Pemberian suplemen kalsium dan vitamin D pada ibu hamil dapat mencegah risiko kejadian preeklampsia berdasarkan hasil dua penelitian sistematis. Penelitian pertama menemukan bahwa pemberian dosis rendah kalsium (<1 g/hari) secara konsisten dapat mengurangi risiko preeklampsia. Penelitian kedua menunjukkan bahwa satu penelitian yang melibatkan 400 ibu hamil menemukan bahwa pemberian 1200 IU vitamin D

1. PENERAPAN PICO
PEMBERIAN SUPLEMEN KALSIUM DAN VITAMIN D PADA IBU HAMIL
DAPAT MENCEGAH RESIKO KEJADIAN PRE EKLAMSIA

2. BAB I
PENDAHULUAN
A. Latar Belakang
Preeklampsia merupakan kelainan yang ditemukan pada waktu kehamilan yang ditandai
dengan berbagai gejala klinis seperti hipertensi, proteinuria, dan edema yang biasanya terjadi
setelah umur kehamilan 20 minggu sampai 48 jam setelah persalinan. Sedangkan eklampsia
adalah kelanjutan dari preeklampsia berat dengan tambahan gejala kejang-kejang atau koma.
Menurut World Health Organization (WHO, 2001), angka kejadian preeklampsia berkisar
antara 0,51% - 38,4%. Preeklampsia dan eklampsia di seluruh dunia diperkirakan menjadi
penyebab kira-kira 14% (50.000-75.000) kematian maternal setiap tahunnya.
Angka kejadian preeklampsia di Amerika Serikat sendiri kira-kira 5% dari semua
kehamilan, dengan gambaran insidensinya 23 kasus preeklampsia ditemukan per 1.000
kehamilan setiap tahunnya (Joseph et al, 2008). Sementara itu di tiap-tiap negara angka
kejadian preeklampsia berbedabeda, tapi pada umumnya insidensi preeklampsia pada suatu
negara dilaporkan antara 3-10 % dari semua kehamilan. Salah satu penyebab kematian
maternal di Indonesia adalah preeklampsia-eklampsia. (Prawirohardjo, 2006).
Faktor predisposisi preeklampsia/eklampsia antara lain adalah paritas, umur ibu hamil
kurang dari 20 tahun dan lebih dari 35 tahun, diabetes melitus, hipertensi kronik, riwayat
keluarga dengan preeklampsia, dan penyakit vaskuler ginjal (Offord,2002). Catatan statistik
seluruh dunia menunjukkan dari insidensi 5%-8% preeklampsia dari semua kehamilan,
terdapat 12% lebih diantaranya dikarenakan oleh primigravida. Menurut data The New
England Journal of Medicine pada kehamilan pertama risiko terjadi preeklampsia sebanyak
3,9%, kehamilan kedua 1,7%, dan kehamilan ketiga 1,8%. Angka kejadian
preeklampsia/eklampsia akan menurun pada ibu dengan paritas 1-3 kali, namun pada paritas
tinggi akan terjadi lagi peningkatan angka kejadian preeklampsia/eklampsia (Offord, 2002).
Angka kejadian preeklampsia berat ditemukan pada kelompok paritas 0 sebanyak
(5,8%) dan pada kelompok paritas lebih dari atau sama dengan 5 sebanyak (4,5%) (Roeshadi,
2006). Menurut Offord (2002) pengaruh paritas sangat besar karena (20%) nullipara pernah
menderita hipertensi atau eklampsia dibanding multipara yang hanya (7%). Preeklampsia
lebih tinggi terjadi pada primigravida dibandingkan dengan multipara. Resiko
preeklampsia/eklampsia pada primigravida dapat terjadi 6 sampai 8 kali dibanding multipara

