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Disertasi Pengaruh Human Placental Lactogen, Leptin

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Disertasi Pengaruh Human Placental Lactogen, Leptin i DISERTASI PENGARUH HUMAN PLACENTAL LACTOGEN, LEPTIN, ASUPAN KALORI DAN IMT PRA-HAMIL TERHADAP PENINGKATAN MASSA LEMAK IBU DALAM KEHAMILAN Studi Terhadap Adaptasi Hemostasis Energi Dalam Kehamilan Sebagai Faktor Risiko Obesitas Pada Perempuan Dan Peranan Human Placental Lactogen Dalam Kesinambungan Suplai Nutrisi Maternal-Fetal THE INFLUENCE OF HUMAN PLACENTAL LACTOGEN, LEPTIN, CALORIE INTAKES AND PRE-PREGNANCY BMI ON BODY FAT MASS GAIN IN PREGNANT WOMEN A Study On Adaptation Of Maternal Energy Hemostasis During Pregnancy As The Risk Factor Of Obesity In Women And The Role Of Human Placental Lactogen In Continuity Of Fetal Nutrition. YUANITA ASRI LANGI P0200313022 SEKOLAH PASCASARJANA PROGRAM S3 ILMU KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASSAR 2017 ii PENGARUH HUMAN PLACENTAL LACTOGEN, LEPTIN, ASUPAN KALORI DAN IMT PRA-HAMIL TERHADAP PENINGKATAN MASSA LEMAK IBU DALAM KEHAMILAN Studi Terhadap Adaptasi Hemostasis Energi Dalam Kehamilan Sebagai Faktor Risiko Obesitas Pada Perempuan Dan Peranan Human Placental Lactogen Dalam Kesinambungan Suplai Nutrisi Maternal-Fetal Disertasi Sebagai Salah Satu Syarat Untuk Mencapai Gelar Doktor Program Studi Ilmu Kedokteran Disusun dan diajukan oleh YUANITA ASRI LANGI P0200313022 Kepada SEKOLAH PASCASARJANA PROGRAM S3 ILMU KEDOKTERAN UNIVERSITAS HASANUDDIN MAKASSAR 2017 iii iv PERNYATAAN KEASLIAN DISERTASI Yang bertanda tangan di bawah ini : Nama : YUANITA ASRI LANGI Nomor Mahasiswa : P0200313022 Program Studi : Ilmu Kedokteran Menyatakan dengan sebenarnya bahwa disertasi yang saya tulis ini benar- benar merupakan hasil karya saya sendiri,bukan merupakan pegambilan tulisan atau pemikiran orang lain.Apabila di kemudian hari terbukti atau dapat dibuktikan bahwa sebagian atau keseluruhan disertasi ini hasil karya orang lain,saya bersedia menerima sangsi atas perbuatan tersebut. Makassar, 2017 Yang menyatakan, YUANITA ASRI LANGI v PRAKATA Segala puji dan syukur dipanjatkan ke hadirat Allah Yang Maha Besar, Sang Khalik, Pencipta Alam Semesta, atas perkenanNYA sehingga saya dapat menyelesaikan proses pendidikan yang menghasilkan disertasi ini. Pembelajaran yang menuntun ke arah tahu untuk menjadi tidak tahu, kesadaran akan keniscayaan pemikiran manusia di hadapan Kesempurnaan dan Kebesaran Sang Maha Pencipta. Untuk ayahanda, almarhum Pdt. William Langi, S.Th, M.Th dan ibunda, Dra. Patmah, kepada siapa pencapaian ini pertama-tama ananda persembahkan. Terima kasih yang tidak terhingga atas limpahan cinta kasih yang membimbing, mendidik, mendorong dan meneguhkan. Untuk suami Ir. Reinhard Hendrik Moga Wattie, terima kasih atas cinta kasih dan kesabaran dalam mendukung saya untuk menjalani dan menyelesaikan pendidikan ini. Anak-anak yang kekasih, Reywulan Gracia Meralda Wattie (alm), Ezra Aditya Waraney Wattie , S.Ked, Kezia Natalia Wattie, yang laksana mentari dan pelangi yang menghangatkan serta memberi sukacita dalam kehidupan ayah dan bunda. Terima kasih untuk keyakinan yang menyemangati bunda untuk meneruskan dan menyelesaikan proses pendidikan yang penuh tantangan ini. Untuk ayahanda