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All Journal International Journal of Public Health Science (IJPHS) MEDIA MEDIKA INDONESIANA Jurnal Kedokteran Diponegoro Journal of Biomedicine and Translational Research Majalah Obstetri dan Ginekologi Indonesian Journal of Obstetrics & Gynecology Science Jurnal Kesehatan Reproduksi Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Medica Hospitalia Diponegoro International Medical Journal (DIMJ) Indonesian Journal of Perinatology
Julian Dewantiningrum
Department Of Obstetrics And Gynecology, Faculty Of Medicine, Diponegoro University, Semarang, Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Maternal hair lead and cytokine pro-inflammatory effects in preterm birth Qolby, Qonita Nur; Dewantiningrum, Julian; Pramono, Besari Adi; Maharani, Nani; Nugraha, Eka Djatnika; Muniroh, Muflihatul
International Journal of Public Health Science (IJPHS) Vol 13, No 4: December 2024
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v13i4.24146

Abstract

This case-control study analyzed the lead (Pb), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels in pregnant women with preterm birth (PTB) in Central Java, Indonesia. Hair samples from 72 pregnant women were collected non-invasively. The prenatal exposure to Pb was determined with the total reflection X-ray fluorescence (TXRF) method. Serum IL-6 and TNF-α were examined using enzyme-linked immunosorbent assays (ELISA). The Pb concentration in hair was slightly higher in women with PTB than those without PTB; however, this difference was not statistically significant. An elevated hair Pb level was not associated with increased PTB risk (OR 24.69, 95% CI 0.93–653.82, p>0.05). A serum TNF-α level ≥27 pg/ml, a serum IL-6 level ≥9 pg/ml, and the spouse’s smoking frequency were significantly associated with increased PTB risk (TNF-α OR 42.25, 95% CI 5.26–339.61; IL-6 OR 22.33, 95% CI 3.12–158.54; spouse’s smoking frequency OR 1.28, 95% CI 1.09–1.5), while the maternal hemoglobin concentration significantly decreased PTB risk (OR 0.43, 95% CI 0.2–0.927). This study demonstrates that maternal hair Pb concentration has no significant relationship with PTB. Serum TNF-α, IL-6, and the spouse’s smoking frequency potentially increased PTB risk, while the maternal hemoglobin level is a protective factor.
Effect of DLBS3233, Metformin, and Their Combination on the Expressions of VEGF and Endometriosis Implants in Endometriosis Mice (A Mouse Model in Endometriosis Study) Wardana, Setya Girindra; Trisetiyono, Yuli; Hadijono, Raden Soerjo; Mulyantoro, Inu; Cahyanti, Ratnasari Dwi; Dewantiningrum, Julian
Diponegoro International Medical Journal Vol 4, No 2 (2023): December 2023
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v4i2.18393

Abstract

Abstract Background: Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The process of angiogenesis is regulated by VEGF which plays an important role in the development of endometriosis implants. Metformin is an insulin sensitizer that is known to have a beneficial effect in the treatment of endometriosis and DLBS3233 is a PPARγ agonist, it is hoped that it can reduce VEGF and reduce endometrial implants..Objective: To explore the effect of DLBS3233, metformin, and combination on VEGF expression and endometrial implant area of endometriosis-induced mice.Methods: This experimental study used 3-months old 28 BALB/c mice of endometriosis that were randomly and equally divided into four groups (K, P1, P2, and P3). On the 15th day, the K group was given a placebo, the P1 group was given DLBS3233 0.25 mg/day for 14 days, the P2 group was given metformin 4 mg/day for 14 days and the P3 group was given a combination. The immunohistochemistry of VEGF expression was performed from the abdominal cavity and pelvic peritoneal tissues of the mice and measured by the Remmele Scale Index, while the extracted mice's endometrial implants were analyzed with a computer tracing method. All data normality tests were calculated with the Shapiro-Wilk test. The mean difference test of all groups was analyzed using the one-way ANOVA test and the Kruskal-Wallis test.Results: There were significant differences in the expressions of VEGF (p=0.005) and endometrial implants (p=0.001). Expression of VEGF in the P3 group was significantly lower compared to others and endometrial implant area in the P2 group was significantly lower compared to others.Conclusion: DLBS3233 and Metformin may be a potentially effective drug treatments for endometriosis by decreasing VEGF expression and endometrial implants. Keywords: DLBS3233, Endometriosis, Metformin, VEGF
Factors Associated With Recurrence Of Epithelial Ovarian Cancer In RSUP Dr. Kariadi Semarang Kurube, Isabela Marsialina; Ambari, Ediwibowo; Iskandar, Teuku Mirza; Tjahjanto, Hary; Dewantiningrum, Julian; Mochtar, Arufiadi Anityo; Trisetiyono, Yuli
Diponegoro International Medical Journal Vol 3, No 2 (2022): December 2022
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v3i2.15448

