Preterm birth risk at high altitude in Peru

Gasco Tantachuco, Manuel Enrique; Tapia Aguirre, Vilma Lucrecia; Gonzales Rengifo, Gustavo Francisco; Sammel, Mary D.; Levine, Lisa D.; Ludmir, Jack; Srinivas, Sindhu K.

dc.contributor.author	Levine, Lisa D.
dc.contributor.author	Gonzales Rengifo, Gustavo Francisco
dc.contributor.author	Tapia Aguirre, Vilma Lucrecia
dc.contributor.author	Gasco Tantachuco, Manuel Enrique
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.ispartofseries	American Journal of Obstetrics and Gynecology
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
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.02
dc.relation.issn	1097-6868