RCOG World Congress 2025

Altitude and Risk of Pre-Eclampsia: Insights from a large-scale epidemiological study in Ecuador

Objectives:

•Examine how altitude influences the risk of pre-eclampsia in pregnant women

•Apply a non-parametric modeling approach that treats altitude as a continuous variable, avoiding arbitrary altitude categories and generating nuanced understanding

•Inform clinical care and health policy in settings where both altitude and maternal health risks are significant

Introduction:

•Pre-eclampsia affects 2–8% of pregnancies globally, with most deaths in low- and middle-income countries.

•Caused by abnormal spiral artery remodeling

•Known risk factors include nulliparity, chronic hypertension, obesity, extreme maternal age, and low socioeconomic status.

•In contrast, role of high altitude on pre-eclampsia risk is understudied and unclear

•Hypothesized to worsen hypoxia-related stress on maternal systems.

•Prior findings are mixed:

•Colorado study1: >2500m → 33% higher risk

•Ecuador study2: 1500–3500m → lower risk, >3500m → higher risk

•Suggests non-linear and context-specific effects of altitude.

RCOG World Congress 2025

Altitude and Pre-Eclampsia Risk: Insights from a large-scale epidemiological study in Ecuador

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