PERLUKAH WANITA HAMIL MENDAPAT SUPLEMENTASI IODIUM ?
Abstract
ABSTRAK
Perlindungan wanita hamil dari kekurangan iodium merupakan salah satu kebijakan perbaikan gizi di Indonesia. Kekurangan iodium pada wanita hamil selain berdampak buruk pada ibu juga mempengaruhi pertumbuhan dan perkembangan janin terutama organ otak. Di Indonesia saat ini, sumber utama asupan iodium berasal dari konsumsi ikan laut dan garam konsumsi beriodium. Akan tetapi tidak semua wanita hamil dapat dengan mudah mendapatkan iodium yang cukup selama kehamilannya. Data proporsi penduduk Indonesia yang mengonsumsi ikan laut sebesar 42,6% dengan rerata konsumsi ikan laut per orang per hari sebesar 25,5 gram. Garam beriodium sesuai SNI mensyaratkan mengandung 30 ppm iodium (KIO3). Dengan perkiraan konsumsi garam beriodium 10 gram per orang per hari, wanita hamil hanya mendapatkan 178 µg iodium dari kebutuhan yang dianjurkan sebesar 250 µg per hari. Bukti empiris menunjukkan bahwa rata – rata konsumsi garam di Indonesia sekitar 5 – 8 gram per orang per hari sehingga asupan iodium harian wanita hamil semakin jauh berkurang dari kebutuhan. Keadaan ini diperberat dengan cakupan rumah tangga mengonsumsi garam beriodium cukup mengandung iodium selama lebih dari 3 dekade hanya berkisar 60% sampai <80%. Hasil Riskesdas 2013 menunjukkan proporsi rumah tangga mengonsumsi garam beriodium cukup berdasarkan hasil tes cepat sebesar 77,1% (target >90%). Sedangkan indikator kecukupan asupan iodium menunjukkan bahwa median ekskresi iodium urin (EIU) wanita hamil di perkotaan dan perdesaan di Indonesia 163 µg/L (adekuat 150 – 249 µg/L), mendekati batas batas bawah (marjinal). Oleh karena itu, suplementasi iodium pada wanita hamil sebagai alternatif sementara untuk memenuhi kebutuhan iodium wanita hamil perlu dipertimbangkan untuk menggunakan dosis harian 150 µg per hari.
References
Zimmermann MB, Jooste PL, Pandav C., 2008. Iodine Deficiency Disorders. Lancet; 372:1251–1262
World Health Organization, 2007. Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination, a Guide for Program Managers, Third Edition. Geneva, Switzerland.
Rohner F., Zimmermann M., Jooste P., Pandav C., Caldwell K., Raghavan R., and Raiten DJ., 2014. Biomarkers of Nutrition for Development—Iodine Review. The Journal of Nutrition. June 25, 1322S – 1342S; doi:10.3945/jn.113.181974.
Hetzel, BS. 1983. Iodine Deficiency Disorders (IDD) and Their Eradication. The Lancet, November 12.
Basil S. Hetzel. Eliminating Iodine Deficiency Disorders — the role of the International Council in the global partnership, Bull World Health Organ vol.80 n.5 Genebra Jan. 2002. http://dx.doi.org/10.1590/S0042-96862002000500014
Delange F, Hetzel B. The Iodine Deficiency Disorders. In: DeGroot LE, Hannemann G, eds. The Thyroid and Its Diseases. http://www.thyroidmanager.org/Chapter20/20-frame.htm (accessed July 12, 2008
Hetzel, B.S., 2004. Towards the Global Elimination of Brain Damage Due to Iodine Deficiency, Oxford University Press, New Delhi.
Hetzel BS. 2005. Towards the global elimination of brain damage due to iodine deficiency—the role of the International Council for Control of Iodine Deficiency Disorders. International Journal of Epidemiology 2005;34:762–764.
Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI, Tahun 2013. Riset Kesehatan Dasar, Riskesdas 2013.
Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan RI, 2014. Survei Konsumsi Makanan Individu, Studi Diet Total 2014.
