HUBUNGAN KADAR ALPHA FETOPROTEIN MATERNAL DENGAN STATUS GIZI DAN LUARAN NEONATUS (A Systematic Review of Randomized Controlled Trial and Primary Studies)
Keywords:
Alpha Fetoprotein (AFP) Maternal, Kadar AFP Serum, Status Gizi Maternal, Luaran Neonatus, Berat Lahir Rendah, Kelahiran Prematur, Pertumbuhan Janin Terhambat, Biomarker KehamilanAbstract
Latar Belakang: Alpha Fetoprotein (AFP) maternal merupakan glikoprotein yang diproduksi oleh hati dan kantung yolk janin yang memiliki peran penting sebagai biomarker kehamilan. Kadar AFP maternal yang abnormal, baik elevasi maupun rendah, telah dikaitkan dengan berbagai komplikasi kehamilan dan luaran neonatus yang buruk. Status gizi ibu hamil berperan signifikan dalam regulasi sintesis AFP dan perkembangan janin. Namun, hubungan komprehensif antara kadar AFP maternal, status gizi maternal, dan luaran neonatus belum dikaji secara sistematik dalam literatur berbahasa Indonesia.
Metode: Systematic review dilakukan berdasarkan guidelines PRISMA. Kriteria inklusi meliputi studi Randomized Controlled Trial (RCT), cohort studies, case-control studies, cross-sectional studies, studi observasional, prospektif, dan retrospektif yang melibatkan populasi ibu hamil dengan pengukuran AFP serum maternal dan luaran neonatus terukur. Penilaian kualitas menggunakan Newcastle-Ottawa Scale (NOS) dan Cochrane Risk of Bias Tool.
Hasil: Sebanyak 15 studi primer memenuhi kriteria inklusi dengan total 400.000+ subjek. Tinjauan mencakup 10 outcome utama: (1) kadar AFP maternal ≥2,5 MoM dikaitkan dengan penurunan berat lahir rata-rata 357-371 g (p<0,001); (2) risiko kelahiran prematur meningkat 4,8 kali lipat pada AFP ≥2,5 MoM; (3) pertumbuhan janin terhambat meningkat (RR 4,0; 95% CI 2,1-7,6); (4) mortalitas perinatal meningkat (RR 4,7); (5) small for gestational age (RR 2,8; 95% CI 2,4-3,2); (6) risiko abrupsi plasenta (RR 4,8); (7) preeklamsia (RR 3,8); (8) kematian janin dalam rahim; (9) sudden infant death syndrome (SIDS); (10) palsi serebral. Status gizi maternal yang buruk (IMT rendah, anemia, defisiensi mikronutrien) berkorelasi dengan perubahan kadar AFP dan memperburuk luaran neonatus. AFP sangat rendah (<0,25 MoM) dikaitkan dengan bayi besar dan komplikasi persalinan.
Kesimpulan: Kadar AFP maternal merupakan biomarker penting yang berkorelasi dengan status gizi ibu hamil dan luaran neonatus. Pemantauan AFP maternal secara terstruktur, terutama pada trimester kedua, berpotensi mengidentifikasi kehamilan risiko tinggi dan memungkinkan intervensi gizi serta perawatan prenatal yang lebih optimal. Diperlukan studi longitudinal prospektif lebih lanjut di populasi Indonesia untuk mengkonfirmasi temuan ini.
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Studi Systematic Review/Meta-Analisis yang Digunakan dalam Diskusi (tidak dimasukkan tabel karakteristik):
González-Fernández D, Koski KG, Weiler HA, Scott ME. Associations of maternal nutritional status and supplementation with fetal, newborn, and infant outcomes in low-income and middle-income settings: an overview of reviews. Nutrients. 2024;16(1):1-32. Tersedia di: https://consensus.app/papers/details/dc659aac210a56f387383b033598ef57/
Jelliffe-Pawlowski LL, Shaw GM, Stevenson DK, Oenbrink ML, Norton ME, Currier RJ, et al. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG. 2015;122(13):1875-1884. Tersedia di: https://consensus.app/papers/details/bcd4c930d46f5e4297bfbdae200d43bc/
Parry S, Elovitz MA, Dilworth MR, et al. Placental protein levels in maternal serum are associated with adverse pregnancy outcomes in nulliparous patients. Am J Obstet Gynecol. 2022;226(2):255.e1-255.e14. Tersedia di: https://consensus.app/papers/details/8f076c48de1256cda09deebba5d6f03c/
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