Hubungan antara status seng ibu hamil dengan perubahan status besi dan kadar hemoglobin pasca suplementasi besi.

Tahun 2002 Volume 37 Nomor 2
Oleh : Hertanto Wahyu Subagio

Latar belakang : Anemia pada keharnilan merupakan masalah yang sulit diatasi. Sekalipun suplernentasi besi pada ibu hainil telah larna dikerjakan, hasilnya saat ini betum memuaskan. Secara teoritis faktor manajemen program dan faktor biornedis berpengaruh pada keberhasilan upava suplementasi besi . Kebanyakan penelitian yang telah dikerjakan selama ini difokuskan pada aspek manajemen program. sementara upaya untuk meneliti aspek biomedis suplementasi hesi belum banvak dikerjakan. Salah satu aspek biornedis yang perlu dilihat adalah pengaruh defisiensi zat gizimikro lain terhadap keberhasilan suplementasi besi,
Tujuan : Penelitian ditujukan untuk menjelaskan hubungan antara status seng dengan perubahan status besi dan kadar hemoglobin pasca suplementasi besi pada ibu hamil.
Metoda : Rancangan penelitian adalah nested case control. Sampel sejumlah 70 orang ibu hamil diambil dengan metoda consecutive sampling. Status seng pra suplementasi besi dinyatakan sebagai variabel paparan. Perubahan kadar hemoglobin serta perubahan status besi yang dinyatakan dalam perubahan kadar serum transferin receptor (sTfR) dinyatakan sebagai variabel efek. Status vitamin A, status besi, dan asupan zat gizi (protein, besi, seng, vitamin A, vitamin C) selama suplementasi besi diperhitungkan sebagai variabel perancu. Analisis dilakukan dengan menghitung rasio odds baik secara bivariat maupun secara multivariat.
Hasil Prevalensi defisiensi seng (64,3%) lebih tinggi dibanding prevalensi defisiensi besi (31,4%). Tidak terjadi kenaikan kadar hemoglobin pasca suplementasi besi, namun terjadi perbaikan status besi yang dinyatakan dalam penurunan kadar sTfR. Pada analisis bivariat didapatkan besar risiko (OR) defisiensi seng terhadap kegagalan meningkatkan kadar Hb pasca suplementasi besi sebesar 6,59 (95% CI : 2,08 — 20,82). Sedangkan besar risiko (OR) defisiensi seng terhadap kegagalan meningkatkan status besi pasca suplementasi besi sebesar 5,87 (95% CI : 1,53— 22,45). Analisis multivariat menunjukkan bahwa dengan indikator keberhasilan suplementasi besi berupa kenaikan nilai Hb secara absolut hanyastatus seng yang mempunyai hubungan bermakna (0R=6,59). Dengan indikator peningkatan status besi, variabel-variabel yang berhubungan adalah status vitamin A (OR=21,77), status seng (0R=9,70) dan status besi (OR=O.04) pra suplementasi besi.
Simpulan : Baik secara bivariat maupun setelah dikontrol dengan variabel-variabel perancu, defisiensi seng merupakan faktor risiko terhadap kegagalan peningkatan hemoglobin dan perbaikan status besi pasca suplementasi besi

Background : A nemia during pregnancy is st/li considered as an overv health problem. Although programs on iron supplementation during pregnancy have been carried out for the last few decades, there have not been fruitful results. Theoreticaih program management and biomedical factors play important roles in the success of iron supplementation. The majority of researchers were focused on the program management aspect, while only a little attention was given to the biomedical aspects of iron supplementation. One biomedical aspect that needs to be explored is the influence of other micronutrients deficiencies on the success of iron supplementation.
Objective : This research is aimed to examine the associations bet zinc status pre iron supplementation and hemoglobin as well as iron status change after iron supplementation in pregnant women
Method: A nested case control study was carried out. A total sample of 1 ivoinen was taken using consecutive sampling procedures. Zinc status pre iron supplementation was used as the exposure variable. The changes of hemoglobin and iron status assessed by the change of serum transferrin receptor (sTfR) were the effected variables. Vitamin A and iron status, and nutrients intake (‘protein, iron, zinc, vitamin A, vitamin C) during iron supplementation were treated as the conJ variables. Odds ratio were calculated using bivariate and multivariare analysis.
Result The prevalence of zinc dejiciencv (64.3%) iuas higher than the prevalence of iron deficiency (31,4%). There was no improvement in hemoglobin level after iron supplementation. Howevet; there was an improved iron status expressed as lowering s TfR post iron supplementation. The odds ratio (OR) for zinc deficiency on the success o iron supplementation wac 6.59 (95°c C 2 08 20.82) when the indicator used is the absolute increase of hemoglobin value post iron supplementation And when the decrease of sTJR used as an indicator, the OR ii’as 5.87 (95% CI: 1.53 22.45). Multivariate analysis using absolute increase of hemoglobin value post iron supplementation as dependent variable showed that zinc statuc (OR=8. 79), had significant association with the dependent variable, And when the decrease of serum sTfR used as an indicator of the success of iron supplenientation, vitamin Al status (OR 21,77) zinc siatus (OR=9. 7O), and iron status pre supplementation (OR= O.04) had significant associations tuith the dependent variable,
conclusion : Before amid after controlling for the confounding variables, zinc deficiency pre iron supplementation is fbimnd to be a risk friclor on the failure f increasing hemoglobin level and improvement of iron status post iron supplementation