Impact of Geographic Altitude on the Nutritional and Anthropometric Status of Pregnant Women in Peru: Evidence for a Contextualized Maternal Policy
DOI:
https://doi.org/10.12873/453baquerizoKeywords:
Pregnancy, Altitude, Hypoxia, Overweight, ObesityAbstract
Introduction: Pre-gestational body mass index (PGBMI) and gestational weight gain (GWG) are key variables in adequate intrauterine growth and development. The impact of altitude, particularly hypobaric hypoxia, on bodily functioning is well known, but questions remain about its impact during pregnancy.
Objective: To study the association between IMCPG, GPG for each month, and the geographical altitude of the place of residence.
Methods: This descriptive, quantitative, non-experimental, cross-sectional, and retrospective study analyzed data from the Nutritional Status Information System for children and pregnant women in Peru, 2024, with a final sample of 243 587 pregnant women. Four altitude classifications (masl) were made: <1500; 1500–2499; 2500–3499; ≥ 3500. The statistical analysis included absolute and relative frequencies and measures of central tendency. To establish differences between the groups, an analysis of variance was performed with multiple post hoc comparisons and a Bonferroni adjustment.
Results: 55.8% had a high IMCPG, the percentage of pregnant women with normal weight increased, and the percentage of pregnant women with obesity decreased as altitude increased. There is a correlation between weight gain and gestational age and an inverse relationship between IMCPG and GPG. By the ninth month, in the overweight and obese categories, the lower altitude range had significantly lower weight gain compared to the other altitudes.
Conclusion: Nutritional anthropometric assessment showed a higher IMCPG and a higher prevalence of pre-pregnancy overweight and obesity in the low-altitude population compared to the high-altitude population. No clear evidence was found regarding different GPG between altitude levels considering the IMCPG category. A contextualized maternal public health policy throughout the process is essential.
References
1. FAO. Panorama de la seguridad alimentaria y nutricional en América Latina y el Caribe. 2020: seguridad alimentaria y nutricional para los territorios más rezagados. Santiago de Chile: Organización de las Naciones Unidas para la Alimentación y la Agricultura; 2020.
2. WHO. WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience. 1st ed. Geneva: World Health Organization; 2022. 1 p.
3. Butte NF, Wong WW, Treuth MS, Ellis KJ, O’Brian Smith E. Energy requirements during pregnancy based on total energy expenditure and energy deposition. The American Journal of Clinical Nutrition. junio de 2004;79(6):1078-87.
4. Ouzounian JG, Elkayam U. Physiologic Changes During Normal Pregnancy and Delivery. Cardiology Clinics. agosto de 2012;30(3):317-29.
5. Faus García M, Vila-candel R, Martín-Moreno JM. Standard international recommendations for gestational weight gain: suitability for our population. Nutr Hosp [Internet]. 2020 [citado 26 de julio de 2025]; Disponible en: https://www.nutricionhospitalaria.org/articles/03340/show
6. MINSA. Guía técnica para la valoración nutricional antropométrica de la gestante [Internet]. Lima: Ministerio de Salud; 2019 p. 38. Report No.: 325. Disponible en: https://cdn.www.gob.pe/uploads/document/file/306405/Resoluci%C3%B3n_Ministerial_N__325-2019-MINSA.PDF
7. Moore LG. Human Genetic Adaptation to High Altitude. High Altitude Medicine & Biology. junio de 2001;2(2):257-79.
8. Mallet RT, Burtscher J, Pialoux V, Pasha Q, Ahmad Y, Millet GP, et al. Molecular Mechanisms of High-Altitude Acclimatization. IJMS. 15 de enero de 2023;24(2):1698.
9. Lichty JA. Studies of Babies Born at High Altitude: I. Relation of Altitude to Birth Weight. AMA Am J Dis Child. 1 de junio de 1957;93(6):666.
10. Moore LG. HYPOXIA AND REPRODUCTIVE HEALTH: Reproductive challenges at high altitude: fertility, pregnancy and neonatal well-being. Reproduction. enero de 2021;161(1):F81-90.
