Research ArticleEffect of Ajwa Dates Consumption to Inhibit the Progression ofPreeclampsia Threats on Mean Arterial Pressure andRoll-Over Test

Ida Royani,1 Suryani As’ad ,2 Nasrudin A Mappaware,3 Mochammad Hatta ,4

and Rabia 5

1Department of Nutritional Science, Faculty of Medicine, Universitas Muslim Indonesia, Makassar 90231, Indonesia2Department of Nutritional Science, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia3Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Muslim Indonesia, Makassar 90231, Indonesia4Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia5Department of Physiotherapy, Faculty of Nursing, Hasanuddin University, Makassar 90245, Indonesia

Correspondence should be addressed to Rabia; rabiaihsan93@gmail.com

Received 27 September 2019; Accepted 19 November 2019; Published 10 December 2019

Academic Editor: Ali Nokhodchi

Copyright © 2019 Ida Royani et al. 'is is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background. Preeclampsia is the major problem and the main leading cause of fetal and maternal mortality worldwide. 'e earlyprediction of preeclampsia in pregnant women is required to prevent the occurrence of preeclampsia. 'e mean arterial pressure(MAP) and roll-over test (ROT) are the combination of measurement which can be used to predict preeclampsia. On the contrary,Ajwa dates were reported to have an enormous activity which contributes to its role in improving health conditions. In this study,we aimed to evaluate the effect of daily consumption of seven Ajwa dates on prevention of preeclampsia, through MAP and ROTchanges. Methods. Forty pregnant women (n� 40) were randomly assigned into the control group (n� 10) and the interventiongroup which received a daily intake of Ajwa dates (n� 30). 'e MAP and ROT were assessed before and after the 8-weekintervention period. Results. 'e intervention group showed the significant reduction in MAP and ROT following the 8-weekintervention period (p< 0.05). Conclusion. Daily consumption of seven Ajwa dates has a remarkable potential to decrease theMAP and ROT in pregnant women at risk of developing preeclampsia, and thus, it can contribute to prevent the developmentof preeclampsia.

1. Introduction

Based on the World Health Organization (WHO) reports in2018, 830 deaths of women were reported every single day,due to pregnancy and childbirth complication.'e maternalmortality arised from the problems in pregnancy andchildbirth. 'e most fatal complications developed inpregnant women are severe bleeding, infection, hyperten-sion in pregnancy (preeclampsia and eclampsia), and unsafeabortion [1]. In Indonesia, hypertension becomes one of theleading causes of maternal death. Hypertension in preg-nancy may include chronic hypertension, preeclampsia, andeclampsia. Of these, preeclampsia is the major problem and

the main leading cause of fetal and maternal mortalityworldwide [2].

Preeclampsia is a syndrome characterized by the ele-vation of systolic blood pressure (≥140mmHg), or diastolicblood pressure (≥90mmHg), persistent after 20weeks’gestation in pregnant women previously having normalblood pressure. 'e condition can be accompanied with orwithout the new onset of proteinuria. It is also associatedwith other signs and symptoms, including blurry vision,stomachache, headache, and edema. Preeclampsia, a syn-drome in pregnant women, can result in complication formaternal and fetal lives. 'e maternal complications mayinclude cardiovascular disease, cerebrovascular disease, liver

HindawiBioMed Research InternationalVolume 2019, Article ID 2917895, 5 pageshttps://doi.org/10.1155/2019/2917895

and renal failure, placental abruption, and disseminatedintravascular coagulation. However, the fetal complicationcan occur in terms of mortality and disability, resultingfrom fetal growth restriction, preterm birth, low birthweight, severe birth asphyxia, stillbirth, and intrapartumdeath. High adverse effect of preeclampsia and the lack ofunderstanding in its pathophysiology encourage the needfor early prediction of preeclampsia in pregnant women;therefore, various prevention methods to delay the pro-gressivity of preeclampsia can be ensued. 'e studyrevealed that the combination of body mass index, MAP,and ROT can be used as prediction factors for the devel-opment of preeclampsia in pregnant women [3–5]. 'edate fruit, Phoenix dactylifera L. is one of the fruits whichhas abundant benefits for health, including as antioxidant,anti-hyperlipidemic, and hepatoprotective agent, andprevents cardiovascular diseases. 'e metabolic analyseswere conducted for 12 kinds of dates which originated fromSaudi Arabia to determine the nutritional composition ineach kind of dates. It revealed that the highest level ofphenolin was observed in Ajwa dates, while the highestflavonoid was found in Ajwa dates and then in Saffawidates. However, the potential of Ajwa dates was not fullyelucidated in pregnant women; thus in the present study,we aimed to evaluate the effect of daily consumption ofseven Ajwa dates on prevention of preeclampsia, throughMAP and ROT changes.

