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High Altitude, Chronic Hypoxia, and Pregnancy

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Part of the book series: Respiratory Medicine ((RM))

Although placental and pregnancy physiology are not the focus of this book, many patients and their providers have concerns about the potential impact of altitude on fetal oxygenation. Understanding the effect of high altitude on the placenta and the potential adverse effects on the pregnancy and the fetus may help the clinician appreciate the potential effects of some advanced lung diseases and chronic hypoxia on the pregnancy and the fetus. This chapter is a succinct review of the effect of high altitude on lung function in pregnancy and placental complications.

The most obvious effect of high altitude on pregnancy outcomes is chronic hypoxia. High altitude associated chronic hypoxia affects 140 million persons in the world living at 8,000 feet or higher. This makes hypoxia at high altitude in pregnancy the most common etiology of maternal-fetal hypoxia ( 1 ).

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References

  1. Moore LG, Niermeyer S, Zamudio S. Human adaptation to high altitude: regional and life-cycle perspectives. Am J Phys Anthropol 1998;Suppl 27:25–64.

    Article  PubMed  Google Scholar 

  2. McAuliffe F, Kametas N, Espinoza J, Greenough A, Nicolaides K. Respiratory function in pregnancy at sea level and at high altitude. BJOG 2004;111(4):311–5.

    Article  PubMed  Google Scholar 

  3. McAuliffe F, Kametas N, Rafferty GF, Greenough A, Nicolaides K. Pulmonary diffusing capacity in pregnancy at sea level and at high altitude. Respir Physiol Neurobiol 2003;34(2):85–92.

    Article  Google Scholar 

  4. Hellegers A, Metcalfe J, Huckabee WE, Prystowsky H, Meschia G, Barron DH. Alveolar PCO2 and PO2 in pregnant and nonpregnant women at high altitude. Am J Obstet Gynecol 1961;82:241–5.

    PubMed  CAS  Google Scholar 

  5. Sobrevilla LA, Cassinelli MT, Carcelen A, Malaga JM. Human fetal and maternal oxygen tension and acid-base status during delivery at high altitude. Am J Obstet Gynecol 1971;111(8):1111–8.

    PubMed  CAS  Google Scholar 

  6. Krampl E. Pregnancy at high altitude. Ultrasound Obstet Gynecol 2002;19(6):535–9.

    Article  PubMed  CAS  Google Scholar 

  7. Kametas NA, Krampl E, McAuliffe F, Rampling MW, Nicolaides KH. Pregnancy at high altitude: a hyperviscosity state. Acta Obstet Gynecol Scand 2004;83(7):627–33.

    PubMed  Google Scholar 

  8. Jensen GM, Moore LG. The effect of high altitude and other risk factors on birthweight: independent or interactive effects? Am J Public Health 1997;87(6):1003–7.

    Article  PubMed  CAS  Google Scholar 

  9. Giussani DA, Phillips PS, Anstee S, Barker DJ. Effects of altitude versus economic status on birth weight and body shape at birth. Pediatr Res 2001;49(4):490–4.

    Article  PubMed  CAS  Google Scholar 

  10. Miller S, Tudor C, Nyima, Thorsten VR, Sonam, Droyoung, Craig S, Le P, Wright LL, Varner MW. Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet. Int J Gynaecol Obstet 2007;98(3):217–21.

    Article  PubMed  CAS  Google Scholar 

  11. Krampl E, Lees C, Bland JM, Espinoza Dorado J, Moscoso G, Campbell S. Fetal biometry at 4300 m compared to sea level in Peru. Ultrasound Obstet Gynecol 2000;16(1):9–18.

    Article  PubMed  CAS  Google Scholar 

  12. Beall CM. Optimal birthweights in Peruvian populations at high and low altitudes. Am J Phys Anthropol 1981;56(3):209–16.

    Article  PubMed  CAS  Google Scholar 

  13. Haas JD, Balcazar H, Caulfield L. Variation in early neonatal mortality for different types of fetal growth retardation. Am J Phys Anthropol 1987;73(4):467–73.

    Article  PubMed  CAS  Google Scholar 

  14. Keyes LE, Armaza JF, Niermeyer S, Vargas E, Young DA, Moore LG. Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia. Pediatr Res 2003;54(1):20–5.

    Article  PubMed  Google Scholar 

  15. Zamudio S. High-altitude hypoxia and preeclampsia. Front Biosci 2007;12:2967–77.

    Article  PubMed  CAS  Google Scholar 

  16. Palmer SK, Moore LG, Young D, Cregger B, Berman JC, Zamudio S. Altered blood pressure course during normal pregnancy and increased preeclampsia at high altitude (3100 meters) in Colorado. Am J Obstet Gynecol 1999;180(5):1161–8.

    Article  PubMed  CAS  Google Scholar 

  17. Moore LG. Human genetic adaptation to high altitude. High Alt Med Biol 2001;2(2):257–79.

    Article  PubMed  CAS  Google Scholar 

  18. Julian CG, Vargas E, Armaza JF, Wilson MJ, Niermeyer S, Moore LG. High-altitude ancestry protects against hypoxia-associated reductions in fetal growth. Arch Dis Child Fetal Neonatal Ed 2007;92(5):F372–7.

    Article  Google Scholar 

  19. Beall CM. Tibetan and Andean patterns of adaptation to high-altitude hypoxia. Hum Biol 2000;72(1):201–28.

    PubMed  CAS  Google Scholar 

  20. Beall CM. Detecting natural selection in high-altitude human populations. Respir Physiol Neurobiol 2007;158(2–3):161–71.

