HUBUNGAN PAPARAN MERKURI DENGAN PERUBAHAN MARKER OKSIDATIF DAN PERKEMBANGAN ANAK DESA KALIREJO KECAMATAN KOKAP KABUPATEN KULON PROGO YOGYAKARTA

ERNAWATI, Promotor : Prof. DR. dr. KRT. Adi Heru Sutomo, M.Sc D.Comm. Nutr. DLSHTM, PKK. dan Co-Promotor : Dr. Med. Dr. Indwiani Astuti

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

INTISARI Latar Belakang:Ibu Hamil dan bayi yang tinggal di sekitar penambangan emas berisiko terhadap paparan Hg dan bisa menyebabkan gangguan perkembangan melalui mekanisme stres oksidatif yang mendasari toksisitas Hg yang langsung merugikan sel-sel otak. Malondialdehyde (MDA) dan 8-Hidroksi-2â��-Deoksiguanosin (8-OHdG) merupakan biomaker kerusakan oksidatif yaitu oksidatif DNA . Tujuan: Mengetahui hubungan paparann Hg dengan perubahan marker oksidatif dan perkembangan anak Metode:Penelitian Observasional Longitudinal memeriksa kadar Hg darah, rambut, urin ibu saat hamil dan ditambah ASI pasca lahir. Darah tali pusat, rambut dan urin, diambil pada saat bayi berumur 3,15 (I ) dan 6,15 bulan ( II ). Kadar MDA dan 8-OHdG diukur dalam urin yang diambil pagi hari. Asupan Hg dari daun singkong, pepaya dan katok saat hamil dan pasca lahir di pantau berdasarkan kuesioner FFQF. Enam belas pasang Ibu dan bayi diperoleh berdasarkan kriteria inklusi dan eksklusi. Perkembangan anak diobsevasi dengan Bayley Scales of Infant and Toddler Developmet III dan pengasuhan orang tua. Analisis statistik deskriptif, bivariat dan multivariat dengan metode SEM dengan Partial least Square regression (PLS regression) software. Hasil:Rerata Hg semua spesimen di atas NAB yang di tetapkan WHO. Rerata MDA diatas kadar orang normal (1,03 �µMol/L) dan 8 OHdG diatas kadar orang yang tidak terpapar Hg sebesar 2,28 nm/ml. Hg darah tali pusat berhubungan dengan Hg rambut bayi I (P=0,026), Hg rambut Ibu I berhubungan dengan Hg rambut bayi I dan II(P=0,001 dan 0,007), urin Ibu I dengan Hg rambut bayi I (P= 0,001), ASI I dengan urin bayi II (P=0,002), dan urin Ibu II dengn Hg urin bayi tahap II (P=0,001). Hg darah Ibu I dan II berhubungan denagn MDA ibu I (P=0,014) dan II (P=0,037). Hg rambut bayi I berhubungan dengan MDA Bayi I (P=0,039 ) dan II (P=0,044 ). Hg darah Ibu II berhubungan dengan 8 OHdG Ibu II ( P=0,032 ), ASI II dengan 8 OHdG bayi II (P=0,011) dan MDA ibu I berhubungan dengan 8 OHdG ibu II (P=0,031). Hg ASI dan Urin bayi I berhubungan dengan Sosioemosional I (P =0,043 dan 0,040), MDA Ibu II berhubungan dengan bahasa dan sosioemosional II (P=0,018 dan P= 0,013 ), MDA bayi I dengan Bahasa dan adaptif II (P=0,028 dan P=0,010 ), MDA bayi II dengan Motorik II (P=0,011). Pengsuhan orang tua I berhubungan dengan Kognitif I (P=0,014) , bahasa I (P= 0,027) dan motorik (P=0,035 ) bayi. Asupan Hg dari sayuran sumber rumah I berhubungan dengan kadar Hg rambut dan urin ibu I (P= 0,020 dan 0,032 ). Kesimpulan:Hg darah tali pusat, Hg rambut dan urin ibu berhubungan dengan kadar Hg rambut bayi serta Hg Urin ibu dan Hg Asi berhubungan Hg urin bayi. Kadar Hg darah Ibu dan kadar Hg rambut behubungan dengan MDA ibu dan bayi . Hg darah ibu dan Hg Asi masing-masing berhubungan dengan 8 OHdg Ibu dan 8 ODG Bayi. Hg ASI dan Urin Bayi I berhubungan dengan Sosioemosional. MDA Ibu dan bayi berhubungan Bahasa dan Sosioemosional dan Bahasa, perilaku adaptif dan motorik. Pengasuhan orang tua berhubungan dengan aspek kognitif, bahasa dan motorik. Asupan Hg dari sayuran sumber rumah berhubungan dengan kadar Hg rambut dan urin ibu Kata Kunci: Lingkungan Penambangan emas, merkuri ( Hg), Marker Oksidatf, MDA, 8-OHdG, Perkembangan anak.

