Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T04:22:02.242Z Has data issue: false hasContentIssue false

Maternal exposure to low-to-medium altitude and birth outcomes: evidence from a population-based study in Chinese newborns

Published online by Cambridge University Press:  14 July 2020

Binyan Zhang
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Wentao Wu
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Guoshuai Shi
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Baibing Mi
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Fangyao Chen
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Ruo Zhang
Affiliation:
Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004, People’s Republic of China
Danmeng Liu
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Yijun Kang
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China
Suhang Shang
Affiliation:
The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, People’s Republic of China
Hong Yan*
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University, Ministry of Education, Xi’an, Shaanxi710061People’s Republic of China
Shaonong Dang*
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi710061, People’s Republic of China Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University, Ministry of Education, Xi’an, Shaanxi710061People’s Republic of China
*
Address for correspondence: Shaonong Dang and Hong Yan, Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, 76 Yanta West Road, Xi’an, Shaanxi710061, People’s Republic of China. Email: tjdshn@mail.xjtu.edu.cn; yanhonge@mail.xjtu.edu.cn
Address for correspondence: Shaonong Dang and Hong Yan, Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, 76 Yanta West Road, Xi’an, Shaanxi710061, People’s Republic of China. Email: tjdshn@mail.xjtu.edu.cn; yanhonge@mail.xjtu.edu.cn

Abstract

Despite high altitude was implicated in adverse birth outcomes, there remained a paucity of evidence on low-to-medium altitude effect. This study aimed to explore the association of low-to-medium altitude with birth outcomes. A population-based cross-sectional survey was performed using a stratified multistage random sampling method among women with their infants born during 2010–2013 in Northwestern China. Altitude was determined in meters based on the village or community of the mother’s living areas. Birth outcomes involved birth weight, gestational age, and small for gestational age (SGA). Generalized linear models were fitted to investigate the association of altitude with birth outcomes. Moreover, the dose–response relationship between altitude and birth outcomes was evaluated with a restricted cubic spline function. A total of 27 801 women with their infants were included. After adjusting for potential confounders, every 100-m increase in the altitude was associated with reduced birth weight by 6.4 (95% CI −8.1, −4.6) g, the slight increase of gestational age by 0.015 (95% CI 0.010, 0.020) week, and an increased risk of SGA birth (odds ratio 1.03, 95% CI 1.02, 1.04). Moreover, there was an inversely linear relationship between altitude and birth weight (P for overall < 0.001 and P for nonlinear = 0.312), and a positive linear relationship between altitude and SGA (P for overall < 0.001 and P for nonlinear = 0.194). However, a nonlinear relationship was observed between altitude and gestational age (P for overall < 0.001 and P for nonlinear = 0.010). The present results suggest that low-to-medium altitude is possibly associated with adverse birth outcomes.

Type
Original Article
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

These authors contributed equally to this work.