    Article  PubMed  Google Scholar 

  21. Vargas M, Vargas E, Julian CG, Armaza JF, Rodriguez A, Tellez W, Niermeyer S, Wilson M, Parra E, Shriver M, Moore LG. Determinants of blood oxygenation during pregnancy in Andean and European residents of high altitude. Am J Physiol Regul Integr Comp Physiol 2007;293(3):R1303–12.

    Article  PubMed  CAS  Google Scholar 

  22. Wilson MJ, Lopez M, Vargas M, Julian C, Tellez W, Rodriguez A, Bigham A, Armaza JF, Niermeyer S, Shriver M, Vargas E, Moore LG. Greater uterine artery blood flow during pregnancy in multigenerational (Andean) than shorter-term (European) high-altitude residents. Am J Physiol Regul Integr Comp Physiol 2007;293(3):R1313–24.

    Article  PubMed  CAS  Google Scholar 

  23. Cadnapaphornchai MA, Ohara M, Morris KG Jr, Knotek M, Rogachev B, Ladtkow T, Carter EP, Schrier RW. Chronic NOS inhibition reverses systemic vasodilation and glomerular hyperfiltration in pregnancy. Am J Physiol Renal Physiol 2001;280(4):F592–8.

    PubMed  CAS  Google Scholar 

  24. Furuhashi N, Kimura H, Nagae H, Yajima A. Maternal plasma endothelin levels and fetal status in normal and preeclamptic pregnancies. Gynecol Obstet Invest 1995;39(2):88–92.

    Article  PubMed  CAS  Google Scholar 

  25. Moore LG, Jahnigen D, Rounds SS, Reeves JT, Grover RF. Maternal hyperventilation helps preserve arterial oxygenation during high-altitude pregnancy. J Appl Physiol 1982;52(3):690–4.

    PubMed  CAS  Google Scholar 

  26. McAuliffe F, Kametas N, Krampl E, Ernsting J, Nicolaides K. Blood gases in pregnancy at sea level and at high altitude. BJOG 2001;108(9):980–5.

    Article  PubMed  CAS  Google Scholar 

  27. Zamudio S, Postigo L, Illsley NP, Rodriguez C, Heredia G, Brimacombe M, Echalar L, Torricos T, Tellez W, Maldonado I, Balanza E, Alvarez T, Ameller J, Vargas E. Maternal oxygen delivery is not related to altitude- and ancestry-associated differences in human fetal growth. J Physiol 2007;582(Pt 2):883–95.

    Article  PubMed  CAS  Google Scholar 

  28. Krampl E, Lees C, Bland JM, Espinoza Dorado J, Moscoso G, Campbell S. Fetal Doppler velocimetry at high altitude. Ultrasound Obstet Gynecol 2001;18(4):329–34.

    Article  PubMed  CAS  Google Scholar 

  29. Zamudio S, Palmer SK, Droma T, Stamm E, Coffin C, Moore LG. Effect of altitude on uterine artery blood flow during normal pregnancy. J Appl Physiol 1995;79(1):7–14.

    PubMed  CAS  Google Scholar 

  30. White MM, McCullough RE, Dyckes R, Robertson AD, Moore LG. Chronic hypoxia, pregnancy, and endothelium-mediated relaxation in guinea pig uterine and thoracic arteries. Am J Physiol Heart Circ Physiol 2000;278(6):H2069–75.

    PubMed  CAS  Google Scholar 

  31. Thaete LG, Neerhof MG, Caplan MS. Endothelin receptor A antagonism prevents hypoxia-induced intrauterine growth restriction in the rat. Am J Obstet Gynecol 1997;176(1 Pt 1):73–6.

    Article  PubMed  CAS  Google Scholar 

  32. Kametas NA, Savvidou MD, Donald AE, McAuliffe F, Nicolaides KH. Flow-mediated dilatation of the brachial artery in pregnancy at high altitude. BJOG 2002;109(8):930–7.

    Article  PubMed  Google Scholar 

  33. Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003;111(5):649–58.

    PubMed  CAS  Google Scholar 

  34. Nevo O, Soleymanlou N, Wu Y, Xu J, Kingdom J, Many A, Zamudio S, Caniggia I. Increased expression of sFlt-1 in in vivo and in vitro models of human placental hypoxia is mediated by HIF-1. Am J Physiol Reg Integr Comp Physiol 2006;291(4):R1085–93.

    Article  CAS  Google Scholar 

  35. Zamudio S, Wu Y, Ietta F, Rolfo A, Cross A, Wheeler T, Post M, Illsley NP, Caniggia I. Human placental hypoxia-inducible factor-1alpha expression correlates with clinical outcomes in chronic hypoxia in vivo. Am J Pathol 2007;170(6):2171–9.

    Article  PubMed  CAS  Google Scholar 

  36. Knottnerus JA, Delgado LR, Knipschild PG, Essed GG, Smits F. Haematologic parameters and pregnancy outcome. A prospective cohort study in the third trimester. J Clin Epidemiol 1990;43(5):461–6.

    CAS  Google Scholar 

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Bourjeily, G. (2009). High Altitude, Chronic Hypoxia, and Pregnancy. In: Rosene-Montella, K., Bourjeily, G. (eds) Pulmonary Problems in Pregnancy. Respiratory Medicine. Humana Press. https://doi.org/10.1007/978-1-59745-445-2_3

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  • DOI: https://doi.org/10.1007/978-1-59745-445-2_3

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