Pentingnya Kalsium dan Vitamin D3

untuk Ibu Hamil dan Menyusui

dr. Keven Tali, SpOG

Spesialis Kebidanan dan Kandungan

@dokterkeven 24 September 2021

Calcium intake in Asia is generally inadequate

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Sebagian besar ibu hamil memiliki kadar serum vitamin A, vitamin
D, kalsium dan seng maternal yang rendah

A high prevalence of Vitamin D deficiency and insufficiency in both

group
The mean serum calcium concetrations and bone density values
wew lower in pregnant subjects than non-pregnant subjects

Low maternal vitamin D and calcium food intake were found to

common in West Sumatra, Indonesia

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It’s a unique period of opportunity for optimum health, growth, and neurodevelopmental across the lifespan

Maternal nutrition during pregnancy and lactation has important implications for optimal fetal
development and long-term health of the offspring

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What are macronutrients and micronutrients?

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 Parisi, 2017

Ideally, optimal nutrition will come from food sources, but food fortification and/or supplementation is advisable in some cases,
particularly in low-resources settings where young girls and women are undernourished
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FETAL
PROGRAMMING

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Maternal and Fetal
Health Regarding
Vit D Deficiency

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 Short term
• Miscarriage
• Stillbirth
• Birth defects/ aneuploidy
• Abnormal fetal development
• Small for gestational age
• Preterm birth
• Preeclampsia
• Preterm birth
• IUGR

Long term
• infertility
• Death
• Altered growth, body composition
• Compromised cardiometabolic, pulmonary and
immune function
• Poor neurodevelopment and cognition
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 Preconceptional care advises on how to prevent certain birth defects that originate during the first
weeks of pregnancy – often before a mother realizes she is pregnant

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Nutrients, 2019
 Nutrient Requirements during Pregnancy and Lactation

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Nutrients, 2021
 Nutrient Requirements during Pregnancy and Lactation

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Nutrients, 2021
 Nutrient Requirements during Pregnancy and Lactation

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Nutrients, 2021
Kalsium
• Kalsium adalah mineral
paling banyak dalam tubuh
dan termasuk paling penting
• Paling banyak ditemukan
dalam tulang dan gigi
• Sekitar 50% dari jumlah
totalnya terionisasi dan
hanya kalsium terionisasi
dapat digunakan oleh tubuh
• Protein dan albumin dalam
darah berikatan dengan
kalsium
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• Termasuk kedalam salah satu
makro elemen (selain natrium,
kalium, mangan, phosphor,
chlorium dan sulfur)
• Dibutuhkan oleh tubuh dalam
jumlah lebih dari 100 mg sehari
• Kadar normal dalam darah 8,6 –
10,3 mg/dL
• Makro elemen berfungsi
sebagai zat yang aktif dalam
metabolism atau sebagai bagian
penting dari struktur sel dan
jaringan
Calcium Functions
Calcium is a major structural element in bones and teeth

Calcium concentrations in the blood and fluid that surround cells are tightly
controlled in order to preserve normal physiological function

Calcium plays a role in mediating vasoconstriction and vasodilatation, nerve

impulse transmission, muscle contraction, and the secretion of hormones like
insulin
Calcium is necessary to stabilize a number of proteins, including enzymes,
optimizing their activities

Calcium interact with vitamin D, sodium, protein, phosphorus, and caffeine

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Fungsi Kalsium
1. Mengaktifkan saraf
2. Melancarkan peredaran darah
3. Melenturkan otot
4. Menormalkan tekanan darah
5. Menyeimbangkan keasaman atau kebasaan darah
6. Menjaga keseimbangan cairan tubuh
7. Mencegah osteoporosis (keropos pada tulang)
8. Mencegah penyakit jantung
9. Menurunkan risiko kanker usus
10. Mengatasi kram, sakit pinggang, wasir, dan reumatik
11. Mengatasi keluhan saat haid dan menopause
12. Meminimalkan penyusutan tulang selama hamil dan menyusui
13. Membantu mineralisasi gigi dan mencegah pendarahan akar gigi
14. Mengatasi kaki, tangan kering dan pecah-pecah
15. Memulihkan gairah seks yang menurun atau melemah serta mengatasi kencing manis atau mengaktifkan pankreas

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 Calcium and Maternal Health
• Preeclampsia
• Preterm Birth
• Postpartum Hemorrhage
• Osteoporosis and Pregancy
• Short-Term Bone Changes
• Calcium and Infant Health
• Calcium and immune System