References

Gluckman, PD, Hanson, MA, Cooper, C, Thornburg, KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008; 359(1), 6173.10.1056/NEJMra0708473CrossRefGoogle ScholarPubMed
Hauspurg, A, Ying, W, Hubel, CA, Michos, ED, Ouyang, P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol. 2018; 41(2), 239246.10.1002/clc.22887CrossRefGoogle ScholarPubMed
Lawn, JE, Blencowe, H, Oza, S, et al. Every newborn: progress, priorities, and potential beyond survival. Lancet 2014; 384(9938), 189205.10.1016/S0140-6736(14)60496-7CrossRefGoogle ScholarPubMed
Iliodromiti, S, Mackay, DF, Smith, GC, et al. Customised and noncustomised birth weight centiles and prediction of stillbirth and infant mortality and morbidity: a cohort study of 979,912 term singleton pregnancies in Scotland. PLoS Med. 2017; 14(1), e1002228.10.1371/journal.pmed.1002228CrossRefGoogle ScholarPubMed
Zeng, LX, Cheng, Y, Dang, SN, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. Br Med J. 2008; 337, 11.10.1136/bmj.a2001CrossRefGoogle ScholarPubMed
Ray, JG, Park, AL, Fell, DB. Mortality in infants affected by preterm birth and severe small-for-gestational age birth weight. Pediatrics. 2017; 140(6), e20171881.10.1542/peds.2017-1881CrossRefGoogle ScholarPubMed
Lee, AC, Katz, J, Blencowe, H, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013; 1(1), e26e36.CrossRefGoogle ScholarPubMed
Jensen, GM, Moore, LG. The effect of high altitude and other risk factors on birthweight: independent or interactive effects? Am J Public Health. 1997; 87(6), 10031007.10.2105/AJPH.87.6.1003CrossRefGoogle ScholarPubMed
Yip, R. Altitude and birth weight. J Pediatr. 1987; 111(6 Pt 1), 869876.10.1016/S0022-3476(87)80209-3CrossRefGoogle ScholarPubMed
Lopez Camelo, JS, Campana, H, Santos, R, Poletta, FA. Effect of the interaction between high altitude and socioeconomic factors on birth weight in a large sample from South America. Am J Phys Anthropol. 2006; 129(2), 305310.CrossRefGoogle Scholar
Zahran, S, Breunig, IM, Link, BG, Snodgrass, JG, Weiler, S. A quasi-experimental analysis of maternal altitude exposure and infant birth weight. Am J Public Health. 2014; 104(Suppl 1), S166S174.10.2105/AJPH.2013.301725CrossRefGoogle ScholarPubMed
Niermeyer, S, Andrade Mollinedo, P, Huicho, L. Child health and living at high altitude. Arch Dis Child. 2009; 94(10), 806811.10.1136/adc.2008.141838CrossRefGoogle ScholarPubMed
Levine, LD, Gonzales, GF, Tapia, VL, et al. Preterm birth risk at high altitude in Peru. Am J Obstet Gynecol. 2015; 212(2), 210.e211–218.10.1016/j.ajog.2014.08.024CrossRefGoogle ScholarPubMed
Martínez, JI, Román, EM, Alfaro, EL, Grandi, C, Dipierri, JE. Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard. J Pediatr (Rio J). 2019; 95(3), 366373.10.1016/j.jped.2018.03.007CrossRefGoogle ScholarPubMed
Wehby, GL, Castilla, EE, Lopez-Camelo, J. The impact of altitude on infant health in South America. Econ Hum Biol. 2010; 8(2), 197211.10.1016/j.ehb.2010.04.002CrossRefGoogle ScholarPubMed
Dang, S, Yan, H, Yamamoto, S. High altitude and early childhood growth retardation: new evidence from Tibet. Eur J Clin Nutr. 2008; 62(3), 342348.10.1038/sj.ejcn.1602711CrossRefGoogle ScholarPubMed
Mi, J, Lin, LM, Liu, YL, Zhang, XL, Cao, LH. Impact factors on birth weight in Chinese population. Chinese J Child Health Care. 2002; 10(1), 1316.Google Scholar
Li, S, Liu, D, Zhang, R, et al. The association of maternal dietary folate intake and folic acid supplementation with small-for-gestational-age births: a cross-sectional study in Northwest China. Br J Nutr. 2019; 122(4), 459467.10.1017/S0007114519001272CrossRefGoogle ScholarPubMed
Yang, JM, Cheng, Y, Pei, LL, et al. Maternal iron intake during pregnancy and birth outcomes: a cross-sectional study in Northwest China. Br J Nutr. 2017; 117(6), 862871.10.1017/S0007114517000691CrossRefGoogle ScholarPubMed
Yang, J, Dang, S, Cheng, Y, et al. Dietary intakes and dietary patterns among pregnant women in Northwest China. Public Health Nutr. 2017; 20(2), 282293.10.1017/S1368980016002159CrossRefGoogle ScholarPubMed
White Paper on Shaanxi Geographical Situation issued by Administration of Shaanxi Provincial Bureau of Surveying and mapping geographic information. Retrieved 7 April 2020 from http://snsm.mnr.gov.cn/Upfiles/uploadfile/201709/20170929162225736.pdf.Google Scholar
Li, Z, Ye, R, Zhang, L, Li, H, Liu, J, Ren, A. Periconceptional folic acid supplementation and the risk of preterm births in China: a large prospective cohort study. Int J Epidemiol. 2014; 43(4), 11321139.10.1093/ije/dyu020CrossRefGoogle ScholarPubMed
Zhu, L, Zhang, R, Zhang, S, et al. Chinese neonatal birth weight curve for different gestational age. Chinese Journal of Pediatrics. 2015; 53(2), 97103.Google ScholarPubMed
Huang, A, Wu, K, Zhao, W, Hu, H, Yang, Q, Chen, D. Attendance at prenatal care and adverse birth outcomes in China: a follow-up study based on maternal and newborn’s health monitoring system. Midwifery. 2018; 57, 2631.CrossRefGoogle ScholarPubMed