Abstract

Introductions: Epithelial ovarian cancer accounts for 90% of all ovarian malignancies. More than 70% of patients will experience a relapse even after receiving operative therapy and chemotherapy. There are several prognostic factors that influence the recurrence of ovarian cancer. In Indonesia, especially at Dr. Kariadi Hospital, Semarang, the data as mentioned above is still very limited.objective: Knowing the disease-free survival rate, optimizing surgery and factors related to the incidence of recurrence in epithelial ovarian cancer patients at Dr. Kariadi Hospital SemarangMethods: This study is a retrospective cohort study with survival analysis. Data were collected through medical records, with the study population are patients with a diagnosis of epithelial ovarian cancer who were treated at Dr. Kariadi Hospital Semarang in period January 2018-December 2019. Furthermore, patients who had been remission were observed for signs of disease recurrence for 2 years period.Results: There were 361 patients with epithelial ovarian cancer who underwent primary treatment at Dr. Kariadi Hospital, Semarang in  2018-2019. Furthermore, there were observations of recurrence in 148 patients who achieved remission. Of these 76 patients (51.4%) experienced recurrence, while 72 patients not relapse. From 148 epithelial ovarian cancer patients who underwent cytoreduction surgery at Dr. Kariadi Hospital, Semarang, 113 patients (76.4%) achieved optimal operation with a residu less than 2 cm, while 35 patients (23.6%) were not optimal with a residu more than 2 cm. FIGO stage (HR 2.44) and tumor residu (HR 2.15) were shown to be significant factors associated with the recurrence of epithelial ovarian cancer.Conclusion: Overall disease-free survival in epithelial ovarian cancer at Dr. Kariadi Semarang were 74.8% (6 months), 57.1% (1 year), 42.5% (18 months), and 37.4% (2 years). Tumor residual factors and FIGO stage were shown to be significant prognostic factors influencing the recurrence of epithelial ovarian cancer. 
Perbandingan Karakteristik dan Luaran Maternal pada Unexpected Spektrum Placenta Akreta saat Pandemi Covid -19 Cahyanti, Ratnasari Dwi; Dewantiningrum, Julian; Pramono, Besari Adi; Larasati, Irene Astrid; Wiyati, Putri Sekar
JURNAL KESEHATAN REPRODUKSI Vol 10, No 2 (2023)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.87601