11. SIEN. Plataforma Nacional de Datos Abiertos. 2024 [citado 27 de febrero de 2024]. SIEN - Sistema de información del Estado Nutricional de niños y gestantes Perú - INS/CENAN (Instituto Nacional de Salud - Centro Nacional de Alimentación y Nutrición). Disponible en: https://www.datosabiertos.gob.pe/dataset/sien-sistema-de-informaci%C3%B3n-del-estado-nutricional-de-ni%C3%B1os-y-gestantes-per%C3%BA-inscenan
12. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group, Voerman E, Santos S, Inskip H, Amiano P, Barros H, et al. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA. 7 de mayo de 2019;321(17):1702.
13. Hernández-Barrera L, Trejo-Valdivia B, Téllez-Rojo MM, Baccarelli A, Wright R, Cantoral A, et al. Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity. Archives of Medical Research. junio de 2024;55(4):103006.
14. Kweon JY, Mun H, Choi MR, Kim HS, Ahn YJ. Maternal obesity induced metabolic disorders in offspring and myeloid reprogramming by epigenetic regulation. Front Endocrinol [Internet]. 16 de enero de 2024 [citado 26 de julio de 2025];14. Disponible en: https://www.frontiersin.org/articles/10.3389/fendo.2023.1256075/full
15. Brown ER, Giussani DA. Cause of fetal growth restriction during high-altitude pregnancy. iScience. mayo de 2024;27(5):109702.
16. Zamudio S. The Placenta at High Altitude. High Altitude Medicine & Biology. mayo de 2003;4(2):171-91.
17. Nuzzo AM, Camm EJ, Sferruzzi-Perri AN, Ashmore TJ, Yung H wa, Cindrova-Davies T, et al. Placental Adaptation to Early-Onset Hypoxic Pregnancy and Mitochondria-Targeted Antioxidant Therapy in a Rodent Model. The American Journal of Pathology. diciembre de 2018;188(12):2704-16.
18. Arenas GA, Lorca RA. Effects of hypoxia on uteroplacental and fetoplacental vascular function during pregnancy. Front Physiol [Internet]. 18 de diciembre de 2024 [citado 26 de julio de 2025];15. Disponible en: https://www.frontiersin.org/articles/10.3389/fphys.2024.1490154/full
19. Krampl E, Kametas NA, Zegarra AMC, Roden M, Nicolaides KH. Maternal plasma glucose at high altitude. BJOG. marzo de 2001;108(3):254-7.
20. Grandfils S, Durand P, Hoge A, Seidel L, Emonts P, Paquot N, et al. Gestational weight gain: Toward best practices in managing gestational weight gain in patients with obesity: Comparison of recommendations. European Journal of Obstetrics & Gynecology and Reproductive Biology. julio de 2024;298:197-203.
21. Hinkle SN, Sharma AJ, Kim SY, Park S, Dalenius K, Brindley PL, et al. Prepregnancy Obesity Trends Among Low-Income Women, United States, 1999–2008. Matern Child Health J. octubre de 2012;16(7):1339-48.
22. Hernández-Vásquez A, Bartra Reátegui A, Vargas-Fernández R. Altitude and Its Association with Low Birth Weight among Children of 151,873 Peruvian Women: A Pooled Analysis of a Nationally Representative Survey. IJERPH. 12 de enero de 2023;20(2):1411.
23. Julian CG, Wilson MJ, Moore LG. Evolutionary adaptation to high altitude: A view from in utero. American J Hum Biol. septiembre de 2009;21(5):614-22.
24. López Camelo JS, Campaña H, Santos R, Poletta FA. Effect of the interaction between high altitude and socioeconomic factors on birth weight in a large sample from South America. American J Phys Anthropol. febrero de 2006;129(2):305-10.
25. Goldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med [Internet]. diciembre de 2018 [citado 26 de julio de 2025];16(1). Disponible en: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1128-1
26. Gonzalez-Candia A, Herrera EA. High Altitude Pregnancies and Vascular Dysfunction: Observations From Latin American Studies. Front Physiol [Internet]. 7 de diciembre de 2021 [citado 26 de julio de 2025];12. Disponible en: https://www.frontiersin.org/articles/10.3389/fphys.2021.786038/full
27. Ahrens S, Singer D. Placental Adaptation to Hypoxia: The Case of High-Altitude Pregnancies. IJERPH. 4 de febrero de 2025;22(2):214.
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