besi dan asam folat (IFO) sedini mungkin dalam jumlah cukup. Lembaga Internasional di dunia mendorong pemberian suplemen mikronutrien multipel (MNM) pada ibu hamil, dimaksudkan memberi efek positip pada pertumbuhan fetus dalam umur gestasi cukup bulan. Pemberian MNM pada semua ibu hamil hasilnya inkonsisten.Penelitian ini bertujuan melihat efek MNM khusus pada ibu hamil tanpa komplikasi terhadap outcome kelahiran yaitu: pertumbuhan (berat lahir), perkembangan (lingkar kepala lahir) dan maturitas (umur gestasi) bayinya. Harapannya adalah setiap bayi lahir bisa dibekali dengan pertumbuhan, perkembangan dan maturitas yang optimal sebagai satu kesatuan hasil kelahiran. Masih diragukan apakah suplementasi MNM pada ibu hamil lebih baik jika dibandingkan dengan IFO untuk memperbaiki antropometri dan umur gestasi. Pertanyaan tersebut ingin dipecahkan melalui pemberian suplemen MNM pada ibu hamil tanpa komplikasi dibandingan IFO. Penelitian ini mengeluarkan faktor yang menyebabkan hambatan pertumbuhan fetus dari populasi studi, memanfaatkan data sekunder studi SUMMIT di Pulau Lombok 2001 ? 2004, desainnya randomized control trial double blind.Analisis data melihat efek MNM terhadap rata-rata tiga outcome dengan statistik MANOVA; terhadap masing-masing outcome secara tersendiri yaitu berat lahir di bawah normal, lingkar kepala di bawah normal dan umur gestasi di bawah normal; terhadap status gizi prahamil rendah dibanding status gizi prahamil baik.Suplementasi MNM meningkatkan rata-rata berat lahir 38,52g lebih tinggi dibanding IFO, secara statistik bermakna. Risiko terjadinya berat lahir <2.600 g pada suplementasi IFO ibu hamil tanpa komplikasi sebesar 1,2 kali dibanding MNM, apabila menggunakan batas α=0,10 secara statistik bermakna, 90%CI: 1,00-1,46. Jika pemberian IFO diganti dengan MNM, akan tercegah sebanyak 13/1.000 bayi dengan berat lahir <2.600 g. Kejadian berat lahir <2.600 g pada pemberian IFO bisa dikurangi 15,1% dari kejadian 83/1.000 bayi lahir bila diganti MNM. Risiko terjadinya berat lahir <2.600 g pada suplementasi IFO jika diganti dengan MNM lebih jelas pada IMT prahamil <18,50 sebesar 1,7 kali bila menggunakan batas α=0,10 secara statistik bermakna, 90%CI: 1,08-2,65. Jika pemberian IFO pada ibu hamil tanpa komplikasi dengan status gizi prahamil rendah diganti dengan MNM, akan tercegah sebanyak 70/1.000 bayi dengan berat lahir <2.600g. Kejadian berat lahir <2.600g pada pemberian IFO ibu hamil tanpa komplikasi dengan IMT prahamil <18,50 bisa dikurangi 40,7% dari kejadian 172/1.000 bayi lahir bila diganti MNM.
Government on developing countries care to all pregnant women for ANC access, give iron?folic acid (IFO) as soon as possible. International agencies on the world stimulate multiple micronutrients (MMN) suplement to pregnant women, that is aimed for giving good of fetal growth in appropriate gestation age. MMN distribution for all pregnant women still have inconsisten result.The purposes of this study look for MMN effect especially on pregnant women without complication for birth outcome: growth (birth weight), development (head circumference at birth) and maturity (gestation age). It is doubted that MMN suplementation on pregnant women is better than IFO for increasing anthropometry and gestation age. This research need specific care with restrict factors that delay fetal growth, using SUMMIT secondary data at Lombok Island 2001-2004 with RCT double blind design.Analyzing data was looking the MMN effect for three mean outcome values by MANOVA statistic, was looking the MMN effect for each outcome individually: birth weight below normal cut-off, head circumference at birth below normal cut-off and gestasion age below normal cut-off, was look at low prepregnancy BMI stratum comparing by normal prepregnancy BMI.MMN suplementation increases mean birth weight as 38,52g more than IFO with statistical significant. The risk of <2,600 g birth weight happened at IFO supplementation on pregnant women without complication were 1.2 time comparing with MNM. If it used at α=0.05 level, it was not statistical significant, but when it used at α=0.10 level, it was statistical significant with 90%CI: 1.00-1.46. If IFO supplementation on pregnant women without complication be replaced by MNM, it would prevent as 13/1,000 infant with <2,600 g birth weight. Incidence of <2.600 g birth weight at IFO supplementation on pregnant women without complication could be decreased 15.1% of 83/1,000 at birth babies happened if it were replaced by MNM. The risk of <2,600 g birth weight happened at IFO supplementation on pregnant women without complication if it be replaced by MNM were clearer on pregnant women without complication at <18.50 prepregnancy BMI stratum as 1.7 time. If it used at α=0.05 level, it was not statistical significant, but when it used at α=0.10 level, it was statistical significant with 90%CI:1.08-2.65. If IFO supplementation on pregnant women without complication at low nourish prepregnancy status were replace with MNM, it would be prevent as 70/1,000 infant with <2,600g birth weight. Incidence of <2,600g birth weight at IFO supplementation on pregnant women without complication at <18.50 prepregnancy BMI stratum could be decreased as 40,7% of 172/1,000 at birth babies happened if it were replaced by MNM. |