2. Materials and Methods

2.1. Study Population and Design. 'e randomized con-trolled study was conducted in Sitti Khadijah 1Muhammadiyah Hospital, Makassar, South Sulawesi,Indonesia, from 28 January through 30 March 2019. 'eresearch protocols in the present study were approved bythe Ethical Committee of Medical Faculty, HasanuddinUniversity (64/UN4.6.4.5.31/PP36/2019). 'e writteninformed consent was obtained from all participants. 'einclusion criteria were as follows: (1) the pregnant womenhaving one of the preeclampsia risk factors, includingobesity, primipara, history of hypertension, preeclampsiahistory in previous pregnancy, and family history ofpreeclampsia; (2) pregnant women having predictedpreeclampsia in one or both biophysical predictor as-sessment (MAP and ROT); (3) gestational age at ≥20weeks; and (4) agreed to be included as study participantsand then the informed consent was obtained. 'e ex-clusion criteria included (1) having fasting blood glucoseand 2-hour postprandial blood glucose beyond normalrange, (2) having previous history of chronic infectiondiseases (i.e., tuberculosis, malaria, and thalassemia), and(3) having degenerative diseases (i.e., cardiovasculardiseases, cancer chronic renal failure, and diabetes mel-litus). 'e screening was performed to include the par-ticipants meeting the established criteria in this study. 'eincluded participants in the present study were thenrandomly assigned into the control group (n � 10) and theintervention group receiving the daily intake of Ajwadates (n � 30).

2.2. Experimental Procedure. At the beginning, the partici-pants in the intervention group were given a counsellingsession. In the counselling session, the researchers providedinformation on risks of preeclampsia, the ways to managethe risk to prevent preeclampsia, and the benefits of dailyconsumptions of 7 pieces of Ajwa dates every single morningfor general health and pregnancy. To reinforce the giveninformation, the leaflet was provided to the interventiongroup. It consisted of information on preeclampsia and Ajwadates. 'e participants in the intervention group were giventhe diary sheet to record their daily intake of Ajwa dates foreight weeks. Forty-nine Ajwa dates were provided per weekto the intervention group. However, in the control group,the counselling session was conducted to inform the par-ticipants on the risks of preeclampsia and the ways tomanage the risk to prevent preeclampsia. 'e control groupwas also encouraged to consume nutritious food, avoid fastfood, and increase the consumption of fruits (except dates)and vegetables. 'e leaflet was provided to reinforce in-formation on preeclampsia and nutrition need for pregnantwomen.

2.3. Outcome Measures. 'e measurements of MAP andROT were performed prior to undergoing the interventionand at the completion of the 8-week intervention period inall participants in both groups. 'e blood pressure wasassessed using a digital sphygmomanometer. Before initi-ating the measurement, the participants were asked to sitand relax.'e systolic and diastolic pressures were recorded,and the MAP was obtained using the following formula:

MAP �(2 × diastolic pressure) + systolic pressure

3. (1)

ROTwas performed by measuring the blood pressure inthe side lying position and supine position. 'e ROT valuewas obtained based on the ROT formula.

2.4. StatisticalAnalysis. All data were presented asmeans±SE.'e data obtained in this study were analysed using the Wil-coxon-signed rank test. All statistical analyses were carried outusing SPSS 22.0 software. A p value less than 0.05 was regardedas statistically significant.

3. Results

In the present study, we aimed to evaluate the potential effectof Ajwa dates on prevention of preeclampsia threats inpregnant women at risk of preeclampsia. 'e baselinecharacteristics of the participants are presented in Table 1.As shown in Table 2, the MAP and ROT were significantlyimproved in the intervention group, while the ROTchangeswere not statistically significant in the control group.However, the MAP in control group was significantly in-creased following the 8-week intervention period.

As shown in Figure 1, the median value of MAP wasdecreased following the 8-week intervention period in theintervention group, while the inverse finding was shown inthe control group. Progressivity of preeclampsia based on

2 BioMed Research International

MAP did not occur in the intervention group, but not in thecontrol group. To monitor the general health of participants,the blood pressure was assessed periodically once per 3 days.'e changes in MAP in both groups every 3 days during 8weeks are shown in Figure 2. In addition, the changes inROT following the 8-week intervention period in terms ofmedian values are shown in Figure 3. 'e ROTdecreased inthe intervention group, while an increase in ROTwas seen inthe control group. It indicates that the progressivity ofpreeclampsia was prevented in the intervention group, butnot in the control group.

