Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction

Colleen Glyde Julian, Marcelino Gonzales, Armando Rodriguez, Diva Bellido, Carlos Salinas Salmon, Anne Ladenburger, Lindsay Reardon, Enrique Vargas, Lorna G. Moore

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ~10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilator and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600–4,100 m) residents aged 18–25 yr with excessive erythrocytosis (EE, Hb concentration (formula presented)18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension.

Original languageEnglish
Pages (from-to)H565-H573
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume309
Issue number4
DOIs
StatePublished - 18 Aug 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 the American Physiological Society.

Keywords

  • Altitude
  • Developmental programming
  • Excessive erythrocytosis
  • Hypoxia
  • Polycythemia

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