Oleh Admin Kalbe Medical pada February 01, 2018 07:30

Probiotik Menurunkan Prevalensi Diabetes Gestasional

Diabetes gestasional (gestational diabetes mellitus/GDM) hanya terjadi selama kehamilan. Biasanya setelah bayi dilahirkan, diabetes gestasional akan pulih, walaupun dalam beberapa kasus ditemukan ibu dengan diabetes gestasional memiliki risiko berkembang menjadi diabetes tipe 2 lebih tinggi. Kelebihan berat badan pre-kehamilan telah menunjukkan kemungkinan 46% mengalami diabetes gestasional, ditambah kenaikan berat badan selama kehamilan yang berlebihan, riwayat GDM atau riwayat keluarga dengan diabetes, PCOS (polycystic ovary syndrome), usia tua, paritas tinggi juga teridentifikasi sebagai faktor risiko. GDM sendiri juga meningkatkan risiko pre-eklampsia, keguguran, lahir preterm, makrosomia, induksi persalinan, dan seksio sesaria.

Dalam studi sebelumnya di Finlandia, pemberian suplemen probiotik mengandung Lactobacillus rhamnosus GG dan Bifidobacterium lactis BB-12 yang digunakan sejak trimester pertama kehamilan dapat menurunkan prevalensi GDM. Sebuah studi terbaru melibatkan ibu hamil yang diberikan suplemen Lactobacillus rhamnosus HN001. Tujuan studi ini adalah untuk mengetahui apakah suplemen ini dapat menurunkan prevalensi GDM. Sebuah penelitian tersamar ganda dilakukan di New Zealand. Penelitian ini dilakukan bersamaan dengan studi penyakit atopi yang dilakukan pada pasien yang sama, sehingga pasien yang digunakan pada uji ini adalah ibu hamil dengan riwayat pribadi atau pasangan dengan penyakit atopi. Uji dilakukan saat usia kehamilan 14-16 minggu.

Total 423 wanita mengikuti uji ini, 212 wanita mendapatkan probiotik Lactobacillus rhamnosus HN001 (6x109 CFU) 1 kapsul sehari dan 211 wanita mendapatkan plasebo. Parameter GDM diperiksa saat usia kehamilan 24-30 minggu. Kriteria diabetes menggunakan definisi dari IADPSG (International Association of Diabetes and Pregnancy Study Groups), yaitu glukosa darah puasa ≥5,1 mmol/L, atau 1 jam post 75 gram kadar glukosa di ≥10 mmol/L atau 2 jam ≥8,5 mmol/L; serta menggunakan definisi NZ glukosa darah puasa ≥5,5 mmol/L atau 2 jam post 75 gram kadar glukosa ≥9 mmol/L.

Dari studi ini, sebanyak 184 (87%) wanita mendapat probiotik menyelesaikan studi, sedangkan kelompok plasebo sebnayak 189 (90%) wanita. Ditemukan trend mengarah ke relatives rate (RR) yang rendah dari GDM pada kelompok probiotik. Probiotik HN001 juga dikaitkan dengan rendahnya kejadian GDM pada wanita berusia ≥35 tahun dan pada wanita yang memiliki riwayat GDM . Menggunakan definisi NZ, prevalensi GDM lebih rendah bermakna pada kelompok probiotik HN001 dibandingkan kelompok plasebo.

Dari penelitian ini, peneliti berspekulasi bahwa pemberian suplemen probiotik mengubah komposisi dan fungsi dari mikrobiota pencernaan yang dapat memperbaiki sensitivitas insulin dan peradangan pada pasien, sehingga menurunkan kemungkinan dari GDM. Efek samping yang sangat rendah mendukung probiotik sebagai intervensi yang relatif aman untuk digunakan saat kehamilan (pada studi ini dilakukan pada usia kehamilan 14-16 minggu) yang juga berdampak pada bayi, dapat dilihat dari skor APGAR.

Dari studi ini memunculkan suatu gambaran bahwa pemberian suplemen probiotik dari usia kehamilan 14-16 minggu dapat menurunkan prevalensi GDM terutama pada wanita yang berusia tua saat hamil dan pada wanita yang sebelumnya memiliki riwayat GDM. Namun terlepas dari intervensi yang dilakukan pada penelitian ini, peneliti menyebutkan masih diperlukan penelitian dengan subjek yang lebih besar, sehingga semakin menguatkan pilihan penggunaan probiotik dalam menurunkan GDM. (OEP)

Image : Ilustrasi
Referensi:
1.Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counseling on pregnancy outcome and prenatal and postnatal growth: A double-blind, placebo-controlled study. Br J Nutr. 2010;103(12):1792-9.
2.Wickens KI, Barthow CA, Murphy R, Abels PR, Maude RM, Stone PR, et al. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: A randomised controlled trial. Br J Nutr. 2017;117:804-13.

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