{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:33Z","timestamp":1788412473543,"version":"build-2803163510"},"reference-count":44,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T00:00:00Z","timestamp":1594684800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["J Dev Orig Health Dis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Despite high altitude was implicated in adverse birth outcomes, there remained a paucity of evidence on low-to-medium altitude effect. This study aimed to explore the association of low-to-medium altitude with birth outcomes. A population-based cross-sectional survey was performed using a stratified multistage random sampling method among women with their infants born during 2010\u20132013 in Northwestern China. Altitude was determined in meters based on the village or community of the mother\u2019s living areas. Birth outcomes involved birth weight, gestational age, and small for gestational age (SGA). Generalized linear models were fitted to investigate the association of altitude with birth outcomes. Moreover, the dose\u2013response relationship between altitude and birth outcomes was evaluated with a restricted cubic spline function. A total of 27 801 women with their infants were included. After adjusting for potential confounders, every 100-m increase in the altitude was associated with reduced birth weight by 6.4 (95% CI \u22128.1, \u22124.6) g, the slight increase of gestational age by 0.015 (95% CI 0.010, 0.020) week, and an increased risk of SGA birth (odds ratio 1.03, 95% CI 1.02, 1.04). Moreover, there was an inversely linear relationship between altitude and birth weight (<jats:italic>P<\/jats:italic>for overall &lt; 0.001 and<jats:italic>P<\/jats:italic>for nonlinear = 0.312), and a positive linear relationship between altitude and SGA (<jats:italic>P<\/jats:italic>for overall &lt; 0.001 and<jats:italic>P<\/jats:italic>for nonlinear = 0.194). However, a nonlinear relationship was observed between altitude and gestational age (<jats:italic>P<\/jats:italic>for overall &lt; 0.001 and<jats:italic>P<\/jats:italic>for nonlinear = 0.010). The present results suggest that low-to-medium altitude is possibly associated with adverse birth outcomes.<\/jats:p>","DOI":"10.1017\/s204017442000063x","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T09:37:20Z","timestamp":1594719440000},"page":"443-451","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Maternal exposure to low-to-medium altitude and birth outcomes: evidence from a population-based study in Chinese newborns"],"prefix":"10.1017","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-9623","authenticated-orcid":false,"given":"Binyan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoshuai","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baibing","family":"Mi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danmeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhang","family":"Shang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaonong","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"S204017442000063X_ref23","first-page":"97","article-title":"Chinese neonatal birth weight curve for different gestational age","volume":"53","author":"Zhu","year":"2015","journal-title":"Chinese Journal of Pediatrics."},{"key":"S204017442000063X_ref35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0121834"},{"key":"S204017442000063X_ref29","first-page":"115","article-title":"Estimating wealth effects without expenditure data or tears: an application to educational enrollments in states of India","volume":"38","author":"Filmer","year":"2001","journal-title":"Demography."},{"key":"S204017442000063X_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq262"},{"key":"S204017442000063X_ref43","doi-asserted-by":"publisher","DOI":"10.4067\/S0034-98872014000800002"},{"key":"S204017442000063X_ref36","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117350"},{"key":"S204017442000063X_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a2001"},{"key":"S204017442000063X_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2017.10.018"},{"key":"S204017442000063X_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu020"},{"key":"S204017442000063X_ref44","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2012.36"},{"key":"S204017442000063X_ref31","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1002\/sim.3841","article-title":"Dose-response analyses using restricted cubic spline functions in public health research","volume":"29","author":"Desquilbet","year":"2010","journal-title":"Stat Med."},{"key":"S204017442000063X_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980016002159"},{"key":"S204017442000063X_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2018.03.007"},{"key":"S204017442000063X_ref16","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1602711"},{"key":"S204017442000063X_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2008.141838"},{"key":"S204017442000063X_ref2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22887"},{"key":"S204017442000063X_ref17","first-page":"13","article-title":"Impact factors on birth weight in Chinese population","volume":"10","author":"Mi","year":"2002","journal-title":"Chinese J Child Health Care."},{"key":"S204017442000063X_ref28","doi-asserted-by":"publisher","DOI":"10.1017\/S000711451700229X"},{"key":"S204017442000063X_ref8","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.6.1003"},{"key":"S204017442000063X_ref38","first-page":"349","article-title":"The association between spontaneous preterm birth and placental histology at high and low altitude areas of southern Saudi Arabia","volume":"18","author":"Ali Kamal","year":"1997","journal-title":"Saudi Med. 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