Altered blood pressure course during normal pregnancy and increased preeclampsia at high altitude (3100 meters) in Colorado

Palmer, Susan K.; Moore, Lorna G.; Young, David A.; Cregger, Betsy; Berman, J. C.; Zamudio, Stacy

doi:10.1016/s0002-9378(99)70611-3

Cited by 218 publications

(169 citation statements)

References 21 publications

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“…Women pregnant at high altitude (>2700 m) have a 2-5-fold increase in the incidence of growth-restricted infants [1,2]. The incidence of preeclampsia is increased 2-4-fold at high altitude [3], and is likewise elevated in women with heart/lung or other disease that impedes oxygen delivery to the fetoplacental unit [4]. At sea level, hypoxia is generally associated with pathologies such as these, precluding investigation of the independent effects of hypoxia on fetoplacental growth and function.…”

Section: Introductionmentioning

confidence: 99%

Effects of chronic hypoxia in vivo on the expression of human placental glucose transporters

2006

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Birth weight is reduced and the risk of preeclampsia is increased in human high altitude pregnancies. There has been little work to determine whether hypoxia acts directly to reduce fetal growth (e.g. reduced blood flow and oxygen delivery), or via changes in functional capacities such as nutrient transport. We therefore investigated the expression of a primary nutrient transporter, the GLUT1 glucose transporter and two in vitro markers of hypoxia (erythropoietin receptor, EPO-R, and transferrin receptor, TfR) in the syncytial microvillous (MVM) and basal membrane fractions (BMF) of 13 high (3100 m) and 12 low (1600 m) altitude placentas from normal term pregnancies. Birth weight was lower at 3100 m than at 1600 m despite similar gestational age, but none of the infants were clinically designated as fetal growth restriction. EPO-R, TfR and GLUT1 were examined by immunoblotting and maternal circulating erythropoietin and transferrin by ELISA. EPO-R was greater on the MVM (C75%) and BMF (C25%) at 3100 m. TfR was 32% lower on the MVM at 3100 m. GLUT1 was 40% lower in the BMF at 3100 m. Circulating EPO was greater at high altitude, while transferrin was similar, and neither correlated with their membrane receptors. BMF GLUT1 was positively correlated with birth weight at high, but not low altitude. In this in vivo model of chronic placental hypoxia, syncytial EPO-R increased as expected, while nutrient transporters decreased, opposite to what has been observed in vitro. Therefore, hypoxia acts to reduce fetal growth not simply by reducing oxygen delivery, but also by decreasing the density of nutrient transporters.

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Section: Introductionmentioning

confidence: 99%

Effects of chronic hypoxia in vivo on the expression of human placental glucose transporters

2006

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“…In this study, maternal age, gravidity, parity, and gestational age were insignificant, but hemoglobin levels increased with altitude (12.9 vs. 11.7 g/L in Group 1 and 2; p<0.01). Palmer et al (12) revealed that the incidence of preeclampsia at 3100 m and 1260 m was 16% and 3%, respectively, and it increased with increasing altitude. In the present study, overall preeclampsia and eclampsia incidence rate was 7.2% (n=582) during the last 5 years, which is in agreement with the literature (6, 7).…”

Section: Discussionmentioning

confidence: 99%

“…With 166 g difference, fetal weight was found to be lower in group 1 than group 2 (2031±964 g in group 1 and 2197±893 in group 2). Palmer et al (12) reported that with 285 g difference, people living at 3100 m altitude had a lower fetal weight than those at 1260 m altitude. At 38%, (62 cases), the fetal death rate in group 1 was higher than that in group 2 with 18% (14 Kumtepe et al Altitude and hypertensive disorders of pregnancy cases), but no studies of high fetal death rates at high altitude could be found in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Preeclampsia is seen in 2-7% of all pregnancies, and its frequency is higher in primigravid than in multigravid women (6,7). It is also more frequently seen in women carrying more than one fetus, older women, women with genetic factors, hyperlipidemia, thrombophilia, obesity, and diabetes mellitus, women experiencing preeclampsia during a previous pregnancy, and those living at high altitudes (8)(9)(10)(11)(12)(13). Preeclampsia is a multisystem disease that affects both mother and fetus.…”

Section: Introductionmentioning

confidence: 99%

“…Because of increased hypoxia, living at high altitude causes important health problems. Studies have revealed that intrauterine growth restriction (IUGR), preterm labor, abruptio placentae, and preeclampsia increase with increasing altitude (12,15). Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome were first reported by Weinstein (16) in 1982, and immediate termination of pregnancy was proposed because of high maternal and perinatal mortality rates.…”

Section: Introductionmentioning

confidence: 99%

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Preeclampsia and eclampsia incidence in the eastern anatolia region of Turkey: the effects of high altitude

