Giving green grass jelly for mda (malondialdehyde) level in pregnant women with hypertension

Background: Hypertension is a disease that often occurs during pregnancy. Many factors influence the occurrence of hypertension, one of which is oxidative stress. Oxidative stress has an important role in the pathogenesis of hypertension in pregnancy and ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery) Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery) 1 Karya Husada University Semarang Jalan R. Soekanto No.46, Sambiroto, Kec. Tembalang, Kota Semarang, Jawa Tengah

may be a pathway that can lead to tissue damage. Oxidative stress can stimulate the release of cytokines, antiangiogenic, microparticles and other important molecules in hypertension. Oxidative stress is caused by an imbalance of prooxidants and antioxidants. So we need antioxidants that can suppress oxidative stress in pregnant women with hypertension. Green grass jelly contains alkaloids and flavonoids. Where flavonoids can act as antioxidants and anti-inflammatory. Flavonoids can reduce arterial stiffness making Reactive Oxygen Species (ROS) decrease so that fat peroxide decreases and is followed by decreased oxidative stress, then endothelial function will increase and vasodilation occurs. Malondialdehyde   The placenta is believed to play a central role in every mediator of hypertension (6). The placenta also plays a role in the development of hypertension in which there is disruption of the placenta, poor invasion, and abnormal angiogenesis which are the main pathological manifestations (7). These events are the result of oxidative stress found in hypertensive placentas (8). Oxidative stress has an important role in the pathogenesis of hypertension in pregnancy and may be a pathway that can cause tissue damage (9). Oxidative stress can stimulate the release of cytokines, antiangiogenics, microparticles and other important molecules in hypertension (10). Oxidative stress is caused by an imbalance of pro-oxidants and antioxidants. So we need antioxidants that can suppress oxidative stress in pregnant women with hypertension (11).
In hypertension, therapy given to pregnant women such as methyldopa, -blockers, /β blockers and diuretics (12). However, the use of nifedipine as an inhibitor in some countries such as the UK is contraindicated. In pregnancy it can cause side effects of headache, tachycardia, hypoperfusion in mother and fetus, possible delay in fetal growth, peripheral edema, and even increase the risk of pulmonary edema (13).
One alternative used to reduce hypertension in pregnant women is green grass jelly which contains alkaloids and flavonoids (14). Where flavonoids can act as antioxidants and antiinflammatory (15). The antioxidant content of flavonoids in green grass jelly is 1867 g/ml (16).

RESULTS AND DISCUSSION RESULT
Based on Table 1, malondialdehyde levels decreased in the intervention group. In the green grass jelly group before the intervention the average was 6.742 nmol/ml and after the intervention the average was 5.428 nmol/ml.
In the control group before the intervention the average was 6.779 nmol/ml and after the intervention the average was 6.723 nmol/ml. Based on Table 2, it shows that the control group has a p-value of 0.145, meaning that there is no significant difference between the malondialdehdye examination before and after the intervention in the control group. In the control group, the mean measurement of malondialdehyde levels from pretest to posttest decreased by 0.0560 nmol/ml. In the green grass jelly intervention group, the mean measurement of malondialdehyde levels from pretest to posttest decreased by 1.3133 nmol/ml or 19.4%.

DISCUSSION
The results of processing data on the value of malondialdehyde levels in the green grass jelly intervention group for 14 days obtained 15 respondents who were pregnant women with mild hypertension experienced a decrease in malondialdehyde levels before and after treatment. The results of descriptive analysis of malondialdehyde content data can be seen in table 2 which shows that the pretest malondialdehyde level is 6.7420 ± 2.0225 and the post-test malondialdehyde level is 5.429 ± 2.0159.
Tests in the treatment group and control group showed that in the green grass jelly intervention group the p-value was 0.000 <0.05, which means that there was a significant difference between the pretest and posttest malondialdehyde levels.
So it can be concluded that there is a significant difference in malondialdehyde levels before and after the green grass jelly intervention. The mean decrease in malondialdehyde levels after the intervention was 1.3133 nmol/ml.
In accordance with the theory that placental ischemia and hypoxia will produce oxidants (free radicals) (9). Oxidants or free radicals are compounds that accept molecules that have unpaired electrons. One of the important oxidants produced by placental ischemia is hydroxyl radicals which are highly toxic, especially to vascular endothelial cell membranes. The production of oxidants in humans is a very natural process, because oxidants are needed for the body's immunology (19). In hypertensive patients, the oxidant will decrease enzymatically in the cells, followed by an increase in lipid peroxide due to the free radical malondialdehyde (MDA) (20). The content of flavonoids in green grass jelly has antioxidant activity by binding to free radicals thereby reducing the concentration of lipid peroxide so that malondialdehyde is not formed. In cases of gestational hypertension malondialdehyde (MDA) is present in plasma, small vessels and decidua basalis (21). The results of the analysis are in accordance with research conducted by Yeni et al (2017), research proves that curcumin which contains antioxidants is able to reduce the level of malondialdehyde (MDA) in cells induced by preeclampsia (22). Another study conducted by Martin all (2016) stated that in a prospective cohort of elderly women with a greater intake of flavonoid polymers were less likely to develop hypertension (23).

CONCLUSION AND RECOMMENDATION
The results of this study prove that offering