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The Journal of Obstetrics and Gyencology of India, 2017
 Calcium and Bone Resorption in Pregnancy
and Early Post-partum
Pregnancy requires increased calcium
requirement, with 20 g to 30 g of calcium
needed for fetal skeletal mineralization
Poor pre-pregnancy bone mineral density, low
calcium and vitamin D intake during pregnancy
and poor socioeconomic status puts these
women on increased risk of low bone mass
and later developing osteoporosis
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Eur J. Endocirnol 2015
Significant transplacental calcium transfer
occurs during pregnancy, especially during the
last trimester, to meet the demands of the
rapidly mineralizing fetal skeleton
Calcium supplementation during pregnancy
and early post-partum is associated with
reduced bone resorption and to prevent
skeletal loss associated with childbearing
Calcium and Infant Health
• The total body bone mineral content was significantly greater in
infants born to calcium-supplemented mothers (64.1 ± 3.2 g) than
that in the placebo group
• Supplemented elemental calcium 2 g/day before 22 weeks gestation

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Calcium in Pregnancy

Fetal calcium level suggests that ionized calcium is transferred from the mother to the fetus at a rate
of 50 mg/day at 20 weeks of gestation to a maximum of 330 mg/day at 35 weeks of gestation

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Diet Modification

Supplementation

Food Fortification
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 Source of Calcium & Vit D

Food is considered as the best source of calcium

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 Micronutrient supplementation in pregnancy:
When to start, Who, What and How much?
Supplementation during pregnancy
Kemkes: Folic acid + Iron
RCOG: Folic acid + vitamin D
WHO: Folic acid + iron, calcium, vitamin A
ACOG: Folic acid + iron. Patient should be screened regarding their diet and vitamin supplements to confirm
they are meeting recommended daily allowances for calcium, iron, vitamin A, vitamin B12, vitamin B, vitamin
D, and other nutrients

Assesment:
• Diet composition
• Physical activity
• BMI
• Anemia
• Risk of specific nutritional problems (folate, iron, calcium, vitamin D12, vitamin D, iodine, Zinc, PUFAs)

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Sumber: WHO, RCOG, ACOG
Calcium Supplementation on Preeclampsia
Recommendation

• Low dietary intake is associated with hypertension in the general

population
• In populations where baseline dietary calcium intake is low, the World
Health Organization (WHO) recommends 1500 to 2000 mg elemental
calcium supplementation divided into three doses per day for
pregnant woman to reduce the risk of preeclampsia

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How much Calcium Do We Need During
Pregnancy?
AKG 2019
• 1200 mg

RDA
• 1000-1300 mg Dosage 1.5-2.0 g elemental calcium/day

ACOG Frequency Daily, with the total daily dosage divided into
three doses (preferably taken at mealtimes)
• 1000 mg for all women, including Duration From 20 weeks, gestation until the end of
pregnant women, aged 19 years and pregnancy
older
Target group All pregnant women, particularly those at
Kemenkes, 2017 higher risk of gestational hypertention

• 1000 mg/hari Settings Areas with low calcium intake

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Guidelines on Vitamin D supplementation
• WHO • RANZCOG
• No routine • 12-20 ng: 1000 IU
• Def -> 200 IU
• IOM: 400-600 IU
• <12 ng: 2000 IU
• >20 ng: 400 IU
• RCOG/ NHS
• 400 IU routine • ACOG
• 800 IU + Calc : HR PE • 1000-2000 IU for deficiency
• 1000 IU: HR + deficiency
• No routine
• Don’t take more than 4000
IU/day

No Vit D serum routine screening recommendation

Lab check is based on expertise
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 Type of Calcium Supplement
Calcium Carbonate

Calcium Citrate
Mineral
Calcium Gluconate
Calcium Calcium Lactat
Microcrystalline
Complex
Hydroxyapatite
Elemental calcium is key because it’s
the actual amount of calcium in the
supplement
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Ideal calcium preparations = calcium preparation containing Mg and Vit D3
components needed to optimize calcium absorption

Magnesium will increase calcium absorption

1
(in hypocalcemic patients)
Calcium
1 2
2 Vitamin D3 (in its active form) will increase
the absorption of calcium from the intestines

Mg D3 3 Magnesium helps with the activation of Vitamin

D3 and Vitamin D3 (in its active form) will
increase the absorption of Magnesium
3
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KESIMPULAN
1. Sebagai negara berkembang diperlukan suplementasi Kalsium untuk
ibu hamil (1,5 – 2 g oral/hari) guna pencegahan preeklamsia,
preterm, perdarahan pasca salin, dan menjaga sistem imun
2. Adequate dietary calcium intake of 1000 – 1500 mg and 400– 800
IU of vitamin D in pregnant and lactating women
3. Kebutuhan akan mineral dari janin yang sedang berkembang,
sebagian besar dipenuhi oleh peningkatan absorpsi kalsium di usus
4. Efek magnesium-zinc-calcium-vitamin D sebagai co-
supplementation

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