3. (Chapman, 2006). Sindrom preeklampsia ringan dengan hipertensi, edema dan proteinuria
sering tidak diketahui atau tidak diperhatikan oleh wanita yang bersangkutan. Sehingga tanpa
disadari preeklampsia ringan akan berlanjut menjadi preeklampsia berat, bahkan eklampsia
pada ibu hamil (Prawirohardjo, 2006). Beberapa penelitian terkait kehamilan mengujicobakan
pemberian terapi micronutrien untuk mencegah risiko pre-eklampsia, diantaranya dengan
pemberian vitamin D, suplemen kalsium, antioksidan, dengan berbagai variasi baik dicampur
antara beberapa micronutrien ataupun hanya tunggal. Pemberian dosisnya juga bervariasi
yaitu high dose dan low dose.
Hasil systematic review Buppasiri (2015) terkait penggunaan intervensi suplementasi
kalsium untuk wanita hamil yaitu :
1. Tidak ada perbedaan signifikan secara statistik antara perempuan yang menerima
suplemen kalsium dan orang-orang yang tidak mendapat kalsium dalam hal mengurangi
risiko kelahiran kurang dari usia kehamilan 37 minggu (RR) 0.86, 95% confidence
interval (CI) 0,70 untuk 1,05; Studi 13, 16,139 perempuan; model acak efek) atau kurang
dari 34 minggu kehamilan (RR 1,04, 95% CI 0.80 untuk 1,36; uji empat, 5669). Hasil
analisis sensitivitas dari kelahiran prematur kurang dari 37 minggu dengan menghapus
dua ujian dengan risiko bias untuk alokasi penyembunyian; hasil kemudian disukai
dengan suplemen kalsium (RR 0,80, 95% CI 0,65 untuk 0,99; uji 11, 15,379 perempuan).
2. Tidak ada perbedaan yang signifikan dalam bayi berat lahir rendah pada antara kelompok
dua pengobatan (RR 0.93, 95% CI 0,81 untuk 1,07; enam percobaan, 14,162 bayi; acak
efek model). Namun, bila dibandingkan dengan kelompok kontrol, perempuan di dalam
grup suplemen kalsium kelahiran untuk bayi lowbirthweight lebih sedikit.
Dari hasil penelitian diatas dapat ditarik kesimpulan bahwa dengan suplementasi kalsium
bisa mengurangi risiko kelahiran prematur dan bayi berat lahir rendah. Oleh karenanya
membuat penulis tertarik untuk mencari jurnal terkait terapi kalsium yang diberikan pada ibu
hamil apakah dapat mengurangi risiko terjadinya pre-eklampsia.
B. Tujuan
Untuk mengetahui apakah pemberian suplemen kalsium dan vitamin D pada ibu hamil
dapat mencegah risiko kejadian pre-eklampsia dan risiko lainnya.

4. C. Manfaat
1. Bagi Bidan
Hasil penelitian dengan systematic review ini diharapkan bisa diaplikasikan di
pelayanan kesehatan dasar untuk mencegah risiko kejadian pre-eklampsia sehingga
dapat menekan angka morbiditas dan mortalitas. Selain itu pendampingan tenaga
kesehatan dimasa prenatal dan antenatal juga sangat penting untuk meminimalkan
munculnya komplikasi lain saat persalinan.
2. Bagi Mahasiswa
Diharapkan hasil penelitian ini bisa menambah wawasan mahasiswa dalam kasus
kebidanan patologi dalam usaha promotif dan preventif, sehingga ketika melakukan
praktik klinik diharapkan bisa diinformasikan juga pada lahan praktik tentang ilmu-
ilmu baru yang up date.
3. Bagi Peneliti selanjutnya
Diharapkan pada peneliti selanjutnya bisa meneliti terapi selain penggunaan suplemen
kalsium, serta melihat variabel lain yang mungkin bisa untuk mencegah risiko
kejadian pre-eklampsi tentunya dengan mempertimbangkan managibility si peneliti
juga,

