{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T22:11:17Z","timestamp":1778623877835,"version":"3.51.4"},"reference-count":30,"publisher":"The Royal Society","issue":"1933","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["royalsocietypublishing.org"],"crossmark-restriction":true},"short-container-title":["Phil. Trans. R. Soc. B"],"published-print":{"date-parts":[[2025,8,21]]},"abstract":"<jats:p>\n                    Exposure to hypobaric hypoxia at high altitude is associated with adverse pregnancy outcomes, including low birth weight and stillbirth. However, the relationship between high altitude and pre-eclampsia remains less well defined, with conflicting findings in previous studies. Improved understanding of pre-eclampsia risk at altitude could help in targeting resources, particularly in low-resourced settings. This study aimed to evaluate the impact of altitude, analysed as a continuous nonlinear variable, on the risk of pre-eclampsia in Ecuador. Publicly available maternal health records from Ecuador (2021\u201323) were obtained from the National Institute of Statistics and Census. Geospatial techniques were used to assign the altitude of maternal residence, and generalized additive models determined the relationship between altitude and pre-eclampsia incidence, adjusting for maternal age, ethnicity, healthcare access, and residence. Models were fitted using restricted maximum likelihood. After adjusting for confounders, no significant increase in pre-eclampsia risk was observed with higher altitude. However, as expected, increased risk was noted at the extremes of maternal age (\n                    <jats:italic toggle=\"yes\">p\u2009<\/jats:italic>\n                    &lt;0.001) and among women with publicly funded care (\n                    <jats:italic toggle=\"yes\">p\u2009<\/jats:italic>\n                    &lt;0.001). Ethnicity was also a risk determinant, but no interaction with altitude was found. Comparison of our findings with population-wide studies elsewhere is a key future goal.\n                  <\/jats:p>\n                  <jats:p>This article is part of the discussion meeting issue \u2018Pregnancy at high altitude: the challenge of hypoxia\u2019.<\/jats:p>","DOI":"10.1098\/rstb.2024.0169","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T07:52:57Z","timestamp":1755762777000},"update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Altitude and risk of pre-eclampsia: insights from a large-scale epidemiological study in Ecuador"],"prefix":"10.1098","volume":"380","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1674-099X","authenticated-orcid":true,"given":"Emma","family":"Mitchell-Sparke","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Cambridge","place":["Cambridge, UK"]},{"name":"Tufts University School of Medicine","place":["Boston, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart","family":"Theeuwes","sequence":"additional","affiliation":[{"name":"Cambridge Stem Cell Institute, University of Cambridge","place":["Cambridge, UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imogen","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Cambridge","place":["Cambridge, UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1308-1204","authenticated-orcid":true,"given":"Dino A.","family":"Giussani","sequence":"additional","affiliation":[{"name":"Department of Physiology, Development, and Neuroscience, University of Cambridge","place":["Cambridge, UK"]},{"name":"Institute of Metabolic Science, University of Cambridge","place":["Cambridge, UK"]},{"name":"Loke Centre for Trophoblast Research, University of Cambridge","place":["Cambridge, UK"]},{"name":"Cambridge Reproduction Strategic Research Initiative, University of Cambridge","place":["Cambridge, UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6510-5626","authenticated-orcid":true,"given":"Catherine","family":"Aiken","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Cambridge","place":["Cambridge, UK"]},{"name":"Institute of Metabolic Science, University of Cambridge","place":["Cambridge, UK"]},{"name":"Loke Centre for Trophoblast Research, University of Cambridge","place":["Cambridge, UK"]},{"name":"Cambridge Reproduction Strategic Research Initiative, University of Cambridge","place":["Cambridge, UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"175","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.08.014"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14913"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-023-00417-6"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00070-7"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.11.005"},{"key":"e_1_3_7_7_2","volume-title":"StatPearls","author":"Karrar SA","year":"2024","unstructured":"Karrar SA, Martingano DJ, Hong PL. 2024 Preeclampsia. 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Treasure island, FL, USA: StatPearls Publishing."},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.08.019"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19074080"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100400"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70611-3"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03602-1"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.2741\/2286"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00383.2009"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2024.109702"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1745181"},{"key":"e_1_3_7_17_2","article-title":"Genetic ancestry and ethnic identity in Ecuador","volume":"2","author":"Nagar SD","year":"2021","unstructured":"Nagar SD, Conley AB, Chande AT, Rishishwar L, Sharma S, Mari\u00f1o-Ram\u00edrez L, Aguinaga-Romero G, Gonz\u00e1lez-Andrade F, Jordan IK. 2021 Genetic ancestry and ethnic identity in Ecuador. 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