Fetal Growth Restriction at High Altitude: Basic Cellular and Subcellular Physiologic Considerations

Abstract

Based on considerable epidemiologic and laboratory based experimental evidence, it is clear that the optimal conditions for fetal growth and development require an environment of maternal homeostasis and well-being, and with the mother’s ability to respond appropriately to a particular stress. In view of its association with increased morbidity and mortality, fetal growth restriction (FGR) is to be avoided at all costs. Chapter 14 presents the clinical aspects of one not uncommon stress, that of high altitude or other [causes of] long-term hypoxia (LTH). Because fetal growth critically depends upon adequate maternal oxygenation, in addition to residence at high altitude (>2500 m), FGR may be associated with conditions such as that of mothers who are moderate to heavy smokers or with cyanotic heart disease, lung disease, severe anemia, and other conditions that cause prolonged hypoxia (Giussani et al. 2001; Hutter et al. 2010; Longo 1984, 1987; Longo and Goyal 2014; Neerhof and Thaete 2008). The importance of oxygen for fetal physiology was a foundation for my research interests and the development of surgical approaches to directly investigate the fetus during pregnancy (methodology described in Yellon and Apostolakis 1994). The chapter reviews the development of ideas in terms of the many physiologic, biochemical, cellular, and molecular aspects of LTH for the fetus and newborn.