5. BAB II
ANALISA PICO
I. Jenis Pertanyaan Klinis
Apakah pemberian suplemen kalsium dan vitamin D pada ibu hamil dapat mencegah
risiko kejadian pre-eklampsia?
II. Formulasi dengan metode PICO
P (Patient) : ibu hamil
I (Intervention) : suplemen kalsium dan vitamin D
C (Comparator) : no suplemen (placebo)
O (Out come) : risiko kejadian pre-eklampsia
III. Pertanyaan ke Istilah Penelusuran
IV. Frase Penelusuran
V. Hasil Penelusuran Pubmed
ISTILAH ISTILAH LAIN/
ALTERNATIVE
Patient/ Problem Pregnant women -
Intervention Calcium supplementation
and vitamin D
-
Comparator No supplemen (placebo) -
Outcomes Pre-ecklampsia risk -
Search Terms
Patient (pregnant women *)
Intervention ( Calcium supplementation and vitamin D*)
Comparison ( No supplemen (placebo)*)
Outcome (pre-eclampsia risk*)
Search Phrase Pubmed
12/ 11/ 2015
pregnant women 84472
(pregnant women*) 69512
(pregnant women*) AND calcium supplementation 233
(pregnant women*) AND ( Calcium supplementation*) 74

6. Hasil Penelusuran The Cochrane
(pregnant women*) AND (calcium supplementation*) AND
vitamin D
5
(pregnant women*) AND (calcium supplementation*) AND
(vitamin D*)
5
(pregnant women*) AND (calcium supplementation*) OR
(vitamin D*) AND (pre-eclampsia risk*)
2
Search Phrase The Cochrane
12/ 11/ 2015
pregnant women 365
(pregnant women*) 359
(pregnant women*) AND calcium supplementation 4
(pregnant women*) AND (calcium supplementation*) 5
(pregnant women*) AND (calcium supplementation*) AND
vitamin D
4
(pregnant women*) AND (calcium supplementation*) AND
(vitamin D*) AND pre-eclampsia risk
2

7. BAB III
PEMBAHASAN
Hasil pencarian jurnal EBM dengan metode PICO yang sesuai dengan pertanyaan
penelitian diperoleh 2 jurnal, yaitu :
Low-dose calcium
supplementation for
preventing pre-eclampsia: a
systematic review
and commentary
Vitamin D supplementation for women
during pregnancy
(Review)
Database Pubmed The Cochrane
Tujuan To review the impact of lower
dose calcium supplementation on
pre-eclampsia risk.
To examine whether supplements with
vitamin D alone or in combination with
calcium or other vitamins and minerals
given to women during pregnancy can
safely improve maternal and neonatal
outcomes.
Inklusi -
Eksklusi
We planned to include in the
initial analysis, trials that met the
following criteria: calcium
supplementation without any co-
supplements; random allocation
with secure allocation
concealment; and double blinding
with placebo.
If the above criteria failed to
produce adequate data, we
planned to include data from
quasi-randomised trials, trials
without placebo control and trials
of multiple supplements, with
appropriate caution in the
interpretation of such data.
We included trials testing vitamin D
alone or in combination with other
micronutrients as long as the intervention
and the control group were treated
similarly. Specifically, we assessed the
following comparisons.
1. Vitamin D alone versus no
treatment/placebo (no vitamins or
minerals).
2. Vitamin D + calcium versus no
treatment/placebo (no vitamin or
minerals).
3. Vitamin D + calcium versus calcium
(but no vitamin D).
4. Vitamin D + calcium + other vitamins
and minerals versus calcium + other
vitamins and minerals (but no vitamin
D).
Search
Strategi
We searched the Cochrane
Pregnancy and Childbirth
Database for randomised trials of
low-dose (<1 g/day) calcium
supplementation during
pregnancy, which included pre-
eclampsia as an outcome, as well
as searching PubMed for the
terms ‘calcium AND (eclampsia
TheTrials Search Co-ordinator from the
Cochrane Pregnancy and Childbirth
Group’s Trials Register conducted the
search on 31 October 2011. The Cochrane
Pregnancy and Childbirth Group’s Trials
Register ismaintained by the Trials Search
Co-ordinator and contains trials identified
from:
1. quarterly searches of the Cochrane