4. Discussion

'e current study revealed that daily consumption of 7pieces of Ajwa dates in pregnant women with preeclampsiarisk had a potential to prevent the occurrence of pre-eclampsia through improvement in MAP and ROT. Re-garding the amount of Ajwa dates, the study on dailyconsumption of seven dates was also conducted by Al Kuranet al. to evaluate its effect on labour parameters and deliveryoutcomes [6]. 'e same number of dates was also used inseveral studies to determine its effect on the labour processin pregnant women [7–9].

It has been reported that positive MAP at the first tri-mester in pregnant women can become the predictor ofgestational hypertension and preeclampsia with detectionrates being 76%. 'e probability of pregnant women withpositive MAP to develop hypertension in 27 weeks of ges-tational age is 3,381 times compared to those with negativeMAP [10, 11].

'e main finding of the present study is that, on day 21,the significant decrease in MAP was shown in pregnantwomen regularly consuming Ajwa dates, while the inversefindings were shown in the control group. At the completionof the 8-week intervention group, the MAP decreased by13%, while 8.1% increase in MAP was observed in thecontrol group. 'e similar findings were shown on ROTvalues, in which 66.4% of reduction was observed in thecontrol group, while 5.6% increase was shown in the controlgroup. 'e mechanism underlying the potential of Ajwa

Table 1: Baseline characteristics in both groups.

Variables Control group (n� 10) Intervention group (n� 30)Age (year)Low risk 7 (70%) 25 (83.3%)High risk 3 (30%) 5 (16.7%)

Educational levelPrimary school 0 (0%) 6 (20%)Junior high school 5 (50%) 5 (16.7%)Senior high school 3 (30%) 12 (40%)Diploma 0 (0%) 4 (13.3%)Bachelor 2 (20%) 3 (10%)

Gestational age (mean± SD) 22.02± 2.04 22.9± 2.95Gravida1st 6 (54.5%) 14 (46.7%)2nd 2 (18.2%) 7 (23.3%)3rd 2 (18.2%) 8 (26.7%)4th 1 (9.1%) 1 (3.3%)

Employment statusEmployed 7 (60%) 21 (70%)Unemployed 3 (30%) 9 (30%)

Table 2: Outcome measurement in two groups.

OutcomeControl group (n� 10) Intervention group (n� 30)

Before After p value Before After p valueMAP 96.70± 4.85 104.3± 3.60 0.003∗ 98.9± 4.41 85.03± 4.38 <0.001∗ROT 30.40± 2.27 32± 4.22 0.223 30.13± 2.16 10.07± 8.09 <0.001∗

MAP, mean arterial pressure; ROT, roll-over test. ∗p< 0.05, statistically significant.

100

8393

103

0

20

40

60

80

100

120

Preintervention Postintervention

Med

ian

Intervention groupControl group

Figure 1: 'e median value of MAP changes in two groups.

BioMed Research International 3

dates in improving MAP and ROT might be due to thepresence of potassium and magnesium in the Ajwa dates.Potassium and magnesium are the important mineralswhich play a role in controlling blood pressure, normal heartrhythm, and muscle contraction. 'e contained potassiumalso has function as a main regulator of blood vessel tomaintain the elasticity of arterial walls which prevent thedeterioration of vascular under high blood pressure. 'eother study revealed the reduction of systolic blood pressureby 14.23mmHg due to the potassium contained in dates(Deglet Nour). In addition, high level of potassium and lowlevel of sodium in Ajwa dates are seemingly suitable forindividuals with hypertension. Furthermore, the magnesiumin Ajwa dates also functions to activate the Na+/K+ pump,which results in lowering of diastolic blood pressure. Hence,dates have become the traditional therapeutic approach forhypertension in Maroko [12–14].

On the contrary, vasodilator activity of flavonoid con-tained in Ajwa dates also contributes to reducing the bloodpressure. As we know, endothelial dysfunction has a com-plex relationship with the hypertension, preceding the de-velopment of pathologic condition in the cardiovascularsystem. 'erefore, improving the endothelial function maycontribute to decrease the blood pressure. High consump-tion of flavonoid-rich foods can prevent the cardiovasculardisease which has been proven in the pharmacological and

epidemiological study [15–19]. 'e similar findings on theantihypertensive activity of Ajwa dates were also reported byQureshi and Khan [20].

5. Conclusions

Based on the findings in the present study, we concluded thatdaily consumption of seven Ajwa dates has a remarkablepotential to decrease the MAP and ROT in pregnant womenat risk of developing preeclampsia, and thus it can contributeto prevent the development of preeclampsia.

Data Availability

'e raw (excel) data used to support the findings of thisstudy are available from the corresponding author uponrequest.

Conflicts of Interest

'e authors declare that they have no conflicts of interestregarding the publication of this paper.

Acknowledgments

'e authors would like to thank the Ministry of ResearchTechnology and Higher Education for providing thescholarship.

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100102104106

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MA

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