Zeng, L, Yan, H, Cheng, Y, Dibley, MJ. Modifying effects of wealth on the response to nutrient supplementation in pregnancy on birth weight, duration of gestation and perinatal mortality in rural western China: double-blind cluster randomized controlled trial. Int J Epidemiol. 2011; 40(2), 350362.CrossRefGoogle ScholarPubMed
Thomas, P, Peabody, J, Turnier, V, Clark, RH. A new look at intrauterine growth and the impact of race, altitude, and gender. Pediatrics. 2000; 106(2), E21.CrossRefGoogle Scholar
Lei, F, Liu, D, Shen, Y, et al. Study on the influence of pregnancy-induced hypertension on neonatal birth weight. J Investig Med. 2018; 66(6), 10081014.CrossRefGoogle Scholar
Kang, YJ, Dang, SN, Zeng, LX, et al. Multi-micronutrient supplementation during pregnancy for prevention of maternal anaemia and adverse birth outcomes in a high-altitude area: a prospective cohort study in rural Tibet of China. Br J Nutr. 2017; 118(6), 431440.10.1017/S000711451700229XCrossRefGoogle Scholar
Filmer, D, Pritchett, LH. Estimating wealth effects without expenditure data or tears: an application to educational enrollments in states of India. Demography. 2001; 38(1), 115132.Google ScholarPubMed
Bloch, JR, Dawley, K, Suplee, PD. Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population. Public Health Nurs. 2009; 26(5), 449459.CrossRefGoogle Scholar
Desquilbet, L, Mariotti, F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010; 29(9), 10371057.Google ScholarPubMed
Mortola, JP, Frappell, PB, Aguero, L, Armstrong, K. Birth weight and altitude: a study in Peruvian communities. J Pediatr. 2000; 136(3), 324329.10.1067/mpd.2000.103507CrossRefGoogle ScholarPubMed
Waldhoer, T, Klebermass-Schrehof, K. The impact of altitude on birth weight depends on further mother- and infant-related factors: a population-based study in an altitude range up to 1600 m in Austria between 1984 and 2013. J Perinatol. 2015; 35(9), 689694.CrossRefGoogle Scholar
Gonzales, GF, Steenland, K, Tapia, V. Maternal hemoglobin level and fetal outcome at low and high altitudes. Am J Physiol Regul Integr Comp Physiol. 2009; 297(5), R1477R1485.CrossRefGoogle ScholarPubMed
Rothhammer, F, Fuentes-Guajardo, M, Chakraborty, R, Lorenzo Bermejo, J, Dittmar, M. Neonatal variables, altitude of residence and Aymara ancestry in northern Chile. PLoS One. 2015; 10(4), e0121834.CrossRefGoogle ScholarPubMed
Galan, HL, Rigano, S, Radaelli, T, et al. Reduction of subcutaneous mass, but not lean mass, in normal fetuses in Denver, Colorado. Am J Obstet Gynecol. 2001; 185(4), 839844.CrossRefGoogle Scholar
Keyes, LE, Armaza, JF, Niermeyer, S, Vargas, E, Young, DA, Moore, LG. Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia. Pediatr Res. 2003; 54(1), 2025.CrossRefGoogle ScholarPubMed
Ali Kamal, ZM. The association between spontaneous preterm birth and placental histology at high and low altitude areas of southern Saudi Arabia, Saudi Med. J. 1997; 18 (4), 349352.Google Scholar
Moore, LG. Fetal growth restriction and maternal oxygen transport during high altitude pregnancy. High Alt Med Biol. 2003; 4(2), 141156.10.1089/152702903322022767CrossRefGoogle ScholarPubMed
Julian, CG, Galan, HL, Wilson, MJ, et al. Lower uterine artery blood flow and higher endothelin relative to nitric oxide metabolite levels are associated with reductions in birth weight at high altitude. Am J Physiol Regul Integr Comp Physiol. 2008; 295(3), R906R915.CrossRefGoogle ScholarPubMed
Postigo, L, Heredia, G, Illsley, NP, et al. Where the O2 goes to: preservation of human fetal oxygen delivery and consumption at high altitude. J Physiol. 2009; 587(3), 693708.CrossRefGoogle ScholarPubMed
Zamudio, S, Torricos, T, Fik, E, et al. Hypoglycemia and the origin of hypoxia-induced reduction in human fetal growth. PLoS One. 2010; 5(1), e8551.10.1371/journal.pone.0008551CrossRefGoogle ScholarPubMed
Pizarro-Ortiz, M, Barra, R, Gajardo, F, Fuentes-Guajardo, M, Rothhammer, F. Perinatal variables from newborns of Aymara mothers suggest a genetic adaptation to high altitude. Rev Med Chil. 2014; 142(8), 961965.CrossRefGoogle ScholarPubMed
Kvalvik, LG, Nilsen, RM, Skjaerven, R, et al. Self-reported smoking status and plasma cotinine concentrations among pregnant women in the Norwegian Mother and Child Cohort Study. Pediatr Res. 2012; 72(1), 101107.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Zhang et al. supplementary material

Zhang et al. supplementary material 1

Download Zhang et al. supplementary material(Image)
Image 125.8 KB
Supplementary material: Image

Zhang et al. supplementary material

Zhang et al. supplementary material 2

Download Zhang et al. supplementary material(Image)
Image 139.2 KB
Supplementary material: Image

Zhang et al. supplementary material

Zhang et al. supplementary material 3

Download Zhang et al. supplementary material(Image)
Image 122.1 KB