Fetal Growth Restriction at High Altitude: Clinical Observations

2018 ◽  
pp. 423-434 ◽  
Author(s):  
Lawrence D. Longo
Keyword(s):  
High Altitude ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Clinical Observations

scholarly journals HYPOXIA AND REPRODUCTIVE HEALTH: Reproductive challenges at high altitude: fertility, pregnancy and neonatal well-being

Reproduction ◽  
2021 ◽  
Vol 161 (1) ◽  
pp. F81-F90
Author(s):  
Lorna G Moore
Keyword(s):  
Blood Flow ◽  
Reproductive Health ◽  
High Altitude ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Access To Health Care ◽  
Well Being ◽  
Growth Restriction ◽  
Intrauterine Development ◽  
Altitude Adaptation

High altitude offers a natural laboratory for studying the effects of chronic hypoxia on reproductive health. Counter to early accounts, fertility (the number of livebirths) appears little affected although stillbirths are more common. Birth weights are lower due to fetal growth restriction, not shortened gestation. Multigenerational (Andean or Tibetan) compared with newcomer residents appear relatively protected from pregnancy loss as well as altitude-associated fetal growth restriction, perhaps due in part to preservation of the normal rise in uterine artery blood flow. Myometrial artery vasodilator response, a key determinant of uterine blood flow, is blunted in healthy Colorado high-altitude residents, similar to what occurs in intrauterine growth restriction or preeclampsia at low altitude. The high-altitude vessels are also more sensitive to the vasodilatory actions of AMP kinase (AMPK) activation. The gene region containing PRKAA1 (coding for AMPK’s alpha-1 catalytic subunit) has been acted upon by natural selection in Andeans and is related to preservation of normal blood flow and fetal growth at high altitude, suggesting one mechanism by which high-altitude adaptation may have been achieved. Preeclampsia is more common at high altitudes but unknown is whether multigenerational residents are protected relative to newcomers. Postnatal loss is diminished in Tibetans vs Han with equal access to health care, perhaps due in part to better maintained arterial O2 saturation during infancy. Finally, pregnancy and intrauterine development not only affect immediate survival but also susceptibility to the later-in-life cardiovascular disease, chronic mountain sickness.

Fetal growth, high altitude, and evolutionary adaptation: A new perspective

2021 ◽  
Author(s):  
Kathryn Wilsterman ◽  
Zachary A Cheviron
Keyword(s):  
Birth Weight ◽  
High Altitude ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Basic Research ◽  
Growth Restriction ◽  
Physiological Processes ◽  
Health Trajectories ◽  
Fetal Physiology ◽  
New Perspective

Residence at high altitude is consistently associated with low birth weight among placental mammals. This reduction in birth weight influences long-term health trajectories for both the offspring and mother. However, the physiological processes that contribute to fetal growth restriction at altitude are still poorly understood, and thus our ability to safely intervene remains limited. One approach to identify the factors that mitigate altitude-dependent fetal growth restriction is to study populations that are protected from fetal growth restriction through evolutionary adaptations (e.g., high altitude-adapted populations). Here, we examine human gestational physiology at high-altitude from a novel evolutionary perspective that focuses on patterns of physiological plasticity, allowing us to identify (1) the contribution of specific physiological systems to fetal growth restriction and (2) mechanisms that confer protection in highland-adapted populations. Using this perspective, our review highlights two general findings: first, that the beneficial value of plasticity in maternal physiology is often dependent on factors more proximate to the fetus; and second, that our ability to understand the contributions of these proximate factors is currently limited by thin data from altitude adapted populations. Expanding the comparative scope of studies on gestational physiology at high altitude and integrating studies of both maternal and fetal physiology are needed to clarify the mechanisms by which physiological responses to altitude contribute to fetal growth outcomes. The relevance of these questions to clinical, agricultural, and basic research combined with the breadth of the unknown highlight gestational physiology at high altitude as an exciting niche for continued work.