ABSTRACT Background: Pregnant mothers and infants living near gold mines had high risk of Hg exposure and could cause development problem through oxidative stress mechanism which underlie Hg toxicity directly damaging brain cells. Malondialdehyde (MDA) and 8-Hidroksi-2â��-Deoksiguanosin (8-OHdG) were used as biomaker oxidative damage, i.e. DNA oxidative. Purpose: to find out the correlation of Hg exposure with changes in oxidative biomaker and infantsâ�� development. Method : Observasional Longitudinal research was done to observe Hg level in maternal blood, hair and urine during pregnancy and postpartum breast milk. Hg level in cord blood, infantsâ�� hair and urine was taken when the infant was 3.15 months old (I) and 6.15 months old (II). Level of MDA and 8-OHdG was measured from the morning urine. Hg intake from cassava, papaya, and katuk leaves during pregnancy was observed using FFQF questionnaire. Sixty pairs of mother and infant were selected using inclusive and exclusive criteria. Infantsâ�� development was observed using Bayley Scales of Infant and Toddler Developmet III and parental caregiving. Descriptive statistics, bivariate, and multivariate analysis were used with SEM method using Partial least Square regression (PLS regression) software. Result : average of Hg in all of specimen was above TLV determined by WHO. Average of MDA level was above normal people level (1.03 �µMol/L) and 8-OhdG level was above the amount in the unexposed people (2.28 nm/ml). Cord blood Hg correlated with infantsâ�� hair Hg I (P= .026), maternal hair Hg I correlated with infantsâ�� hair Hg I and II (P= .001 and .007), maternal urine I with infantsâ�� hair Hg I (P= .001), breast milk I with infants urine II (p = .002), and maternal urine II with infantsâ�� urine Hg II (p= .001). Maternal blood Hg I and II correlated with maternal MDA I (P= .014) and II (P= .037). Infantsâ�� hair Hg I correlated with infantsâ�� MDA I (P= .039) and II (P= .044). Maternal blood Hg II correlated with maternal Hg 8 OHdGII (p= .032), breast milk II with infantsâ�� 8 OHdG II (P=.011) and maternal MDA I correlated with maternal 8 OHdG II (P = .031). Breast milk and infantsâ�� urine I correlated with socio-emotional I (P= .043 and .040), maternal MDA II correlated with language and socio-emotional II (P= .018 and P= .013), infantsâ�� MDA I with language and adaptive II (P= .028 and P= .010), infantsâ�� MDA II with motoric II (P=.011). Parental caregiving I correlated with infantsâ�� cognitive I (P= .014), language I (P= .027) and motoric (P= .035). Hg intake from home source vegetables I correlated with maternal hair and urine I (P= .020 and .032). Conclusion:There was correlation between cord bloods Hg, maternal hair and urinary Hg with infantsâ�� hair Hg. Maternal urinary Hg and breast milk Hg correlated with infantsâ�� urinary Hg. Maternal blood and hair Hg correlated with maternal and infantsâ�� MDA. Maternal blood Hg and breast milk Hg each correlated with maternal and infantsâ�� 8 OHdG, respectively. Hg in breast milk and infantsâ�� urine I correlated with socio-emotional. Maternal and infantsâ�� MDA correlated with language, socio-emotional, adaptive behaviour and motoric. Parental care giving correlated with cognitive, language, and motoric. Hg intake from home grown vegetables correlated with maternal hair and urinary Hg. Key words: gold mine environment, mercury (Hg), oxidative marker, MDA, 8-OHdG, infant development

Kata Kunci : Lingkungan Penambangan emas, merkuri ( Hg), Marker Oksidatf, MDA, 8-OHdG, Perkembangan anak / gold mine environment, mercury (Hg), oxidative marker, MDA, 8-OHdG, infant development