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Uterine artery blood flow, fetal hypoxia and fetal growth
Open accessAbstract
Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100–4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.
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“Thus, in some studies of Andeans, absolute oxygen delivery to the gravid uterus at high altitude is maintained or even increased above lowland values, despite the low maternal pO2, while in others the uterine oxygen supply is less at high than low altitude irrespective of ancestry (69, 295, 443, 604).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [69]
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“Indeed, in Andean women, the increase in uterine blood flow during pregnancy at high altitude can exceed that seen at low altitude (69, 295).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [69]
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“In turn, this may explain some of the ethnic differences in birth weight seen between populations with long and short ancestry at altitude (69).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [69]
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Metadata
- Authors
- Browne, V. A., Julian, C. G., Toledo-Jaldin, L., Cioffi-Ragan, D., Vargas, E., & Moore, L. G.
- Affiliations
- University of Colorado Denver (US)
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
- Corresponding author
- Moore, Lorna G.
- Venue
- Philosophical Transactions of the Royal Society B: Biological Sciences
- Publisher
- The Royal Society
- Published
- 2015-03-05
- Volume
- 370
- Issue
- 1663
- Pages
- 20140068
- ISSN
- 0962-8436 (ISSN-L)
- 1471-2970
- PMC
- PMC4305169
- OpenAlex
- W2166117052
- Cited by
- 127
- References
- 100
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 16 · 2023: 17 · 2022: 13 · 2021: 17 · 2020: 12 · 2019: 14 · 2018: 12 · 2017: 8 · 2016: 2 · 2015: 7
- FWCI
- 10.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Philosophical Transactions of the Royal Society B Biological Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- U.S. Public Health Service (079647)
- Fogarty International Center (TW 01188, R03TW001188)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD057022)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Physiology (medical) › High Altitude and Hypoxia
- Keywords
- uterine artery blood flow, fetal hypoxia, fetal growth, fetal growth restriction, preeclampsia, gestational hypertension, high altitude, Andean women, Doppler ultrasound, fetal heart rate, evolutionary trade-offs, bipedalism, brain expansion, reproductive success
- MeSH terms
- Altitude, Biological Evolution, Female, Fetal Hypoxia, Fetus, Heart Rate, Humans, Models, Biological, Pregnancy, Regional Blood Flow, Fetal Development, Uterine Artery
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