Abstract

Latar belakang: Pandemi COVID-19 mempengaruhi sistem pelayanan kesehatan di dunia. Kegawatan maternal yang diakibatkan oleh Spektrum Placenta Akreta (SPA) menjadi tantangan di bidang obstetri, khususnya dalam kinerja multidisplin tim dan dukungan sumber daya fasilitas kesehatan.Tujuan: Membandingkan karakteristik dan luaran dari pasien dengan unexpected dan expected SPA saat pandemi COVID-19.Metode: Desain penelitian secara cross-sectional. Pengambilan sampel kasus SPA secara consecutive sampling dari data rekam medis RSUP Dr. Kariadi, Semarang, pada periode 2020 – 2021.Hasil dan Pembahasan: Limapuluh tiga dari 154 kasus (34,42%) merupakan unexpected SPA. Tidak terdapat perbedaan karakteristik yang meliputi umur, indeks massa tubuh, jumlah riwayat sectio cesarea, jumlah riwayat placenta previa, cara persalinan dan kerjasama tim. Jumlah perdarahan dan kebutuhan transfusi darah yang diberikan tidak terdapat perbedaan pada kedua kelompok. Terdapat risiko untuk Cesarean histerektomi pada unexpected SPA (adjusted OR 4,13 (1,31-55,02)). Case Fatality Rate (CFR) pada unexpeted 5,67%, sedangkan pada expected 0,9%. Pada kasus unexpexted SPA didapatkan 3 kasus dengan terkonfirmasi COVID-19 dan meninggal.Kesimpulan: Tata kelola spektrum placenta akreta di RSUP Dr. Kariadi selama pandemi COVID-19 tidak terdapat perbedaan luaran maternal pada kasus unxpected dan expected dan didapatkan kualitas pelayanan optimal dengan CFR yang rendah.Kata kunci: Spektrum Placenta Akreta (SPA), unxpected dan expected, pandemi COVID-19, luaran maternal
In Utero Ultrasonography Parameters as a Children Growth Prediction at Age 2 – 3 : Parameter Ultrasonografi in Utero sebagai Prediksi Pertumbuhan Anak Usia 2-3 Tahun Mazaya, Radiva H.; Dewantiningrum, Julian; Rahmadi, Farid A.; Anantyo, Dimas T.
Indonesian Journal of Obstetrics and Gynecology Volume 11 No. 2 April 2023
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v11i2.1791

Abstract

ltrasound parameters during pregnancy and the growth of children aged 2 – 3 years.Methods: This was an analytic observational study with a longitudinal approach using data from the first 1,000 days of life. Study conducted at the Faculty of Medicine, Diponegoro University. The research subjects were children aged 2 – 3 years old with good nutritional status and democratic parenting from 14 City Health Centers in Semarang. The ultrasound parameters obtained were Biparietal Diameter (BPD), Abdomen Circumference (AC), Head Circumference (HC), Femur Length (FL) at 20 – 24 weeks of gestation. Data were obtained during the second trimester. Data on the growth of children at the age of 2 years obtained are height, weight, and HC. Statistical test using Pearson correlation test, with p<0.1 is considered significant.Results: The level of confidence used in this study was 90% and obtained 45 research subjects with a female gender of 26 children (57.8%) and 19 male children (42.2%). The Pearson test showed that there was no significant relationship between BPD and height (p=0.18; r=-0.20), AC and height (p=0.12; r=-0.23), and FL and height (p=0.17; r=-0.20). There was a significant relationship between HC and height (p=0.04; r=-0.29), BPD and weight (p=0.06; r=-0.28), HC and weight (p=0.01; r=-0,.5), AC and weight (p=0.08; r=-0.26), FL and weight (p=0.05; r=-0.29) and prenatal HC and postnatal HC (p=0.03; r=-0.32).Conclusion: There is a significant relationship between ultrasound parameters during pregnancy and the growth of children aged 2 – 3 years.Keywords: abdominal circumference, biparietal diameter, child growth, femur length, head circumference, pregnancy.AbstrakTujuan: Untuk mengetahui hubungan antara parameter ultrasonografi saat kehamilan dengan pertumbuhan anak usia 2-3 tahun.Metode: Penelitian ini merupakan penelitian observasional analitik dengan pendekatan longitudinal menggunakan data penelitian 1.000 hari pertama kehidupan yang dilakukan di Fakultas Kedokteran Universitas Diponegoro. Subjek penelitian adalah anak usia 2 – 3 tahun dengan gizi baik dan pola asuh demokratis dari 14 Puskesmas Kota Semarang. Parameter USG yang diperoleh adalah diameter biparietal (BPD), lingkar abdomen (AC), lingkar kepala (HC), dan panjang femur (FL) pada usia kehamilan 20 – 24 minggu. Data diperoleh selama trimester kedua. Data tumbuh kembang anak usia 2 tahun yang diperoleh adalah tinggi badan, berat badan, dan lingkar kepala. Uji statistik menggunakan uji korelasi Pearson, dengan p<0,1 dianggap signifikan.Hasil: Tingkat kepercayaan yang digunakan dalam penelitian ini adalah 90% dan diperoleh 45 subjek penelitian dengan jenis kelamin perempuan 26 anak (57,8%) dan 19 anak laki-laki (42,2%). Uji Pearson menunjukkan bahwa tidak ada hubungan yang signifikan antara BPD dengan tinggi badan (p=0,18; r=-0,20), AC dan tinggi badan (p=0,12; r=-0,23), dan FL dan tinggi (p=0,17; r=-0,20). Terdapat hubungan yang signifikan antara HC dengan tinggi badan (p=0,04; r=-0,29), BPD dan berat badan (p=0,06; r=-0,28), HC dengan berat badan (p=0, 01; r=-0,35), AC dan berat badan (p=0,08; r=-0,26), FL dan berat badan (p=0,05; r=-0,29) dan HC prenatal dan postnatal HC (p=0,03; r=-0,32).Kesimpulan: Terdapat hubungan yang signifikan antara parameter ultrasonografi saat kehamilan dan pertumbuhan anak usia 2 – 3 tahun.Kata kunci: diameter biparietal, kehamilan, lingkar abdomen, lingkar kepala, panjang femur, pertumbuhan anak.
Ethnopharmacological insights and clinical prospects of ten Indonesian medicinal plants for pregnancy, postpartum, and lactation: a systematic review Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Rahardjo, Theresia Monica; Suryawan, Aloysius; Rahardjo, Bambang; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Perinatology Vol. 6 No. 1 (2025): (Available online: 1 June 2025)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i1.77

