{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:08:58Z","timestamp":1790028538136,"version":"4.0.1"},"reference-count":36,"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":[{"name":"Wellcome"}],"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>Leh, Ladakh, is situated at an altitude of more than 3500 metres above sea level (masl) and serves as a natural hypoxic environment for studying the effects of a low-oxygen environment on pregnancy. Over a 10 year collaboration, pregnant women in Leh were recruited and studied, alongside their partners and offspring at birth. The aim was to better elucidate underlying mechanisms that might both protect from, as well as predispose to, poor fetal growth. Phenotypic data were analysed alongside genomic data generated by the Infinium\u2122 Global Screening Array-24 BeadChip. Patient records from low-altitude sites (Bylakuppe 850 m a.s.l) and Delhi (200 m) were compared with data from Leh. A cohort of 318 pregnant women in Ladakh were studied, with an average birthweight for those born at term of 3.15 kg. Compared with women who delivered an appropriate for gestational age (AGA) baby in Leh, those who delivered a small for gestational age (SGA) (&lt;10th birth weight centile) were statistically older and lighter and had smaller maternal uterine artery diameters at 18\u221222 weeks of gestation. This difference was not maintained between AGA and SGA babies at low altitude in the Delhi cohort. Genetic analysis of Ladakh babies suggested a genetic history most closely related to neighbouring Tibeto-Burman-speaking populations and birth weight analysis replicated previous identified SNPs related to metabolic, skeletal and height genes, offering novel avenues of investigation.<\/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.2024.0396","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":2,"title":["High-altitude pregnancy adaptation: evidence from a Himalayan population in Leh"],"prefix":"10.1098","volume":"380","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2971-6865","authenticated-orcid":true,"given":"Sara L.","family":"Hillman","sequence":"first","affiliation":[{"name":"Institute for Women's Health, University College London Faculty of Population Health Sciences","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padma","family":"Dolma","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Sonam Norboo Memorial Hospital","place":["Leh, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.150"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.6.1003"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-019-02788-3"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6300(1997)9:6<751::AID-AJHB8>3.0.CO;2-U"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/1096-8644(200101)114:1<42::AID-AJPA1004>3.0.CO;2-B"},{"key":"e_1_3_7_7_2","first-page":"459","article-title":"Altitude, ethnic and sex differences in birth weight and length in Bolivia","volume":"52","author":"Hass JD","year":"1980","unstructured":"Hass JD, Frongillo EA, Stepick CD, Beard JL, Hurtado L. 1980 Altitude, ethnic and sex differences in birth weight and length in Bolivia. Hum. Biol. 52, 459\u2013477.","journal-title":"Hum. Biol."},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.1102"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1152\/physiolgenomics.00063.2014"},{"key":"e_1_3_7_10_2","first-page":"65","article-title":"Cultural relationship between the people of Ladakh and Tibet","volume":"43","author":"Jolden T","year":"2018","unstructured":"Jolden T, Rinchen Tundup R. 2018 Cultural relationship between the people of Ladakh and Tibet. Tibet J. 43, 65\u201371.","journal-title":"Tibet J."},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.20400"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.1310060411"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-001759"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002717"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904223401603"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044160"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.303.6809.1019"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13522"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.577"},{"key":"e_1_3_7_20_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/293271","article-title":"Oxidative stress in placenta: health and diseases","volume":"2015","author":"Wu F","year":"2015","unstructured":"Wu F, Tian FJ, Lin Y. 2015 Oxidative stress in placenta: health and diseases. BioMed Res. Int. 2015, 1\u201315. (doi:10.1155\/2015\/293271)","journal-title":"BioMed Res. Int."},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00383.2009"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.89.6.2673"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22189675"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-021-01593-5"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.296.5566.261b"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1086\/519795"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1101\/gr.094052.109"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1534\/genetics.112.145037"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature19806"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269671"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.91046.2008"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP270995"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00644.2019"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1113\/JP279341"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1038\/ng2121"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/ng.122"},{"key":"e_1_3_7_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-06766-z"}],"container-title":["Philosophical Transactions of the Royal Society B: Biological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.2024.0396","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/full-xml\/10.1098\/rstb.2024.0396","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.2024.0396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:19:18Z","timestamp":1778620758000},"score":1,"resource":{"primary":{"URL":"http:\/\/royalsocietypublishing.org\/rstb\/article\/235071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,21]]},"references-count":36,"journal-issue":{"issue":"1933","published-print":{"date-parts":[[2025,8,21]]}},"alternative-id":["10.1098\/rstb.2024.0396"],"URL":"https:\/\/doi.org\/10.1098\/rstb.2024.0396","relation":{},"ISSN":["0962-8436","1471-2970"],"issn-type":[{"value":"0962-8436","type":"print"},{"value":"1471-2970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,21]]},"assertion":[{"value":"2024-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-20","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"20240396"}}