Kumtepe¹,

Dündar²,

Çetinkaya³

et al. 2011

J Turkish German Gynecol Assoc

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Objective: Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal mortality and morbidity. The purpose of this study was to determine the distribution map related to pregnancy toxicosis of provinces in our region and the effects of altitude on hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and eclampsia. Materials and Methods:Patients who were admitted to Atatürk University, Obstetrics and Gynecology Department with preeclampsia, eclampsia and a diagnosis of HELLP syndrome for the 5 years between1998-2002 were chosen. The birth rate was obtained from the health directorate of provinces in our area during the same period. Provinces were divided into two groups by altitude: less than and more than 1500 m above sea level. Results:The rates of HELLP syndrome and eclampsia diagnoses were 1.4 per 10.000 patients living above 1500 m altitude. However, this rate was 0.96 per 10.000 patients living below 1500 m altitude (p < 0.01). The highest rate of eclampsia and HELLP syndrome was seen in the Ardahan province, in 36 patients per 10,000 births, whereas the lowest rate was seen in the Iğdır province, 9.9 patients per 10,000 births. Conclusion:Altitude contributes to occurrence of HELLP syndrome and eclampsia. Since the rate of pregnancy related hypertension is higher at high altitude, it is vital that these patients should be diagnosed during the early stages of the diseases in order to decrease complications. (J Turkish-German Gynecol Assoc 2011; 12: 26-30) Key words: Preeclampsia, eclampsia, HELLP syndrome, high altitude Received: 21 November, 2010 Accepted: 29 January, 2011 Amaç: Gebeliğin hipertansif hastalıkları maternal ve perinatal mortalite ve morbiditenin önde gelen sebebi olmaya devam etmektedir. Bu çalışmanın amacı, bölgemizdeki illere gore gebelik toksikozu dağılım haritası çıkarmak ve hemoliz, yükselmiş karaciğer enzimleri, düşük platelet (HELLP) sendromu ve eklampsi üzerine yüksek rakımın etkilerini belirlemektir.

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Oxygen transport in Tibetan women during pregnancy at 3,658 m

Moore

Zamudio

Zhuang³

et al. 2001

Am. J. Phys. Anthropol.

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116

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High-altitude reduces infant birth weight as a result of intrauterine growth restriction (IUGR) and is associated with increased neonatal mortality. We hypothesized that babies born to Tibetan compared to Han (Chinese) high-altitude residents were protected from IUGR as the result of increased maternal O(2) transport due, in turn, to increased uterine artery (UA) blood flow. We studied 68 nonpregnant or pregnant Tibetan or Han residents of Lhasa, Tibet Autonomous Region, China (3,658 m). The pregnant women had higher hypoxic ventilatory responses (HVR A) and resting ventilations (V(E)) than their nonpregnant counterparts (Tib HVR = 134 +/- 16 (SEM) vs. 30 +/- 8, Han HVR = 134 +/- 16 vs. 66 +/- 18 A units; Tib V(E) = 11.8 +/- 0.3 vs. 10.1 +/- 0.5, Han V(E) = 10.7 +/- 0.5 vs. 9.4 +/- 0.5 l BTPS/min; all P < 0.05). Pregnancy did not change hemoglobin concentration in the Han but lowered values more than 2 g/dl in the Tibetans, serving to reduce arterial O(2) content below Han values (15.4 +/- 0.3 vs. 17.4 +/- 0.5 ml O(2)/100 ml whole blood, P < 0.05). Compared with the Han, the pregnant Tibetans had higher UA blood flow velocity (58.5 +/- 2.9 vs. 49.1 +/- 3.2, P < 0. 05) and distributed a higher portion of common iliac (CI) blood flow to the UA (4.8 +/- 0.4 vs. 3.3 +/- 0.3, P < 0.05). Birth weights averaged 635 g greater in the Tibetan than Han high-altitude residents (3,280 +/- 78 vs. 2,645 +/- 96 g, P < 0.01), or 694 g more when adjusted for maternal age, parity, height, and near-term body weight. Heavier birth weight babies were born to women with higher V(E) (r = 0.62, P < 0.01) and greater distribution of CI blood flow to the UA (r = 0.42, P < 0.05). We conclude that increased UA blood flow, and not higher arterial O(2) content, permits Tibetan women to increase uteroplacental O(2) delivery and protect their infants from altitude-associated IUGR.

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Altered blood pressure course during normal pregnancy and increased preeclampsia at high altitude (3100 meters) in Colorado

Cited by 218 publications

References 21 publications

Effects of chronic hypoxia in vivo on the expression of human placental glucose transporters

Effects of chronic hypoxia in vivo on the expression of human placental glucose transporters

Preeclampsia and eclampsia incidence in the eastern anatolia region of Turkey: the effects of high altitude

Oxygen transport in Tibetan women during pregnancy at 3,658 m

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