Abstract

Background: The perinatal period involves significant physiological and metabolic transitions, particularly concerning hypertensive disorders, preeclampsia, hemorrhage, lactation challenges, and oxidative stress. Although pharmacological therapies are available, their safety and accessibility remain inconsistent, especially in resource-limited settings. Indonesia’s extensive biodiversity and deep-rooted ethnomedicinal traditions offer promising yet underutilized botanical alternatives. This study aimed to review the efficacy of Indonesian medicinal plants used in pregnancy, postpartum, and lactation. Methods: This systematic review investigates ten Indonesian medicinal plants traditionally used during pregnancy, postpartum recovery, and lactation: Sauropus androgynus, Curcuma longa, Moringa oleifera, Nigella sativa, Centella asiatica, Orthosiphon aristatus, Syzygium polyanthum, Andrographis paniculata, Solanum nigrum, and Zingiber officinale. Literature from 2000 to 2025 was reviewed using PRISMA guidelines across global and regional databases. Phytochemical composition, mechanisms of action, therapeutic effects (e.g., antihypertensive, antidiabetic, galactagogue, hemostatic, antioxidant), and clinical relevance were critically evaluated. Results: All ten plants demonstrated pharmacological potential relevant to perinatal health challenges. Notably, Zingiber officinale offers antiemetic and anti-inflammatory benefits during early pregnancy, complementing the lactogenic, antihypertensive, and wound-healing properties of other species. However, gaps persist in human trials, dosage standardization, and regulatory oversight. Conclusion: The review highlights the importance of integrating validated traditional botanicals into perinatal care through interdisciplinary research, targeted clinical trials, and culturally responsive health policies. Bridging ethnopharmacology with maternal health systems offers a scalable, sustainable pathway toward maternal wellness and equity in Indonesia and comparable global settings.
Blood Cadmium and Preterm Birth: A Systems Toxicology Review of Molecular Mechanisms, Placental Disruption, and Translational Obstetric Implications Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Pribadi, Adhi; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 2 July 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i2.949

