Effects of Altitude versus Economic Status on Birth Weight and Body Shape at Birth

Giussani, Dino A.; Phillips, P Seamus; Anstee, Sydney; Barker, D. J. P.

doi:10.1203/00006450-200104000-00009

Cited by 200 publications

(217 citation statements)

References 52 publications

(41 reference statements)

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“…Populations established at high altitude are therefore unique, permitting the investigation of adaptive biological traits during pregnancy and early development to the common, selective pressure of exaggerated fetal hypoxia. Accordingly, many seminal studies have reported that pregnancy at high altitude not only leads to low birth weight (23)(24)(25)(26)(27), but that this effect is reduced in populations with a prolonged high-altitude native ancestry, as in Andeans and Tibetans (14)(15)(16)(17)(18). The selected advantageous traits of highaltitude native ancestry that reduce fetal growth restriction are so powerful that they overwhelm any additional detrimental effects of maternal malnutrition on fetal growth.…”

Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

“…In Bolivia, Andean relative to European populations are generally impoverished, with a continuing high prevalence of maternal malnutrition during pregnancy. This explains the apparent paradox of European financially affluent families giving birth to babies of lower weight than those of Andean families who are highly impoverished in La Paz (15). In this study, we confirm previous observations demonstrating a protective effect of Andean ancestry (15)(16)(17) in a larger population of birth records drawn from individuals who are now adults in Bolivia and can therefore be used for investigating the effect of high-altitude hypoxic pregnancy on the relationship between birth size and the developmental programming of disease in humans.…”

Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

“…This explains the apparent paradox of European financially affluent families giving birth to babies of lower weight than those of Andean families who are highly impoverished in La Paz (15). In this study, we confirm previous observations demonstrating a protective effect of Andean ancestry (15)(16)(17) in a larger population of birth records drawn from individuals who are now adults in Bolivia and can therefore be used for investigating the effect of high-altitude hypoxic pregnancy on the relationship between birth size and the developmental programming of disease in humans. This study also extends previous reports to show that high-altitude native ancestry confers graduated protection against the effects of high altitude on birth weight with the greatest effect evident in Andeans, intermediate in Mestizos, and least in babies of European families, and that this protection is selective for birth weight rather than birth length.…”

Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

“…More than 140 million people live at altitudes >2,500 m where lowered oxygen availability has been shown to reduce fetal growth and birth weight, thus comprising the largest single human group at risk for fetal growth restriction. Of note, multigenerational highaltitude populations demonstrate protection against the effects of high-altitude hypoxia on fetal growth (14)(15)(16)(17)(18). Experimental studies in animal models support the likelihood that prenatal hypoxia can program cardiac, vascular, and metabolic dysfunction in the adult offspring (19)(20)(21), and that high-altitude ancestry protects against the effect of chronic hypoxic development on fetal growth (22).…”

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Graduated effects of high-altitude hypoxia and highland ancestry on birth size

et al. 2013

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Background: We present a cohort of ca. 25,000 birth records from Bolivia of men and women who are currently adults. We used this cohort to test the hypothesis that high altitude reduces birth weight and that highland ancestry confers graduated protection against this effect. Methods: Birth records were obtained from obstetric clinics and hospitals in La Paz (3,600 m) and Santa Cruz (420 m). Only singleton, healthy term (>37 wk) pregnancies of nonsmoking mothers were included. Andean, Mestizo, or European ancestry was determined by validated analysis of parental surnames. results: High altitude reduced body weight (3,396 ± 3 vs. 3,090 ± 6 g) and length (50.8 ± 0 vs. 48.7 ± 0 cm) at birth (P < 0.001). Highland ancestry partially protected against the effects of high altitude on birth weight (Andean = 3,148 ± 15 g; Mestizo = 3,081 ± 6 g; and European = 2,957 ± 32 g; trend P < 0.001) but not on birth length. The effects of high-altitude pregnancy on birth size were similar for male and female babies. conclusion: High altitude reduces birth weight and highland native ancestry confers graduated protection. Given previous studies linking reduced birth weight with increased risk of cardiovascular disease, further study is warranted to test whether adults from high-altitude pregnancy are at increased risk of developing cardiovascular disease.i n addition to the interaction between our genetic makeup and traditional lifestyle risk factors, such as smoking and obesity, it is now accepted that the quality of the environment in prenatal life programs cardiovascular health and the risk of developing heart disease (1). Overwhelming evidence derived from human studies dating back more than two decades and encompassing six continents now links development under suboptimal intrauterine conditions with low birth weight and increased rates of coronary heart disease and the metabolic syndrome (2-8). Epidemiologic studies relating the type of suboptimal intrauterine condition with physiological dysfunction in later life have largely focused on human populations undergoing alterations in maternal nutrition or on human pregnancy affected by maternal psychological stress or by exposure to stress hormones (9-11). This focus on the nutrient supply to the fetus or on maternofetal stress in humans is supported by a large number of investigations in experimental animal models demonstrating that cardiovascular dysfunction in adulthood can be programmed in pregnancy by inappropriate nutrition or by exposure to glucocorticoid excess (1,12,13).In addition to the alterations in maternal nutrition and maternal stress, fetal hypoxia is one of the most common suboptimal conditions in complicated pregnancy. More than 140 million people live at altitudes >2,500 m where lowered oxygen availability has been shown to reduce fetal growth and birth weight, thus comprising the largest single human group at risk for fetal growth restriction. Of note, multigenerational highaltitude populations demonstrate protection against the effects of high-altitude hypoxi...

