Pengaruh ibu hamil perokok pasif terhadap kejadian lahir mati di Kota Ambon

PAUNNO, Magdalena, dr. Ova Emilia, SpOG, M.M.Ed, Ph.D

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Intervensi pada perawatan ibu hamil dapat menurunkan kematian perinatal hingga 75%. ANC di Kota Ambon dikategorikan baik, bila dilihat angka rata-rata secara nasional yaitu K1 89%, K4 87,76% namun, kejadian lahir mati sangat tinggi dibanding angka nasional. Salah satu penyebab langsung lahir mati adalah hypokxia yaitu kekurangan oksigen dalam tubuh ibu, akibat dari ibu hamil terpapar asap rokok. Di Kota Ambon, 65% rumah tangga mempunyai 1 orang perokok, dan hampir semua perokok (90%) merokok di rumah. Angka ini lebih tinggi dari angka nasional. Faktor lain menyebabkan lahir mati adalah kualitas antenatal care, umur, paritas anemia ibu selama hamil, pendidikan ibu yang rendah. Tujuan: Penelitian ini untuk mengetahui apakah ibu hamil perokok pasif merupakan faktor risiko kejadian lahir mati. Metode: Penelitian observasional dengan rancangan kasus-kontrol. Lokasi penelitian pada 3 RS di Kota Ambon yaitu: RSUD dr. M. Haulussy, RS. Al-Fatah, RS. Sumber Hidup. Subjek penelitian 1:1 69 lahir mati (kasus) dan 69 lahir hidup (kontrol) pada bulan Januari sampai dengan bulan Desember 2007. Pengambilan sampel dengan cara non probability sampling, ditentukan secara quota sample . Analisis data terdiri dari analisis univariabel, analisis bivariabel menggunakan uji chi-square (c²), stratifikasi serta analisis multivariabel menggunakan regresi logistik. Hasil : Ada hubungan yang bermakna antara ibu hamil perokok pasif dengan kejadian lahir mati. Analisis bivariabel OR=3,36 (95% CI=1,20- 5,41) analisis multivariabel OR=2,8 (1,01-7,94). Faktor risiko lain yang mempengaruhi kejadian lahir mati adalah: Kualitas antenatal care mempunyai nilai OR=3,2 (95% CI=1,39-7,52), ibu hamil anemia OR=2,3 (95% CI=1,20-5,41) dan pendidikan OR=2,42 ( 1,15-5,10).Saat analisis strativikasi, ibu tidak anemia mempunyai hubungan bermakna dengan lahir mati OR=5,7 (95% CI 1,10-55,22). Umur, paritas dan pendidikan bukan merupakan faktor risiko lahir mati di Kota Ambon. Kesimpulan : Ibu hamil perokok pasif merupakan faktor risiko terhadap kejadian lahir mati di Kota Ambon. Faktor lain yang menyebabkan lahir mati adalah kualitas antenatal care dan anemia ibu hamil.

Background: The fetal well being is influenced by the health condition of mother, fetus, and placenta. The direct cause of stillbirth is hypoxia, that is, the lack of oxygen in a pregnant woman’s body due to the exposure of cigarette smoke that contains carbon monoxide and nicotine. Anoxia can affect the fetus because there is an obstruction in placenta’s function. In pregnancy, placenta functions as an organ of respiratory, metabolism, endocrine, nutrient storage, and transportation and it is able to select food substance and other processes before they reach the fetus. In addition, other factors causing stillbirth are the quality of antenatal care, anemia during pregnancy, and woman’s lower educational level. Objective: To study wheter a passive smoking during pregnancy is a risk factor of incidence of stillbirth. Method: This was an observational study with case-control study design. Study sites were in three hospitals of Ambon municipality, namely Dr. M. Haulussy Distric Hospital, Al-Fatah Hospital, and Sumber Hidup Hospital. Subjects were divided into two groups which were case and control with comparison of 1:1 (69 stillbirth as case and 69 live births as control) from January to December 2007. Samples were taken using purposive sampling. The analysis of quantitative data used univariable analysis with frequency distribution, bivariable analysis with chi-square test (c²), and multivariable analysis with logistic regression. Results: Multivariable analysis showed that there was a significant relationship between passive smoking during pregnancy and the incidence of stillbirth with OR=3.36 (95% Cl=1.31-8.64); p=0.00 and R² = 0.03. Another risk factor that affected the incidence of stillbirth was antenatal care with OR=3.21 (95% Cl=1.44-7.15); p=0.00; R² = 0.08. Meanwhile, anemic woman during pregnancy had OR=3.04 (95% Cl=1.49-6.19); p=0.00; R² = 0.08 and woman’s lower educational level had OR=2.38 (95% Cl=1.18-4.81); p=0.00; R² = 0.06. However, age and parity were not risk factors of the incidence of stillbirth in Ambon.

Kata Kunci : Ibu hamil,Perokok pasif,Lahir mati,pregnant woman, passive smoking, stillbirth