Abstract

Objectives: Preterm birth (PTB) remains a leading global cause of neonatal morbidity and mortality, with multifactorial origins including inflammation, endocrine disruption, and placental dysfunction. Recent evidence identifies cadmium (Cd), a persistent environmental toxicant, as a modifiable contributor to PTB. This review aims to integrate the mechanistic, molecular, and clinical literature on maternal blood cadmium exposure and its role in the pathogenesis of PTB.Methods: A systematic and integrative review was conducted following PRISMA 2020 guidelines. Literature from 2000 to 2025 was retrieved using PubMed, Scopus, Embase, and Web of Science. Eligible studies included molecular toxicology, animal models, human epidemiological data, and placental mechanistic research addressing cadmium exposure and preterm birth. Inclusion criteria emphasized mechanistic clarity, gestational outcome relevance, and measurable cadmium biomarkers. Figures, tables, and mechanistic diagrams were used to illustrate toxicological convergence pathways.Results: Cadmium disrupts placental homeostasis via oxidative stress, endothelial dysfunction, impaired trophoblast invasion, progesterone suppression, and activation of inflammatory cascades such as the NLRP3 inflammasome. Consistent associations between maternal cadmium burden and PTB risk were found across animal, cellular, and human population studies. However, heterogeneity in exposure assessment, absence of unified risk thresholds, and confounding from co-exposures challenge causal inference. Literature remains fragmented, lacking integration between mechanistic insights and clinical risk models.Conclusions: Cadmium should be reclassified as a central agent in the pathophysiology of PTB. We propose a precision obstetrics framework that includes environmental cadmium screening in high-risk pregnancies, implementation of exposome-informed policies, and prospective multicenter studies with molecular endpoints. Obstetric care must evolve to include toxicological risk profiling as standard practice in the prevention of PTB.Kadmium dalam Darah dan Kelahiran Prematur: Tinjauan Toksikologi Sistemik terhadap Mekanisme Molekuler, Disrupsi Plasenta, dan Implikasi Obstetri TranslasiAbstrakTujuan: Kelahiran Prematur (preterm birth/PTB) tetap menjadi penyebab utama morbiditas dan mortalitas neonatal di seluruh dunia dengan etiologi multifaktorial yang mencakup inflamasi, gangguan endokrin, dan disfungsi plasenta. Bukti terbaru mengidentifikasi kadmium (Cd), suatu toksikan lingkungan persisten, sebagai faktor kontribusi yang dapat dimodifikasi terhadap PTB. Tinjauan ini bertujuan untuk mengintegrasikan literatur mekanistik, molekuler, dan klinis mengenai paparan kadmium dalam darah maternal dan perannya dalam patogenesis PTB.Metode: Tinjauan sistematis dan integratif dilakukan sesuai pedoman PRISMA 2020. Literatur dari tahun 2000 hingga 2025 dikumpulkan melalui database PubMed, Scopus, Embase, dan Web of Science. Studi yang memenuhi syarat mencakup toksikologi molekuler, model hewan, data epidemiologi manusia, dan penelitian mekanistik plasenta yang mengevaluasi hubungan antara paparan kadmium dan kelahiran prematur. Kriteria inklusi menekankan kejelasan mekanistik, relevansi terhadap hasil kehamilan, serta penggunaan biomarker kadmium yang terukur. Gambar, tabel, dan diagram mekanistik digunakan untuk mengilustrasikan jalur konvergensi toksikologis.Hasil: Kadmium mengganggu homeostasis plasenta melalui stres oksidatif, disfungsi endotel, gangguan invasi trofoblas, supresi progesteron, dan aktivasi jalur inflamasi seperti inflammasom NLRP3. Hubungan konsisten antara beban kadmium maternal dan risiko PTB ditemukan dalam studi hewan, seluler, dan populasi manusia. Namun, adanya heterogenitas dalam penilaian paparan, belum adanya ambang risiko yang seragam, serta pengaruh faktor pajanan lainnya menjadi tantangan dalam penarikan kesimpulan kausal. Literatur masih terfragmentasi dan belum mengintegrasikan temuan mekanistik dengan model risiko klinis secara menyeluruh.Kesimpulan: Kadmium seharusnya diklasifikasikan ulang sebagai agen sentral dalam patofisiologi PTB. Kami mengusulkan suatu kerangka kerja obstetri presisi yang mencakup skrining lingkungan terhadap kadmium pada kehamilan berisiko tinggi, menerapkan kebijakan berbasis exposome, serta studi prospektif multisentra dengan titik akhir molekuler. Pelayanan kebidanan harus berkembang dengan mengadopsi profil risiko toksikologis sebagai bagian dari praktik standar dalam pencegahan kelahiran prematur.Kata kunci: Disrupsi Plasenta; Interaksi Endokrin-Inflamasi; Kesehatan Reproduksi Lingkungan; Mekanisme Kelahiran Prematur; Toksisitas Kadmium,
Risk Factors of Ectopic Pregnancy at Dr. Kariadi Hospital Zahwa, Kamila Zettira; Trisetiyono, Yuli; Pramono, M Besari Adi; Dewantiningrum, Julian
Diponegoro International Medical Journal Vol 6, No 1 (2025): July 2025
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v6i1.25368

