Risk of Maternal and Fetal Complications According to Geographic Altitude in Andean Regions: A Systematic Review
Abstract
Introduction: maternal–fetal complications represent a significant burden for global public health. Geographic altitude is an environmental factor that influences their occurrence and severity, with effects on quality of life and healthcare costs.
Objective: to synthesize the evidence from 2015–2024 on the impact of altitude on the risk of maternal and fetal complications in Andean regions.
Method: a comparative quantitative systematic review that included seven high-quality studies with predefined altitude categories.
Results: exposure to ≥2,500 meters above sea level was associated with an increased risk of gestational hypertension and hypertensive disorders of pregnancy. Preeclampsia showed a variable pattern: it generally decreased at ≥2,500 meters, but increased at ≥3,500 meters, especially among Afro-Ecuadorian and Montubio populations even at 1,500–3,500 meters. Eclampsia decreased with altitude, whereas HELLP syndrome and maternal mortality increased at both intermediate and high altitudes compared with low-altitude levels. Fetal complications were also influenced by altitude. At ≥2,500 meters, higher risks of preterm birth, low birth weight, small for gestational age, and stillbirths were observed, along with a progressive reduction in neonatal weight for every 1,000-meter rise.
Conclusions: altitude exerts a direct effect on multiple maternal and fetal complications, modulated by sociodemographic factors such as ethnicity, maternal age, and access to obstetric services. The need to adapt intervention strategies and prenatal care in Andean regions is underscored, considering the interaction between altitude and social vulnerability.
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Copyright (c) 2026 Jaime Alfredo Ortega Romero , Estela de los Ángeles Gispert Abreu, Guillermo Gamarra Astuhuaman , José Argandoña Galarza , Pastor Castell-Florit Serrate , Inche Arce Elsa , Haydeé Elizabeth Medina Atencio
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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