Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia
Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia
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DOI：
10.1203/01.pdr.0000069846.64389.dc
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发表时间：
2003-07-01
影响因子：
3.6
通讯作者：
Moore, LG
中科院分区：
文献类型：
--
作者：
Keyes, LE;Armaza, JF;Moore, LG
与其他南美国家相比，玻利维亚的婴儿死亡率和死产率高，出生体重低。大多数玻利维亚人生活在海拔2500米或更高的地方。我们试图确定高海拔对玻利维亚先兆子痫、妊娠期高血压和其他妊娠相关并发症发生频率的影响。然后我们询问高海拔地区子痫前期和妊娠期高血压的增加是否导致低出生体重和死胎的增加。我们对1996年至1999年在玻利维亚低海拔地区（300米，圣克鲁斯，n = 813）和高海拔地区（3600米，拉巴斯，n = 1607）接受产前护理的妇女进行了回顾性队列研究。与低海拔地区出生的婴儿相比，高海拔地区出生的婴儿体重更低（3084 +/- 12 g比3366 +/- 18 g， p < 0.01），宫内生长受限发生率更高[16.8%；95%置信区间（CI）： 14.9-18.6 vs 5.9%；95% ci: 4.2-7.5；P < 0.01]。在高海拔地区，先兆子痫和妊娠期高血压的发生率是前者的1.7倍（95% CI: 1.3-2.3），在初产妇中是后者的2.2倍（95% CI: 1.4-3.5）。高海拔和高血压并发症都独立地降低了出生体重。所有调查的产妇、胎儿和新生儿并发症在高海拔地区比低海拔地区更常见，包括胎儿窘迫（优势比，7.3;95% CI: 3.9-13.6）和新生儿呼吸窘迫（优势比，7.3;95% CI: 3.9-13.6; p < 0.01）。妊娠高血压并发症增加了高海拔地区死产的风险（优势比，6.0;95% CI: 2.2-16.2），但在低海拔地区没有增加（优势比，1.9;95% CI: 0.2-17.5）。这些发现表明，高海拔是玻利维亚宫内死亡率和母婴健康恶化的一个重要因素。
Infant mortality and stillbirth rates in Bolivia are high and birth weights are low compared with other South American countries. Most Bolivians live at altitudes of 2500 m or higher. We sought to determine the impact of high altitude on the frequency of preeclampsia, gestational hypertension, and other pregnancy-related complications in Bolivia. We then asked whether increased preeclampsia and gestational hypertension at high altitude contributed to low birth weight and increased stillbirths. We performed a retrospective cohort study of women receiving prenatal care at low (300 m, Santa Cruz, n = 813) and high altitude (3600 m, La Paz, n = 1607) in Bolivia from 1996 to 1999. Compared with babies born at low altitude, high-altitude babies weighed less (3084 +/- 12 g versus 3366 +/- 18 g, p < 0.01) and had a greater occurrence of intrauterine growth restriction [16.8%; 95% confidence interval (CI): 14.9-18.6 versus 5.9%; 95% CI: 4.2-7.5; p < 0.01]. Preeclampsia and gestational hypertension were 1.7 times (95% CI: 1.3-2.3) more frequent at high altitude and 2.2 times (95% CI: 1.4-3.5) more frequent among primiparous women. Both high altitude and hypertensive complications independently reduced birth weight. All maternal, fetal, and neonatal complications surveyed were more frequent at high than low altitude, including fetal distress (odds ratio, 7.3; 95% CI: 3.9-13.6) and newborn respiratory distress (odds ratio, 7.3; 95% CI: 3.9-13.6; p < 0.01). Hypertensive complications of pregnancy raised the risk of stillbirth at high (odds ratio, 6.0; 95% CI: 2.2-16.2) but not at low altitude (odds ratio, 1.9; 95% CI: 0.2-17.5). These findings suggest that high altitude is an important factor worsening intrauterine mortality and maternal and infant health in Bolivia.