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Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

Section: Andean Mestizo and European Birth Sizementioning

confidence: 99%

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confidence: 99%

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Graduated effects of high-altitude hypoxia and highland ancestry on birth size

et al. 2013

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“…Because chronic hypoxia causes growth retardation, birth weight modestly decreases as altitude increases. 27,28 As such, Andean populations who live at high altitude over many generations have an increased frequency of low birth weight infants. However, these newborns have an average birth weight that is higher than those from populations living at high altitude for a shorter period of time, such as Europeans.…”

Section: Prevalence Of Low Birth Weight Newbornsmentioning

confidence: 99%

High Altitude Renal Syndrome (HARS)

Aréstegui

Fuquay

Sirota

et al. 2011

Journal of the American Society of Nephrology

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Evaluation of Linear Growth at Higher Altitudes

Baye

Hirvonen²

2020

JAMA Pediatr

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Irrespective of their genetic makeup, children living in an ideal home environment that supports healthy growth have similar growth potential. However, whether this potential is true for children residing at higher altitudes remains unknown. OBJECTIVE To investigate whether altitude is associated with increased risk of linear growth faltering and evaluate the implications associated with the use of the 2006 World Health Organization growth standards, which have not been validated for populations residing 1500 m above sea level. DESIGN, SETTINGS, AND PARTICIPANTS Analysis of 133 nationally representative demographic and health cross-sectional surveys administered in 59 low-and middle-income countries using local polynomial and multivariate regression was conducted. A total of 964 299 height records from 96 552 clusters at altitudes ranging from −372 to 5951 m above sea level were included. Demographic and Health Surveys were conducted between 1992 and 2018. EXPOSURES Residence at higher altitudes, above and below 1500 m above sea level, and in ideal home environments (eg, access to safe water, sanitation, and health care). MAIN OUTCOMES AND MEASURES The primary outcome was child linear growth deficits expressed in length-for-age/height-forage z scores (HAZ). Associations between altitude and height among all children and those residing in ideal home environments were assessed. Child growth trajectories above and below 1500 m above sea level were compared and the altitude-mediated height deficits were estimated using multivariable linear regression. RESULTS In 2010, a total of 842 million people in the global population (approximately 12%) lived 1500 m above sea level or higher, with 67% in Asia and Africa. Eleven percent of the sample was children who resided 1500 m above sea level or higher. These children were born at shorter length and remained on a lower growth trajectory than children residing in areas less than 1500 m above sea level. The negative association between altitude and HAZ was approximately linear through most part of the altitude distribution, indicating no clear threshold for an abrupt decrease in HAZ. A 1000-m above sea level increase in altitude was associated with a 0.163-unit (95% CI, −0.205 to −0.120 units) decrease in HAZ after adjusting for common risk factors using multivariable linear regressions. The HAZ distribution of children residing in ideal home environments was similar to the 2006 World Health Organization HAZ distribution, but only up to 500 m above sea level. CONCLUSIONS AND RELEVANCE The findings of this study suggest that residing at a higher altitude may be associated with child growth slowing even for children living in ideal home environments. Interventions addressing altitude-mediated growth restrictions during pregnancy and early childhood should be identified and implemented.

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Effects of Altitude versus Economic Status on Birth Weight and Body Shape at Birth

Cited by 200 publications

References 52 publications

Graduated effects of high-altitude hypoxia and highland ancestry on birth size

Graduated effects of high-altitude hypoxia and highland ancestry on birth size

High Altitude Renal Syndrome (HARS)

Evaluation of Linear Growth at Higher Altitudes

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