Abstract

Background: Ectopic pregnancy lead to maternal death. There were several risk factors for ectopic pregnancy, including age, IUD, parity, history of ectopic pregnancy, history of pelvic and abdominal surgery, infertility, history of PID, history of abortion, and infertility treatment. This study aimed to prove the correlation between these factors with ectopic pregnancy at RSUP Dr. Kariadi.Objective: This study examines to prove the correlation between these factors with ectopic pregnancy at RSUP Dr. KariadiMethods: This study was an analytical observational study with case control design consisted of 134 samples, divided into ectopic pregnancy (n=67) and threatened abortion as controls (n=67), collected from patient medical records from 2019 – 2024 using purposive sampling. Data analysis was carried out using bivariate analysis with Chi Square & Fisher Exact Test and multivariate analysis with Logistic Regression Test.Results: There were correlation between history of ectopic pregnancy (p = 0,034), history of abortion (p = 0,002), and infertility (p = 0,009) with ectopic pregnancy. Other variables didn’t have significant relationship with ectopic pregnancy (p>0,05). Two risk factors were identified for ectopic pregnancy: history of abortion (p = 0,001; aOR = 3,516; 95% CI 1,632 – 7,577) and infertility (p = 0,005; aOR = 2,913; 95% CI 1,387 – 6,119).Conclusion: There were correlation between history of ectopic pregnancy, history of abortion, and infertility with ectopic pregnancy, while other variables were not related to ectopic pregnancy. History of threatened abortion and infertility were risk factors for ectopic pregnancy.
Cadmium Exposure and Preeclampsia: A Systematic Review of Environmental Risk in Pregnancy Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Pribadi, Adhi; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 3 November 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i3.951

