TINJAUAN KRITIS INTERVENSI MULTI MIKRONUTRIEN PADA 1000 HARI PERTAMA KEHIDUPAN - Sri Sumarmi Sri Sumarmi (Persagi, 2017)
Indonesia is one of 35 countries which join Scaling Up Nutrition (SUN) movement, a global movement worldwide effort to end under-nutrition, emphasizing on the first 1000 days of life. There are several critical notes in term of program implementation. This article will discuss the critical point view of the implementation of SUN movement in Indonesia focussing on the importance of nutrition intervention during preconception period, particularly with multi microminutrients supplementation. Several literature-based evidences as well as the author’s research evidence will be discussed in this paper. Based on literature review, there were many prospective cohort studies in several countries provided evidence that women who consumed multivitamin supplement during preconception period had 50% reduced risk of prematurity compared to those did not consume multivitamin supplement (RR= 0,050); reduced risk of preeclampsia about 45-71% (OR=0,029-0,55); and reduced risk of small for gestational age (SGA) by 36%. Current randomized double blind community based trial conducted in Probolinggo East Java revealed that extended multi micronutrients intervention 2-6 month prior to pregnancy provided better effect on birth weight and placental weight, as well as maternal endocrine and immune response. Those evidences ensure the plaucibility that multi micronutrients supplementation begin at preconception period is more important then just during pregnancy. Otherwise, many evidences were also revealed that multi micronutrients supplementation better effect to improves pregnancy outcomes. It was implied when the intervention is provided only during pregnancy, it means that critical period of early pregnancy (peri-conceptional period) is missing. Furthermore, it might be better to use multi micronutrients begin at preconception period and during pregnancy, instead of iron folic acid. Indonesia merupakan salah satu dari 35 negara di dunia yang mendukung gerakan global Scaling Up Nutrition (SUN), yang intinya untuk menyelamatkan 1000 hari pertama kehidupan (1000 HPK). Ada beberapa catatan dalam pelaksanaan gerakan penyelamatan 1000 HPK di Indonesia. Artikel ini berisi analisis kritis terhadap kebijakan program intervensi 1000 HPK, dengan fokus pentingnya pemenuhan gizi pada periode prakonsepsi (preconception nutrition), terutama suplementasi multi mikronutrien dalam menunjang keberhasilan program. Berbagai evidence disajikan melalui studi literatur maupun evindence dari hasil penelitian yang dilakukan oleh penulis. Penelitian prospective cohort di beberapa negara membuktikan bahwa wanita hamil yang mengkonsumsi suplemen multivitamin pada masa prakonsepsi mengalami penurunan risiko kelahiran prematur sebesar 50% (RR = 0,50) dibandingkan wanita yang tidak mengkonsumsi multivitamin. Konsumsi multivitamin pada masa prakonsepsi dapat menurunkan risiko pre-eklampsia sebesar 45% hingga 71% (OR = 0,029-0,55) dan menurunkan risiko small for gestational age (SGA) sebesar 36%. Penelitian randomized trial terbaru yang dilakukan di Kabupaten Probolinggo Jawa Timur membuktikan bahwa suplementasi multi-mikro nutrient 2-6 bulan sebelum hamil memberikan efek yang lebih baik terhadap respon imun maternal, serta hormon human placental lactogen (hPL) yang akhirnya meningkatkan berat plasenta dan berat bayi lahir, serta penurunan risiko aborsi dan prematuritas. Berbagai bukti empiris tersebut meyakinkan plausibilitas bahwa pemberian suplementasi zat gizi mikro sejak periode prakonsepsi lebih penting dibandingkan hanya diberikan pada masa kehamilan. Di sisi lain, berbagai penelitian telah membuktian keunggulan suplementasi multi mikronutrien dalam meningkatan luaran kehamilan jika dibandingkan suplementasi tablet besi asam folat. Hal ini menunjukkan bahwa apabila intervensi diberikan pada saat kehamilan, maka periode kritis awal kehamilan (perikonsepsi) telah terlewatkan. Selain itu, perlu dipikirkan untuk menggantikan suplemen zat besi asam folat dengan suplemen multi mikronutrien yang diberian sejak masa prakonsepsi.