Fetal growth restriction and maternal oxygen transport during high altitude pregnancy
Fetal growth restriction and maternal oxygen transport during high altitude pregnancy
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DOI：
10.1089/152702903322022767
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发表时间：
2003-06-01
影响因子：
2.1
通讯作者：
Moore, LG
中科院分区：
文献类型：
--
作者：
Moore, LG
高海拔会降低出生体重，由于妊娠晚期胎儿生长受到限制，海拔每增加 1000 米，平均体重下降 100 克。宫内生长受限（IUGR）会增加低海拔和高海拔地区的新生儿或婴儿死亡率，但现有研究尚不清楚高海拔地区的 IUGR 特异性死亡率是否与低海拔地区相似、低于或高于。怀孕会增加母亲的通气量并提高高海拔地区的动脉 O-2 饱和度，这有助于预防与高原相关的 IUGR。慢性缺氧会干扰母体对妊娠的循环调节，与海平面相比，血容量较低，心输出量的增加也减少。与低海拔地区相比，子宫动脉和其他子宫胎盘血管的生长和重塑在高海拔地区不完全，导致髂总血流从髂外动脉到子宫动脉的重新分配较少，近期子宫动脉血流量较低。多代高海拔人群（例如安第斯人和藏人）的适应允许更高的子宫动脉血流量并防止与海拔相关的 IUGR。
High altitude reduces birth weights, averaging a 100-g fall per 1000 m elevation gain, as the result of restriction of third trimester fetal growth. Intrauterine growth restriction (IUGR) raises neonatal or infant mortality at low as well as at high altitude, but existing studies are unclear as to whether IUGR-specific mortality at high altitude is similar to, less than, or greater than at low altitude. Pregnancy increases maternal ventilation and raises arterial O-2 saturation at high altitude, which helps to protect against altitude-associated IUGR. Chronic hypoxia interferes with the maternal circulatory adjustments to pregnancy such that blood volume is lower and the rise in cardiac output diminished compared with sea level. The growth and remodeling of the uterine artery and other uteroplacental vessels is incomplete at high compared with low altitude, with the result that there is less redistribution of common iliac flow from the external iliac to the uterine arteries and lower uterine artery blood flow near term. Adaptations in multigenerational high altitude populations (e.g., Andeans and Tibetans) permit higher uterine artery blood flows and protect against altitude-associated IUGR.