8. OR pre-eclampsia OR
hypertension) AND pregnancy
AND (trial OR random)’.
Central Register of Controlled Trials
(CENTRAL);
2. weekly searches of MEDLINE;
3. weekly searches of EMBASE;
4. handsearches of 30 journals and the
proceedings of major conferences;
5. weekly current awareness alerts for a
further 44 journals plus monthly
BioMed Central email alerts.
Details of the search strategies for
CENTRAL, MEDLINE and EMBASE, the
list of handsearched journals and
conference proceedings, and the list of
journals reviewed via the current
awareness service can be found in the
‘Specialized Register’ section within the
editorial information about the Cochrane
Pregnancy and Childbirth Group.
Trials identified through the searching
activities described above are each
assigned to a review topic (or topics). The
Trials Search Co-ordinator searches the
register for each review using the topic list
rather than keywords. In addition, we
searched the World Health Organization
(WHO) International Clinical Trials
Registry Platform (ICTRP) for any
ongoing or planned trials and the
Networked Digital Library of Theses and
Dissertations (NDLTD) for grey literature
on 28 October 2011 For the identification
of ongoing and unpublished studies,we
contacted on 8 April 2011 different
institutions including the WHO
Departments of Reproductive Health and
Research and the Department of Nutrition
for Health and Development, the WHO
regional offices, UNICEF, the
Micronutrient Initiative (MI), the Global
Alliance for ImprovedNutrition (GAIN)
and the US Centers for Disease Control
and Prevention (CDC). We did not apply
any date or language restrictions but we
only found English language papers.
Metode Randomised trials of low-dose
(<1 g/day) calcium
supplementation during
Randomised and quasi-randomised trials
with randomisation at either individual or
cluster level, evaluating the effect of

9. pregnancy. supplementation with vitamin D alone or
in combination with other micronutrients
for women during pregnancy.
Bias Two authors assessed the risk of
bias and extracted data from the
original papers or translations of
papers other than those in English
using a purpose-designed data
extraction form. We expressed
outcomes as summary risk ratios
with 95% confidence intervals
(95% CI), using the Mantel–
Haenszel method with a fixed
effect model (REVMAN
software, Information
Management System, Nordic
Cochrane Centre, Copenhagen,
Denmark). If there was significant
heterogeneity we used a random
effects model. Risk of bias was
based on the adequacy of reported
allocation concealment, and was
categorised as: low risk of bias
(e.g. telephone or central
randomisation; consecutively
numbered sealed opaque
envelopes); or high risk of bias
(open random allocation; unsealed
or non-opaque envelopes,
alternation; date of birth, or
method not stated).
Figure 2. Risk of bias graph: review
authors’ judgements about each risk of
bias item presented as percentages
across all included studies.

10. Figure 3. Risk of bias summary: review
authors’ judgements about each risk of
bias item for each included study.
Hasil Pre-eclampsia was reduced
consistently with LDC with or
without co-supplements (nine
trials, 2234 women, relative risk
[RR] 0.38; 95% confidence
interval [95% CI] 0.28–0.52), as
well as for subgroups:
1. LDC alone (four trials, 980
women, RR 0.36; 95% CI
0.23–0.57]);
1. Only one trial with 400 women
reported on pre-eclampsia: women
who received 1200 IU vitamin D
along with 375 mg of elemental
calcium per day were as likely to
develop pre-eclampsia as women
who received no supplementation
(average risk ratio (RR) 0.67; 95%
confidence interval (CI) 0.33 to 1.35).
Data from four trials involving 414