Abstract

Objective: To systematically evaluate current scientific evidence on the association between cadmium (Cd) exposure and the risk of preeclampsia in pregnant women, and to explore underlying mechanisms and population-specific patterns.Methods: This systematic review was conducted according to PRISMA guidelines. Comprehensive literature searches were performed across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar without time restriction, focusing on the past 15 years. Inclusion criteria encompassed original human studies measuring cadmium exposure—biological, dietary, or environmental—and reporting preeclampsia as an outcome. Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: Twenty-five eligible studies were included, spanning case-control, cohort, and cross-sectional designs across diverse geographic regions. Most studies found a positive association between cadmium exposure and increased preeclampsia risk, though methodological heterogeneity exists. Proposed mechanisms include cadmium-induced oxidative stress, endothelial dysfunction, placental insufficiency, and hormonal dysregulation. Evidence also highlights differences in risk based on diet, region, and environmental regulation. However, inconsistencies in exposure metrics and population stratification remain.Conclusion: The cumulative evidence suggests cadmium is a plausible environmental risk factor for preeclampsia. Future research must standardize exposure assessments and address population-specific modifiers. This review provides critical groundwork for hypothesis-driven studies and policy frameworks addressing toxic metal exposure in maternal health.Paparan Kadmium dan Preeklampsia: Tinjauan Sistematis terhadap Risiko Lingkungan pada KehamilanAbstrakTujuan: Penelitian ini bertujuan untuk melakukan tinjauan sistematis terhadap bukti ilmiah terkini mengenai hubungan antara paparan kadmium (Cd) dan risiko preeklampsia pada ibu hamil, serta mengeksplorasi mekanisme biologis yang mendasari dan pola risiko spesifik populasi.Metode: Tinjauan sistematis ini disusun berdasarkan pedoman PRISMA. Pencarian literatur dilakukan secara menyeluruh melalui basis data PubMed, Scopus, Web of Science, ScienceDirect, dan Google Scholar tanpa batasan waktu, dengan fokus pada publikasi 15 tahun terakhir. Kriteria inklusi meliputi penelitian asli pada manusia yang mengukur paparan kadmium—baik secara biologis, dietetik, maupun lingkungan—dan melaporkan preeklampsia sebagai luaran. Risiko bias dinilai menggunakan Newcastle-Ottawa Scale.Hasil: Sebanyak 25 studi memenuhi kriteria dan dianalisis, mencakup desain studi kasus-kontrol, kohort, dan potong lintang dari berbagai wilayah geografis. Mayoritas studi menunjukkan adanya hubungan positif antara paparan kadmium dan peningkatan risiko preeklampsia, meskipun terdapat heterogenitas metodologis. Mekanisme yang diusulkan meliputi stres oksidatif akibat kadmium, disfungsi endotel, insufisiensi plasenta, dan disregulasi hormonal. Bukti juga menunjukkan perbedaan risiko berdasarkan pola diet, lokasi geografis, dan tingkat pengawasan lingkungan. Namun, masih terdapat ketidakkonsistenan dalam metrik paparan dan stratifikasi populasi.Kesimpulan: Bukti kumulatif mendukung bahwa kadmium merupakan faktor risiko lingkungan yang potensial terhadap preeklampsia. Penelitian selanjutnya perlu menstandarkan metode pengukuran paparan dan mempertimbangkan faktor-faktor spesifik populasi. Tinjauan ini memberikan landasan penting bagi studi berbasis hipotesis dan penyusunan kebijakan terkait paparan logam toksik dalam kesehatan maternal.Kata kunci: Komplikasi kehamilan; paparan kadmium; preeklampsia; stres oksidatif; toksikologi lingkungan
Perinatal exposure to ultraprocessed foods and its impact on maternal gut dysbiosis, placental inflammation, and neonatal immune programming: A systematic review Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Pribadi, Adhi; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Majalah Obstetri & Ginekologi Vol. 33 No. 3 (2025): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I32025.236-248