Djokomoeljanto R. 1996. Status Kelenjar Tiroid Selama Kehamilan dalam Kumpulan Naskah Temu Ilmiah dan Simposium Nasional III Penyakit Kelenjar Tiroid. Badan Penerbit Universitas Diponegoro. Semarang.
Glinoer D., 2007. The importance of iodine nutrition during pregnancy. Public Health Nutrition: 10(12A), 1542–1546 doi: 10.1017/S1368980007360886
Zimmermann MB. The Effects of Iodine Deficiency in Pregnancy and Infancy. Pediatric and Perinatal Epidemiology, 2012, 26 (Suppl. 1), 108–117. doi: 10.1111/j.1365-3016.2012.01275.x
Angela M. Leung, MD, MSc, Elizabeth N. Pearce, MD, MSc*, and Lewis E. Braverman, MD. 2011. Iodine Nutrition in Pregnancy and Lactation. Endocrinol Metab Clin North Am. 2011 December; 40(4): 765–777. doi:10.1016/j.ecl.2011.08.001.
Hartono B. 2001. Perkembangan Fetus dalam Kondisi Defisiensi Iodium dan Cukup Iodium, dalam Kumpulan Naskah Pertemuan Ilmiah Nasional Gangguan Akibat Kekurangan Yodium (GAKY). Badan Penerbit Universitas Diponegoro. Semarang.
Glinoer D., Nayer PD., Delange F., Lemone M. TOPPET V., Spehl M, Grunt JP, Kinthaert J., Lejeune B. 1995. A Randomized Trial for the Treatment of Mild Iodine Deficiency during Pregnancy : Maternal and Neonatal Effects. Journal of Clinical Endocrinology and Metabobsm. Vol. 80, No. 1. p. 258-269. USA.
European Food Safety Authority, 2006. Tolerable Upper Intake Levels for Vitamins and Minerals, Scientific Committee on Food Scientific Panel on Dietetic Products, Nutrition and Allergies. http://www.efsa.eu.int.
Kementerian Kesehatan RI. 2013. Peraturan Menteri Kesehatan Republik Indonesia Nomor 75 Tahun 2013 Tentang Angka Kecukupan Gizi yang Dianjurkan Bagi Bangsa Indonesia.
Institute of Medicine, Academy of Sciences, 2001. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC: National Academy Press.
Gustavo C. Román, 2007. Autism: Transient in utero hypothyroxinemia related to maternal flavonoid ingestion during pregnancy and to other environmental antithyroid agents, Journal of the Neurological Sciences 262 (2007) 15–26.
Sullivan KM., 2009. Iodine deficiency as a cause of autism. Journal of the Neurological Sciences 276 (2009) 202.
Roman GC., Ghassabian A, Schokking JJB, Jaddoe VWV., Hofman A., de Rijke YB., Verhulst FC., Tiemeier H. 2013. Association of Gestational Maternal Hypothyroxinemia and Increased Autism Risk, Ann Neurol. 2013 Aug, p. 1-10
ICCIDD, 2013. Increased risk of autism in children born to mothers with poor thyroid function, IDD Newsletter. Volume 41 Number 3 August.
Green AS., Abalovich M., Alexander E, Azizi F., Mestman J., Negro R., Nixon A., Pearce EN., Soldin OP., Sullivan S., Wiersinga W. 2011. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Thyroid. Volume 21, Number 10. DOI: 10.1089/thy.2011.0087.
Leung AM., Braverman LE., 2014. Consequences of excess iodine. Nat Rev Endocrinol. March ; 10(3): 136–142. doi:10.1038/nrendo.2013.251.
R. Djokomoeljanto, Satoto, Untoro R., 2004. IDD Control in Indonesia in Towards the Global Elimination of Brain Damage Due to Iodine Deficiency, A global program for human development with a model applicable to a variety of health, social and environmental problems. Oxford University Press, Delhi.
Direktur Jenderal, Kementerian Kesehatan Republik Indonesia, 2009. Surat Edaran Nomor JM.03.03/BV/2195/09, Tanggal 3 Juli 2009, Tentang Percepatan Penanggulangan GAKI.
