Perinatal Outcomes at High Altitude: Analysis of Birth Weight, Low Birth Weight, and Small for Gestational Age in Relation to Maternal Factors. Catamarca, Northwestern Argentina
DOI:
https://doi.org/10.12974/2311-8687.2025.13.08Keywords:
Fetal growth, Geographical altitude, Intrauterine growth restriction, Neonatal health, Puna, Sociodemographic factorsAbstract
This study compared birth weight (BW) and associated gestational and maternal determinants among newborns from high- and low-altitude regions in Catamarca, northwestern Argentina. A retrospective population-based analysis was conducted using vital records from 1990 to 2010, including 485 births from high-altitude areas (HA; 3,323 m above sea level) and 65,538 births from low-altitude areas (LA; 520 m above sea level). Neonatal outcomes were classified according to international standards: low birth weight (LBW; <2,500 g) and small for gestational age (SGA; <10th percentile). Mann–Whitney U tests, chi-square tests, generalized linear models, and logistic regression was used. Newborns from HA exhibited significantly lower BW and a higher frequency of LBW and SGA compared with those from LA. BW was strongly influenced by gestational age, with preterm birth being the main predictor of reduced weight; the altitude–prematurity interaction showed a partial attenuation of this effect in HA newborns. LBW was associated with preterm pregnancy and younger maternal age, whereas high altitude and post-term pregnancy were associated with SGA. Additionally, younger maternal age and low educational level increased the risk of SGA. These findings demonstrate the combined influence of altitude, fetal maturation, and sociodemographic factors on neonatal outcomes and underscore the need for targeted perinatal strategies in high-altitude populations.
References
Ticona-Rendón M, Huanco-Apaza D. Curva de referencia peruana del peso de nacimiento para la edad gestacional y su aplicación para la identificación de una nueva población neonatal de alto riesgo. Revista Peruana de Medicina Experimental y Salud Publica. 2007; 24(4): 325-35.
Villamonte-Calanche W, Manrique-Corazao F, Jerí-Palomino M, De-La-Torre C, Roque-Roque J, Wilson N. Neonatal anthropometry at 3400 m above sea level compared with INTERGROWTH 21st standards. J Matern Fetal Neonatal Med. 2016; https://doi.org/10.3109/14767058.2016.1163682
Eichstaedt C, Antao T, Pagani L, Cardona A, Kivisild T, Mormina M. The Andean Adaptive Toolkit to Counteract High Altitude Maladaptation: Genome-Wide and Phenotypic Analysis of the Collas. PLOS ONE. 2014; 9(3): e93314. https://doi.org/10.1371/journal.pone.0093314
Julian C, Wilson M, López M, Yamashiro H, Tellez W, Rodriguez A, et al. Augmented uterine artery blood flow and oxygen delivery protect Andeans from altitude-associated reductions in fetal growth. American journal of physiology, Regulatory, integrative and comparative physiology. 2009; 296(5). https://doi.org/10.1152/ajpregu.90945.2008
Julian C, Hageman J, Wilson M, Vargas E, Moore, LG. Lowland origin women raised at high altitude are not protected against lower uteroplacental O2 delivery during pregnancy or reduced birth weight. American journal of human biology: the official journal of the Human Biology Council. 2011; 23(4): 509-16. https://doi.org/10.1002/ajhb.21167
Brown E, Giussani D. Cause of fetal growth restriction during high- altitude pregnancy. iScience. 2024; 27(109702). https://doi.org/10.1016/j.isci.2024.109702
Cossio-Bolaños M, de Arruda M, Núñez Álvarez V, Lancho Alonso J. Efectos de la altitud sobre el crecimiento físico en niños y adolescentes. Rev Andal Med Deporte. 2011; 42(2): 71-6.
Pan American Health Organization, UNICEF. Health inequalities in Latin America and the Caribbean: A Sustainable Development Goal baseline assessment for women, children, and adolescents. 2022; Available from: https: //iris.paho.org/items/949df579-26c9-4f7e-9d51-8a6786e250c2
Blencowe H, Krasevec J, de Onis, M, Black R, An X, Stevens G, et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2019; 7(7): e849-60. https://doi.org/10.1016/S2214-109X(18)30565-5
UNICEF, World Health Organization. UNICEF-WHO Low Birthweight Estimates: Levels and trends 2000-2015. UNICEF/WHO [Internet]. 2019; Available from: https: //www.who.int/publications/i/item/WHO-NMH-NHD-19.21
Ogah A, Pandey V, Kawatu N, Kapasa M. Relationship between environmental factors and adverse birth outcomes in a rural high altitude community in East Africa. J Afric Neonatal. 2023; 2: 39-50.