scholarly journals Fetal Gene Variants Associated With Birth Weight Protection in a Native High Altitude Ladakhi Population

2021 ◽  
Author(s):  
Sushil Bhandari ◽  
Padma Dolma ◽  
Mitali Mukerji ◽  
Bhavana Prasher ◽  
Hugh Montgomery ◽  
...  
Keyword(s):  
Birth Weight ◽  
High Altitude ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Principal Component ◽  
Growth Restriction ◽  
Obstetric Outcomes ◽  
Hypoxic Environment ◽  
Show Evidence ◽  
Genomic Regions

Abstract Pathological low birth weight ‘fetal growth restriction’ (FGR) is an important predictor of adverse obstetric outcomes including stillbirth. It is more common amongst native lowlanders when gestating in the hypoxic environment of high altitude, whilst populations who have resided at high altitude for many generations are relatively protected. Genetic study of pregnant populations at high altitude allows for exploration of the hypoxic influence on FGR pathogenesis.Pregnant women were recruited from Sonam Norboo Memorial Hospital, Ladakh between February 2017- January 2019 in this study. Principal component, admixture and genome wide association analysis (GWAS) were applied on umbilical cord blood DNA samples from 316 neonates, to explore ancestry and the genetic influence on low birth weight.Our findings support Tibetan ancestry in the Ladakhi population, with subsequent admixture with neighboring Indo-Aryan populations. Fetal growth protection was evident in Ladakhi neonates. Seven loci from five different genomic regions (ZBTB38, ZFP36L2, HMGA2, CDKAL1, PLCG1) previously associated with birthweight, were likewise similarly associated here. In summary, the Ladakhi population show evidence of enrichment of variants in genes that may help mitigate altitude-associated fetal growth restriction, supporting novel biological pathways and therapeutic targets for FGR, worthy of further investigation.

FETAL GROWTH RESTRICTION WITH EARLY AND LATE MANIFESTATION, PROGNOSTIC MARKERS

2020 ◽  
pp. 27-30
Author(s):  
Yakubova D.I.
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Prenatal Screening ◽  
Prognostic Markers ◽  
Growth Restriction ◽  
Late Manifestation ◽  
Late Form ◽  
Early Manifestation

Objective of the study: Comprehensive assessment of risk factors, the implementation of which leads to FGR with early and late manifestation. To evaluate the results of the first prenatal screening: PAPP-A, B-hCG, made at 11-13 weeks. Materials and Methods: A retrospective study included 110 pregnant women. There were 48 pregnant women with early manifestation of fetal growth restriction, 62 pregnant women with late manifestation among them. Results of the study: The risk factors for the formation of the FGR are established. Statistically significant differences in the indicators between groups were not established in the analyses of structures of extragenital pathology. According to I prenatal screening, there were no statistical differences in levels (PAPP-A, b-hCG) in the early and late form of FGR.

INTRAUTERINE GROWTH RETARDATION - A REVIEW ARTICLE

2018 ◽  
pp. 184-195
Author(s):  
Minh Son Pham ◽  
Vu Quoc Huy Nguyen ◽  
Dinh Vinh Tran
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Growth Potential ◽  
National Guidelines ◽  
Intrauterine Growth ◽  
No Gold Standard

Small for gestational age (SGA) and fetal growth restriction (FGR) is difficult to define exactly. In this pregnancy condition, the fetus does not reach its biological growth potential as a consequence of impaired placental function, which may be because of a variety of factors. Fetuses with FGR are at risk for perinatal morbidity and mortality, and poor long-term health outcomes, such as impaired neurological and cognitive development, and cardiovascular and endocrine diseases in adulthood. At present no gold standard for the diagnosis of SGA/FGR exists. The first aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines. Another aim to summary a number of interventions which are being developed or coming through to clinical trial in an attempt to improve fetal growth in placental insufficiency. Key words: fetal growth restriction (FGR), Small for gestational age (SGA)

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