Abstract

HIGHLIGHTS Perinatal ultraprocessed food (UPF) exposure disrupts maternal gut microbiota composition, increasing pro‑inflammatory taxa and systemic endotoxemia. Placental immune activation and oxidative stress represent key mediators linking maternal diet to fetal immune and metabolic programming. Neonatal outcomes include altered regulatory T‑cell development, Th2 immune skewing, allergic sensitization, and early metabolic risk. Integrated dietary counseling, microbiota‑targeted interventions, and public health policies are urgently needed to mitigate transgenerational immune health risks.   ABSTRACT Objective: To synthesize and critically evaluate evidence linking perinatal exposure to ultraprocessed foods (UPFs) with maternal gut dysbiosis, placental inflammation, and neonatal immune programming, and to identify translational implications for perinatal care. Materials and Methods: A systematic narrative review was conducted following PRISMA 2020 guidelines, without PROSPERO registration. Literature searches of major databases (2000–March 2025) identified 1,845 records. After screening and eligibility assessment, 20 studies were included. Study quality was appraised using validated tools, and data were synthesized thematically into evidence domains covering maternal microbiota, inflammatory pathways, placental changes, and neonatal immune outcomes. Results: Maternal UPF consumption was associated with gut dysbiosis characterized by reduced microbial diversity, increased pro-inflammatory taxa, and systemic endotoxemia. Elevated inflammatory biomarkers including lipopolysaccharide, interleukin‑6, tumor necrosis factor‑a, and C‑reactive protein were frequently reported. Limited placental studies revealed increased innate immune activation and oxidative stress. Neonatal immune alterations included regulatory T cell suppression, T helper 2 skewing, increased allergic sensitization, and metabolic programming changes. Evidence strength was highest for maternal gut dysbiosis and immune programming but limited for direct placental mechanisms. Translational opportunities include dietary counseling, microbiota-targeted interventions, and public health strategies aimed at improving maternal diet quality. Conclusion: Perinatal exposure to UPFs adversely impacts the maternal gut–placenta–fetal immune axis. Integrated dietary interventions and population-level nutrition policies are urgently needed to mitigate downstream transgenerational immune risk.
Co-Authors Adhi Pribadi Afina Yuliani Putri Agoes Oerip Poerwoko Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Aloysius Suryawan Anak Agung Ngurah Jaya Kusuma Anantyo, Dimas T. Anantyo, Dimas Tri Andanaputra, Waskita Ekamaheswara Kasumba Andonotopo, Wiku Anita Deborah Anwar Anityo Mochtar, Arufiadi Annastasia Ediati Bachnas, Muhammad Adrianes Bachrudin, Rizky Aditya Bambang Rahardjo Besari Adi Pramono Budi Irawan Cahya Novenita Azzahra Ch Nawangsih Prihharsanti Cut Meurah Yeni Darmawan, Ernawati Dewi Astri Purnaningtyas Dharma, Wibisana Andika Krista Djanas, Dovy Dwi Pudjonarko Ediwibowo Ambari Efendi Lukas Eric Edwin Yuliantara Evert Solomon Pangkahila Hadijono, Raden Soerjo Hapsari, Anggiyasti Vidya Harry Kurniawan Gondo Hary Tjahjanto Haryana, Bambang Herman Kristanto I Nyoman Hariyasa Sanjaya Inu Mulyantoro Khanisyah Erza Gumilar Kurjak, Asim Kurube, Isabela Marsialina Larasati, Irene Astrid Liza Afriliana Maria Mexitalia Mazaya, Radiva H. Mochtar, Arufiadi Anityo Mona Galatia Marpaung Mulyantoro, Inu Muniroh, Muflihatul Nani Maharani Noor Pramono Nugraha, Eka Djatnika Nugraha, Laksmana Adi Krista Nuswil Bernolian Pramono, M Besari Adi Pramono, Mochammad Besari Adi Putra, Ridwan Abdullah Putri Sekar Wiyati Qolby, Qonita Nur Rabiah Adawiyah Radith Aulia Rahmad R. B. Wicaksono Rahmadi, Farid A. Rahman, Farhan Aulia Ratnasari Dwi Cahyanti, Ratnasari Dwi Rizky Syahriar Syoufana Ryan Saktika Mulyana Sarastry, Razmaeda Soejoenoes, Ariawan Sri Sulistyowati Stanojevic, Milan Suharyo Hadisaputro Teuku Mirza Iskandar, Teuku Mirza Thaufik Hidayat, Syarief Theresia Monica Rahardjo Ushan, Ery Perdana Wardana, Setya Girindra Widyawati Widyawati Wiradnyana, Anak Agung Gede Putra WISNU PRABOWO Yan Wisnu Prajoko Yuli Trisetiyono, Yuli Zahwa, Kamila Zettira Zaki Hetami