11. 2. LDC plus linoleic acid (two
trials, 134 women, RR 0.23;
95% CI 0.09–0.60);
3. LDC plus vitamin D (two
trials, 1060 women, RR 0.49;
0.31–0.78) and
4. LDC plus antioxidants (one
trial, 60 women, RR 0.24;
95% CI 0.06–1.01).
Overall results were consistent
with the single quality trial of
LDC alone (171 women, RR 0.30;
95% CI 0.06–1.38). LDC plus
antioxidants commencing at 8–12
weeks tended to reduce
miscarriage (one trial, 60 women,
RR 0.06; 95% CI 0.00–1.04).
women consistently show that women
who received vitamin D supplements
had higher concentrations of vitamin D
in serum at term than those women
who received no intervention or a
placebo; however the magnitude of the
response was highly heterogenous.
2. Data from three trials involving 463
women suggest that women who
receive vitamin D supplements during
pregnancy less frequently had a baby
with a birthweight below 2500 grams
than those women receiving no
treatment or placebo; statistical
significance was borderline (RR 0.48;
95% CI 0.23 to 1.01).
3. In terms of other conditions, there were
no significant differences in adverse
side effects including nephritic
syndrome (RR 0.17; 95% CI 0.01 to
4.06; one trial, 135 women); stillbirths
(RR 0.17; 95% CI 0.01 to 4.06; one
trial, 135 women) or neonatal deaths
(RR 0.17; 95% CI 0.01 to 4.06; one
trial, 135 women) between women who
received vitamin D supplements in
comparison with women who received
no treatment or placebo. No studies
reported on preterm birth, maternal
death, admission to neonatal intensive
care unit/ special nursery or Apgar
scores.

12. DAFTAR PUSTAKA
AC Johnson, SM Tremble, SL Chan, J Moseley. 2006. Magnesium sulfate treatment reverses
seizure susceptibility and decreases neuroinflammation in a rat model of severe
preeclampsia. http://journals.plos.org/plosone/article?id=10.1371/ journal.pone.
0113670. Diakses 23 November 2015
Buppasiri P, Lumbiganon P, Thinkhamrop J, et al. 2015. Calcium supplementation (other
than for preventing or threating hypertension) for improving pregnancy and infant
outcomes (Review). Available at http://www.thecochranelibrary.com. [Accessed 15
November 2015)
De-Regil LM, Palacios C, Ansary A, et al. 2015. Vitamin D supplementation for women
during pregnancy (Review). Available at: http://www.thecochranelibrary.com.
[Accessed 15 November 2015)
Hofmeyr, G.J., Belizán, J.M. & von Dadelszen, P., 2014. Low-dose calcium supplementation
for preventing pre-eclampsia: a systematic review and commentary. BJOG : an
international journal of obstetrics and gynaecology, 121(8), pp.951–7. Available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4282055&tool=pmcentrez
&rendertype=abstract [Accessed 15 November 2015].
Joseph, Sarka Lisonkova. 2008. Incidence of preeclampsia: risk factors and outcomes
associated with early- versus late-onset disease : Presented at the 26th annual
meeting of the Society for Pediatric and Perinatal Epidemiologic Research, Boston,
MA, June 17-18, 2013. http://www.ajog.org/article/S0002-9378%2813%2900859-
4/pdfSummary. Diakses 23 November 2015
Offord, D. 2002. How halmiltons children are strarting out .Outcames of Birth: Canadian
Centre for Studies of Children risk. http/www.offordcentre.com. diakses 15
November 2015
Prawirohardjo, Sarwono. 2006. Buku panduan praktis pelayanan kesehatan maternal dan
neonatal. Yayasan BinaPustaka. Jakarta
RH Roeshadi. 2006. Upaya menurunkan angka kesakitan dan angka kematian ibu pada
penderita preeklampsia dan eklampsia. Disampaikan dalam acara pengukuhan Guru
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