Врачи призывают к индивидуальным рекомендациям для беременных женщин, занимающихся активностями на высоте

Individual guidance on high altitude activities needed for patients who are pregnant Key takeaways: - There is a lack of evidence on risks related to high altitude activities during pregnancy. - Individualized advice on high-altitude activities while pregnant is warranted until more research is conducted. PARK CITY, Utah — While high-altitude activities are generally safe for women who are pregnant, a presenter here said recommendations should be made based on the individual and their goals. “We lack evidence on what is safe or dangerous for pregnancy, so we have been making fear-based recommendations,” Linda E. Keyes, MD, FACEP, FAWM, adjoint professor of emergency medicine at the University of Colorado, told Healio. “Instead, we should be making recommendations that are compatible with the pregnant person’s goals and risk tolerance until we can get more research about what is safe and what is not.” In her presentation at the International Extreme Sports Medicine Congress, Keyes said current guidelines from the American College of Obstetricians and Gynecologists and the International Climbing and Mountaineering Federation recommend women who are pregnant should not travel to high altitudes after 20 weeks, while current Canadian guidelines recommend women who are pregnant should avoid physical activity at greater than 2,500 meters. However, Keyes said these recommendations are not evidence based and that women who are pregnant either “do not know about these recommendations or they ignore them.” For instance, in a survey conducted by Keyes and colleagues, more than 300 women reported being exposed to high altitude during pregnancy. “In fact, one woman climbed a 7,000-meter peak while she was pregnant, 28 of them had been above 4,000 meters when they were pregnant and two went sky diving, including in the second trimester,” Keyes said. “Any activity you can think of, pregnant women are doing these things.” The survey also showed no statistical difference in clinically meaningful complications among women who were and were not exposed to high altitude for short stays during pregnancy. Keyes said another study showed that “fetuses do not get stressed when they are at an altitude of about 8,500 feet,” while the published literature has shown babies of women who live at high altitudes had no increased risk for congenital malformations, though these women are at greater risk for other complications, such as preeclampsia and still birth. “What we do not know is how long and during what parts of pregnancy does exposure need to be at high altitude to become a risk,” Keyes said. “There might be something special about second trimester exposure and preeclampsia, but all of this is murky and, for sure, there are other factors that we do not know about.” But Keyes said it is important to remember there are benefits to outdoor exercise during pregnancy, with an association between exercising at any altitude and improved maternal and fetal outcomes. She also said outdoor exercise has been reported to lead to better physical and mental health compared with indoor exercise. “We should not be encouraging pregnant women to try new mountain sports that could be dangerous for them,” Keyes told Healio. “But for a patient who wants to continue their sport through pregnancy who is already comfortable doing that activity, we should be encouraging that and help them to do that even if it is not to the same level as they did it pre-pregnancy.” For more information: Linda E. Keyes, MD, FACEP, FAWM, can be contacted at [email protected]; https://www.isharemountains.org/.