Tapia J, Murray J, Ormachea-Muñoz M, Bhattacharya P. The Unique Altiplano-Puna Plateau: Environmental Perspectives. Journal of South American Earth Sciences. 2022; 115(103725). https://doi.org/10.1016/j.jsames.2022.103725
Moreno-Romero S, Marrodám Serrano M, Dipierri J. Peso al nacimiento en ecosistemas de altura. Noroeste argentino: Susques. Observatorio medioambiental. 2003; (6): 161-76.
Lopez Camelo J, Campaña R, Poletta F. 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): 305-10. https://doi.org/10.1002/ajpa.20274
Grandi C, Dipierri J, Luchtenberg G, Moresco A, Alfaro E. Efecto de la altitud sobre el peso al nacer y eventos perinatales adversos en dos poblaciones argentinas. Revista de la Facultad de Ciencias Médica. 2013; 70(2): 55-62. https://doi.org/10.31053/1853.0605.v70.n2.20232
Lomaglio DB, Verón JA, Díaz MC, Gallardo F, Alba JA, Marrodán, M.D. el peso de los recién nacidos en el noroeste argentino: variación regional en la provincia de Catamarca. CUADERNOS. 2007; (32): 229-39.
Revollo G, Dipierri J, Díaz M del P, Alfaro-Gómez E. Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard. Arch Argent Pediatr. 2023; e202310051.
Candelas N, Terán J, López Barbancho D, Díaz M, Lomaglio D, Marrodán M. Altitude effect on birth weight and prematurity in the Province of Catamarca (Argentina). Am J Hum Biol. 2015; 27(4): 526-9. https://doi.org/10.1002/ajhb.22680
Martinez J, GB Revollo, Alfaro E, Grandi C, Dipierri J. Proportionality indices, geographic altitude, and gestational age in newborns from Jujuy, Argentina. American Journal of Human Biology. 2020; 33(1). https://doi.org/10.1002/ajhb.23454
Martinez J, Figueroa M, Martínez-Carrión J, Alfaro-Gómez E, Dipierri J. Birth Size and Maternal, Social, and Environmental Factors in the Province of Jujuy, Argentina. Int J Environ Res Public Health. 2022; 19: 621. https://doi.org/10.3390/ijerph19020621
Instituto Nacional de Estadística y Censos. Censo nacional de población y vivienda 2022 [Internet]. 2023. Available from: https: //censo.gob.ar/index.php/datos_definitivos_catamarca/
Dirección provincial de estadística y censos. Anuario estadístico 2019 [Internet]. 2019. Available from: https: //www.estadistica.gob.ar/publicaciones/Anuario2019.pdf
International Fetal and Newborn Growth Consortium. The International Fetal and Newborn Growth Standards for the 21st Century INTERGROWTH-21st Study Protocol [Internet]. 2009. Available from: www.intergrowth21.org.uk
Moore L, Zamudio S, Zhuang J, Sun S, Droma T. Oxygen transport in tibetan women during pregnancy at 3,658 m. Am J Phys Anthropol. 2001; 114(1): 42-53. https://doi.org/10.1002/1096-8644(200101)114:1<42::AID-AJPA1004>3.0.CO;2-B
Zamudio S, Droma T, Norkyel K, Acharya G, Zamudio J, Niermeyer S, et al. Protection from intrauterine growth retardation in Tibetans at high altitude. Am J Phys Anthropos. 1993; 91(2): 215-24. https://doi.org/10.1002/ajpa.1330910207
Grant, Giussani D, Aiken C. Fetal growth and spontaneous preterm birth in high-altitude pregnancy: A systematic review, meta-analysis, and meta-regression. Int J Gynecol Obstet. 2022; 157: 221-9. https://doi.org/10.1002/ijgo.13779
Moore L, Young D, McCullough R, Droma T, Zamudio S. Tibetan protection from intrauterine growth restriction (IUGR) and reproductive loss at high altitude. Am J Hum Biol. 2001; 13: 635-44. https://doi.org/10.1002/ajhb.1102
Bennett A, Sain S, Vargas E, Moore L. Evidence that parent-of-origin affects birth-weight reductions at high altitude. Am J Hum Biol. 2008; 20(5): 592-7. https://doi.org/10.1002/ajhb.20784
