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Preterm birth risk at high altitude in Peru

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dc.contributor.author Levine, Lisa D.
dc.contributor.author Gonzales, Gustavo F.
dc.contributor.author Tapia, Vilma L.
dc.contributor.author Gasco, Manuel
dc.contributor.author Sammel, Mary D.
dc.contributor.author Srinivas, Sindhu K.
dc.contributor.author Ludmir, Jack
dc.date.accessioned 2019-02-06T14:52:12Z
dc.date.available 2019-02-06T14:52:12Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5264
dc.description.abstract OBJECTIVE: High altitude has been implicated in a variety of adverse pregnancy outcomes including preeclampsia and stillbirth. Smaller studies show conflicting data on the association between high altitude and preterm birth (PTB). The objective of this study was to assess the association between altitude and PTB. STUDY DESIGN: A retrospective cohort study was performed using data from the Perinatal Information System, which includes deliveries from 43 hospitals in Peru from 2000 through 2010. Altitude was classified into the following categories: low (0-1999 m), moderate (2000-2900 m), and high (3000-4340 m). The primary outcome was PTB (delivery <37 weeks). Secondary outcomes were cesarean delivery and small for gestational age (SGA). Deliveries less than 23 weeks are not included in the database. chi(2) analyses were performed to compare categorical variables, and a logistic regression was used to calculate the odds ratios and control for confounders. Clustering by hospital was accounted for using generalized estimating equations. RESULTS: A total of 550,166 women were included (68% low, 15% moderate, 17% high altitude). The overall PTB rate was 5.9%, with no difference in the PTB rate among the 3 altitudes (5.6%, 6.2%, 6.8%, P = .13). There was a significant difference in cesarean rates (28.0%, 26.6%, 20.6%, P < .001) with a 34% decreased risk at high vs low altitude adjusted for confounders (adjusted odds ratio, 0.66; 95% confidence interval, 0.51-0.85). There was a difference in SGA (3.3%, 3.6%, 5.0%, P = .02) with a 51% increased risk at high vs low altitude adjusted for confounders (adjusted odds ratio, 1.49; 95% confidence interval, 1.14-1.93). CONCLUSION: High altitude is not associated with PTB. At high altitude, the cesarean rate was reduced and the SGA rate was increased. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1097-6868
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru en_US
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Retrospective Studies en_US
dc.subject Young Adult en_US
dc.subject Odds Ratio en_US
dc.subject high altitude en_US
dc.subject Cohort Studies en_US
dc.subject Peru/epidemiology en_US
dc.subject Pregnancy en_US
dc.subject Altitude en_US
dc.subject Risk Factors en_US
dc.subject preterm birth en_US
dc.subject Infant, Newborn en_US
dc.subject cesarean delivery en_US
dc.subject Cesarean Section/statistics & numerical data en_US
dc.subject Infant, Small for Gestational Age en_US
dc.subject Premature Birth/epidemiology en_US
dc.subject small for gestational age en_US
dc.title Preterm birth risk at high altitude in Peru en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.ajog.2014.08.024


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