Augmented uterine artery blood flow and oxygen delivery protect Andeans from altitude-associated reductions in fetal growth
Open accessAbstract
The effect of high altitude on reducing birth weight is markedly less in populations of high- (e.g., Andeans) relative to low-altitude origin (e.g., Europeans). Uterine artery (UA) blood flow is greater during pregnancy in Andeans than Europeans at high altitude; however, it is not clear whether such blood flow differences play a causal role in ancestry-associated variations in fetal growth. We tested the hypothesis that greater UA blood flow contributes to the protection of fetal growth afforded by Andean ancestry by comparing UA blood flow and fetal growth throughout pregnancy in 137 Andean or European residents of low (400 m; European n = 28, Andean n = 23) or high (3,100–4,100 m; European n = 51, Andean n = 35) altitude in Bolivia. Blood flow and fetal biometry were assessed by Doppler ultrasound, and maternal ancestry was confirmed, using a panel of 100 ancestry-informative genetic markers (AIMs). At low altitude, there were no ancestry-related differences in the pregnancy-associated rise in UA blood flow, fetal biometry, or birth weight. At high altitude, Andean infants weighed 253 g more than European infants after controlling for gestational age and other known influences. UA blood flow and O 2 delivery were twofold greater at 20 wk in Andean than European women at high altitude, and were paralleled by greater fetal size. Moreover, variation in the proportion of Indigenous American ancestry among individual women was positively associated with UA diameter, blood flow, O 2 delivery, and fetal head circumference. We concluded that greater UA blood flow protects against hypoxia-associated reductions in fetal growth, consistent with the hypothesis that genetic factors enabled Andeans to achieve a greater pregnancy-associated rise in UA blood flow and O 2 delivery than European women at high altitude.
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In the majority of studies, the normal pregnancy-induced rise in uterine blood flow is blunted at high altitude in association with a reduced diameter of the uterine arteries and/or lower nitric oxide synthesis, regardless of ancestry.
“However, in the majority of studies, the normal pregnancy-induced rise in uterine blood flow is blunted at high altitude in association with a reduced diameter of the uterine arteries and/or lower nitric oxide synthesis, regardless of ancestry (294, 295, 577, 603, 604).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
Pregnant Tibetan women have higher uterine artery diameters and blood velocity than Han women at high altitude, while Andean women have twice the increment in uterine artery diameter during pregnancy than European women at high altitude.
“Pregnant Tibetan women have higher uterine artery diameters and blood velocity than Han women at high altitude (107, 389), while Andean women have twice the increment in uterine artery diameter during pregnancy than European women at high altitude (295, 577, 604).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
In some studies, the protective effect of Andean ancestry on uterine artery haemodynamics is only seen at high altitude while in others, the ethnic differences are also evident at sea level.
“In some studies, the protective effect of Andean ancestry on uterine artery haemodynamics is only seen at high altitude while in others, the ethnic differences are also evident at sea level (295, 604).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
In Andean women, the increase in uterine blood flow during pregnancy at high altitude can exceed that seen at low altitude.
“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 [295]
This results in differences in uterine blood flow between Andean and European women, which are detectable at 20 weeks of gestation before fetal growth slows.
“This results in differences in uterine blood flow between Andean and European women, which are detectable at 20 weeks of gestation before fetal growth slows (295).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
In human infants near term, the diameters of the umbilical vein and artery are both smaller at high than low altitude, which results in a lower absolute blood flow in the umbilical circulation, irrespective of ethnicity.
“In human infants near term, the diameters of the umbilical vein and artery are both smaller at high than low altitude, which results in a lower absolute blood flow in the umbilical circulation, irrespective of ethnicity (295, 443).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
In human populations, the adverse consequences of high altitude on uterine artery diameter and uterine blood flow are less pronounced with long than short ancestry at high altitude.
“In human populations, the adverse consequences of high altitude on uterine artery diameter and uterine blood flow are less pronounced with long than short ancestry at high altitude (295, 387).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [295]
In some studies of Andeans, absolute oxygen delivery to the gravid uterus at high altitude is maintained or even increased above lowland values despite low maternal pO2, while in others the uterine oxygen supply is less at high than low altitude irrespective of ancestry.
“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 [295]
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Gas Exchange across the Placenta
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Self-citation
- Authors
- Julian, C. G., Wilson, M. J., Lopez, M., Yamashiro, H., Tellez, W., Rodriguez, A., Bigham, A. W., Shriver, M. D., Rodriguez, C., Vargas, E., & Moore, L. G.
- Affiliations
- University of Colorado Denver (US)
- Pennsylvania State University (US)
- Universidad Mayor de San Andrés (BO)
- Wake Forest University (US)
- ORCID
- Venue
- American Journal of Physiology-Regulatory, Integrative and Comparative Physiology
- Publisher
- American Physiological Society
- Published
- 2009-05
- Volume
- 296
- Issue
- 5
- Pages
- R1564-R1575
- ISSN
- 0363-6119 (ISSN-L)
- 1522-1490
- PMC
- PMC2689835
- OpenAlex
- W2139645408
- Cited by
- 141
- References
- 36
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 8 · 2023: 5 · 2022: 11 · 2021: 9 · 2020: 9 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 15 · 2014: 5 · 2013: 13 · 2012: 8
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Physiology-Regulatory, Integrative and Comparative Physiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (HLBI-079647, HLBI-60131)
- Fogarty International Center (TW 01188, R03TW007957, R03TW001188)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › High Altitude and Hypoxia
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- uterine artery blood flow, fetal growth, high altitude, birth weight, fetal oxygen delivery, hypoxia, fetal biometry, fetal head circumference, Indigenous American ancestry, maternal ancestry, pregnancy, Doppler ultrasound
- MeSH terms
- Adult, Altitude, Arteries, Biological Transport, Birth Weight, Bolivia, Europe, Female, Humans, Oxygen, Pregnancy, Regional Blood Flow, Uterus, Case-Control Studies, White People, American Indian or Alaska Native, Fetal Development
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