Wu D, Liu Y, Chen W, Shao J, Zhuoma P, Zhao D, et al. How Placenta Promotes the Successful Reproduction in High-Altitude Populations: A Transcriptome Comparison between Adaptation and Acclimatization. Molecular Biology and Evolution. 2022; 39(6). https://doi.org/10.1093/molbev/msac120
Arenas GA, Lorca RA. Effects of hypoxia on uteroplacental and fetoplacental vascular function during pregnancy. Front Physiol [Internet]. 2024 Dec 18 [cited 2025 Dec 4]; 15: 1490154. Available from: https: //www.frontiersin.org/articles/10.3389/fphys.2024.1490154/full. https://doi.org/10.3389/fphys.2024.1490154
Ahrens S, Singer D. Placental Adaptation to Hypoxia: The Case of High-Altitude Pregnancies. IJERPH [Internet]. 2025 [cited 2025 Dec 4]; 22(2): 214. Available from: https: //www.mdpi.com/1660-4601/22/2/214. https://doi.org/10.3390/ijerph22020214
Moore LG, Charles SM, Julian CG. Humans at high altitude: Hypoxia and fetal growth. Respiratory Physiology & Neurobiology [Internet]. 2011 [cited 2025 Dec 22]; 178(1): 181-90. Available from: https: //linkinghub.elsevier.com/retrieve/pii/S1569904811001558. https://doi.org/10.1016/j.resp.2011.04.017
Shen L, Wang J, Duan Y, Yang Z. Prevalence of low birth weight and macrosomia estimates based on heaping adjustment method in China. Scientific Reports. 2021; (11): 15016. https://doi.org/10.1038/s41598-021-94375-2
Ahammed B, Maniruzzaman M, Ferdausi F, Abedin M, Hossain M. Socioeconomic and Demographic Factors Associated with Low Birth Weight in Nepal Data from 2016 Nepal Demographic and Health Survey. Soc Health Behav. 2020; 3(4): 158-65. https://doi.org/10.4103/SHB.SHB_46_20
Dolma P, Angchuk P, Jain V, Dadhwal V, Kular D, Williams D, et al. High-altitude population neonatal and maternal phenotypes associated with birthweight protection. Pediatric Research. 2022; 91: 137-42. https://doi.org/10.1038/s41390-021-01593-5
Ogah A, Ogah JAO, Ogah E, Chidongo P. Determinants of Postdate Pregnancies and Neonatal Phenotype in a Rural Low-Income, High-Altitude Population. Neonatal. 2024; 4(1): 11. https://doi.org/10.35702/neo.10011
Bianchi ME, Restrepo JM. Low Birthweight as a Risk Factor for Non-Communicable Diseases in Adults. Front Med [Internet]. 2022 [cited 2025 Dec 22]; 8: 793990. Available from: https: //www.frontiersin.org/articles/10.3389/fmed.2021.793990/full. https://doi.org/10.3389/fmed.2021.793990
Calkins K, Devaskar SU. Fetal Origins of Adult Disease. Current Problems in Pediatric and Adolescent Health Care [Internet]. 2011 July [cited 2025 Dec 22]; 41(6): 158-76. Available from: https: //linkinghub.elsevier.com/retrieve/pii/S1538544211000265. https://doi.org/10.1016/j.cppeds.2011.01.001
Rybertt T, Azua E, Rybertt F. Retardo de crecimiento intrauterino: consecuencias a largo plazo. Revista Médica Clínica Las Condes [Internet]. 2016 July [cited 2025 Dec 22]; 27(4): 509-13. Available from: https: //linkinghub.elsevier.com/retrieve/pii/S0716864016300608. https://doi.org/10.1016/j.rmclc.2016.07.010
Romanello M. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. The Lancet. 2023; 402(10397): 2346-94. https://doi.org/10.1016/S0140-6736(23)01859-7
Lakhoo DP, Brink N, Radebe L, Craig MH, Pham MD, Haghighi MM, et al. A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health. Nature Medicine. 2024; 31. https://doi.org/10.1038/s41591-024-03395-8
Bigham AW, Lee FS. Human high-altitude adaptation: forward genetics meets the HIF pathway. Genes & Development. 2014; 28(20): 2189-204. https://doi.org/10.1101/gad.250167.114