dan ibunda mertua, Johannis Watti BA serta Nelly Linuh (almarhum), Pdt. Bestintje Lahiwu, STh, MTh, terima kasih atas limpahan kasih sayang, vi kepercayaan, dukungan d an kesabaran yang senantiasa diberikan pada saya.Dengan selesainya Disertasi ini, perkenankanlah penulis menyampaikan penghargaan dan terima kasih yang tulus serta setinggi- tingginya atas keluangan waktu yang sangat berharga, bimbingan, kesabaran, kepercayaan dan dukungan moril kepada : Prof. Dr.dr. Syakib Bakri, SpPD-KGH, sebagai promotor yang telah banyak memberikan bimbingan, petunjuk dan pencerahan yang sangat berguna mulai dari awal perencanaan disertasi, pelaksanaan penelitian sampai pada penyelesaian disertasi ini. Beliau bijak dan sangat teliti dalam melihat berbagai hal terkait disertasi ini serta menuntun saya untuk belajar menganalisis, menyimpulkan serta menyampaikan fakta-fakta ilmiah dengan cara yang benar. Prof. Dr.dr. Suryani As’ad, M.Sc,SpGK(K) sebagai ko-promotor, yang senantiasa memberikan semangat, bimbingan, pencerahan dan dorongan yang sangat berguna sejak saya memulai pendidikan doktoral selanjutnya pada setiap tahapan perencanaan dan penyusunan disertasi ini. Beliau banyak memberikan bimbingan mengenai metode dan pelaksanaan penelitian serta penyusunan publikasi ilmiah. Beliau pula yang mendorong penulis untuk mengikuti seleksi hibah dana penelitian (grant) dari Yayasan Institut Danone Indonesia. vii Dr.dr.Agussalim Bukhari, PhD, MSc, SpGK (K) sebagai ko-promotor, yang telah banyak memberikan bimbingan, petunjuk dan pencerahan yang sangat berguna sejak awal perencanaan disertasi ini sampai pada penyusunan dan penyelesaian. Beliau banyak memberikan bimbingan mengenai aktifitas tingkat biomolekular hemostasis energi serta menuntun saya memahami metode penelitian di bidang nutrisi serta analisisnya. Beliau juga membimbing saya untuk menyiapkan dan turut melakukan pemeriksaan laboratorium ELISA terkait penelitian ini di Laboratorium Hasanuddin University Medical Research Center (HUM-RC). Hormat dan penghargaan setinggi-tingginya, diiringi ucapan terima kasih, disampaikan pula kepada : Prof. Dr.dr. Dwia Aries Tina NK, selaku Rektor Universitas Hasanuddin, Prof. Dr. dr. Andi As’adul Islam, SpBS, FICS, selaku Dekan Fakultas Kedokteran Universitas Hasanuddin dan Prof.dr. Mochammad Hatta, Ph.D, SpMK (K) selaku Ketua Program Studi S3 Ilmu Kedokteran Pascasarjana Universitas Hasanuddin, yang telah memberikan kesempatan dan dukungan kepada saya untuk mengikuti dan menyelesaikan pendidikan di Program Pascasarjana Universitas Hasanuddin. Prof. Dr.dr. Pradana Soewondo, SpPD-KEMD sebagai penguji eksternal serta Prof.dr. Mochammad Hatta, Ph.D, Sp.MK(K), Prof.dr. Veni Hadju, M.Sc, Ph.D, Dr.dr. A. Mardiah Tahir, Sp.OG(K), Dr.dr. Burhanuddin Bahar, MS, yang telah berkenan meluangkan waktu yang sangat berharga viii untuk membimbing, mengkoreksi, memberikan saran-saran, selaku penguji, sejak pengajuan proposal penelitian, seminar hasil, ujian pra-promosi sampai pada ujian promosi. Prof.Dr.dr.Karel Pandelaki, SpPD-KEMD, sebagai Guru dan Senior yang sejak awal senantiasa mendorong dan mendukung saya untuk melanjutkan pendidikan tingkat doktoral. Beliau pula berkenan sebagai penguji yang membimbing saya dalam setiap tahapan ujian yang menghasilkan disertasi ini. Kepada