Lyn Patrick, ND. 2008. Iodine: Deficiency and Therapeutic Considerations. Review Article. Alternative Medicine Review. Volume 13, Number 2, 2008. Page 116 – 127.
Caulfield LE, Richard SA, Rivera JA,et al. Stunting, wasting, and micronutrient deficiency disorders. In : Disease Control Priorities in Developing Countries. Editors: Jamison DT, Breman JG, Measham AR, et al., 2nd edn. New York: Oxford University Press, 2006; pp. 551–568.
Kartono D., dan Mulyantoro DK., 2010. Asupan Iodium Anak Usia Sekolah di Indonesia. Gizi Indonesia. 33(1):8-19.
Direktorat Gizi Masyarakat, Direktorat Jenderal Kesehatan Masyarakat, Kementerian Kesehatan RI 2015. Buku Saku Pemantauan Status Gizi dan Indikator Kinerja Gizi 2015.
UNICEF, Programme Against Micronutrient Malnutrition (PAMM), Micronutrient Initiative (MI), International Council for Control of Iodine Deficiency Disorders (ICCIDD), World Health Organization (WHO). 1995. Monitoring Universal Salt Iodization Programmes.
Micronutrient Initiative, International Agricultural Center. Micronutrient Fortification of Foods. Current Practices, Research, and Opportunities.
Mannar MGV., Dunn JT. 1995. Salt Iodization for the Elimination of Iodine Deciciency. MI/ICCIDD/WHO/UNICEF, Micronutrient Initiative, Ottawa, ON, Canada.
Saidin, M. Muherdiyantiningsih, Endi Ridwan, Nur Ikhsan, Astuti Lamid, Sukati, Lies Karyadi, 2002. Efektifitas Penambahan Vitamin A dan Zat Besi pada Garam Beriodium terhadap Status Gizi dan Konsentrasi Belajar Anak Sekolah Dasar, Penelitian Gizi dan Makanan, 25 (1) : 14-25.
Mulyantoro DK., Hakimi M., Basuki E., 2013. Hubungan Kadar Iodium dalam Garam Beriodium di Rumah Tangga dengan Kecukupan Iodium Berdasarkan Nilai Ekskresi Iodium Urin (EIU) pada Wanita Usia Subur. MGMI Vol. 5, No. 1, Desember 2013:41-52.
Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. 2015 Gambaran Konsumsi Pangan, Permasalahan Gizi dan Penyakit Tidak Menular Penduduk Indonesia. Studi Diet Total (SDT) 2014.
Kusrini I., MUlyantoro DK., Sukandar PB., Budiman B., 2016. Hipotiroidisme pada Ibu Hamil di Daerah Replete dan Non Replete Gondok di Kabupaten Magelang. Jurnal Kesehatan Reproduksi. Vol 7 No.1.
Andersson M., Benoist B., Delange F. and Zupan J. 2007. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutrition: 10(12A), 1606–1611. doi: 10.1017/S1368980007361004
World Health Organization 2007. Reaching Optimal Iodine Nutrition in Pregnant and Lactating Women and Young Children. Joint Statement by the World Health Organization and the United Nations Children’s Fund.
Zhou SJ., Anderson AJ., Gibson RA., and Makrides M. 2013. Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials. Am J Clin Nutr. doi: 10.3945/ajcn.113.065854. Printed in USA. American Society for Nutrition
The Public Health Committee of the American Thyroid Association, 2006. Iodine Supplementation for Pregnancy and Lactation—United States and Canada: Recommendations of the American Thyroid Association. Thyroid. Volume 16, Number 10. Mary Ann Liebert, Inc.
Green AS., Sullivan S., Pearce EN. 2012. Iodine Supplementation During Pregnancy and Lactation. JAMA, December 19,Vol 308, No. 23; 2463 – 2464.
National Health and Medical Research Council (NHMRC), 2010. Iodine Supplementation for Pregnant and Breastfeeding Women. https://www.nhmrc.gov.au/guidelines-publications/new45
Taylor PN., Okosieme OE., Dayan CM., Lazarus JH. 2014. Impact of iodine supplementation in mild-to moderate iodine deficiency: systematic review and meta-analysis. European Journal of Endocrinology. 170, R1–R15.
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