Prof. dr. A.R. Sumual, SpPD-KEMD (almarhum) yang akan selalu dikenang dengan penuh rasa syukur dan ucapan terima kasih atas bimbingan, dukungan dan kepercayaan yang senantiasa diberikan kepada saya, serta secara khusus mendorong saya untuk mendalami bidang Endokrinologi, Metabolik dan Diabetes. Direktur Utama RSUP Prof.dr. R.D. Kandou Manado, dr. Maxi R. Rondonuwu, DHSM, MARS yang telah mengijinkan saya untuk melanjutkan dan menyelesaikan tahapan Pendidikan formal tertinggi ini. Kepada tim peneliti, Iwan R. Tumbel S.Kep (Ns), dr. Ray Rattu, dr. Endrile G Balansa, dr. Kevin Irawan, dr. Mulyadi Saul, dr. Megawati Sukardi, dr. Jennifer Sentosa, Febriana Tinamba S.Farm, Esther Lontoh, S.Kep (Ns), MS, Treesje Rengku, S.Kep (Ns), Djelly Kuhu S.Kep (Ns) dan Kezia Natalia Wattie yang penuh sukacita dan kesabaran, bersama-sama membina hubungan dengan para ibu hamil baik di Puskesmas maupun ketika ix harus melakukan kunjungan rumah di lokasi-lokasi yang tidak terduga dan menantang. Kepada tim Laboratorium Klinik Prodia Manado, yang dengan setia dan sukacita, memenuhi jadwal kunjungan lapangan yang padat bersama-sama dengan tim peneliti. Laboratorium Klinik Prodia Makassar yang telah membantu dalam penyimpanan sampel sebelum pengerjaan dimulai. Kepada Tinjo M. Ginting, DCN, selaku ahli nutrisi, atas kesediaan untuk melakukan analisis asupan gizi para ibu hamil. Kepada Prof. dr. Syafruddin, Ph.D selaku pimpinan Laboratorium Hasanuddin University Medical Research Center (HUM-RC) dan dr. Sitti Wahyuni, Ph.D selaku Kepala Unit Laboratorium Umum HUM-RC yang telah mengijinkan saya melakukan pengerjaan analisis sampel di Laboratorium HUM-RC. Secara khusus kepada Sulhidayah ST dan Risma Gala, A.Md yang telah membantu sekaligus menuntun saya dalam melakukan pemeriksaan laboratorium dengan metode ELISA. Suatu pengalaman dan pembelajaran yang mengesankan dan inspiratif. Kepada Kepala Dinas Kesehatan Kota Manado, dr. Robby Jansen Mottoh yang telah mendukung dan mengijinkan saya untuk melakukan penelitian di Puskesmas-Puskesmas di Kota Manado. Para teman sejawat dr. Jiro Lanes, Kepala PKM Bahu, dr. Meyni Manumpil, Kepala PKM Tuminting, dr. Neni Tubagus, Kepala PKM Wawonasa, dr. Anastasya Sampaleng, Kepala PKM Ranomuut dan dr. Rudi Hartoyo, dokter di PKM Ranomuut, dr. Ritha x Pangkerego DK, Kepala PKM Ranotana serta para teman-teman bidan di masing-masing PKM yang telah mendukung pelaksanaan penelitian ini. Kepada Yayasan Institut Danone Indonesia yang telah mendukung melalui kesempatan untuk mengikuti seleksi hibah dana penelitian yang sangat membantu terlaksananya penelitian ini. Secara khusus kepada dr. Widjaja Lukito, PhD, SpGK selaku Ketua Yayasan, yang senantiasa terbuka untuk memberikan bimbingan dan dorongan. Terima kasih banyak atas kesempatan mengikuti Realtime Manuscript Workshop yang sangat berharga, sekaligus belajar menggunakan uji statistik yang sesuai dengan disain penelitian ini. Banyak pihak yang telah membantu penyelesaian dan penerbitan disertasi ini yang tidak dapat saya sebutkan satu persatu. Dengan ketulusan hati, saya sampaikan terima kasih dan penghargaan yang setinggi-tingginya. Kiranya Allah Yang Maha Besar senantiasa melimpahkan karunia dan rahmatNYA kepada kita semua, dalam tugas,
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