辅助生殖技术与宫内心血管重塑有关，这种重塑在出生后仍持续存在。

Assisted reproductive technologies are associated with cardiovascular remodeling in utero that persists postnatally.

机构信息

Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clinic, Fetal and Perinatal Medicine Research Group (B.V.-A., F.C., M.C.-L., M.C., S.C., J. Balasch, E.G.) and Cardiology Department, Thorax Institute, Hospital Clínic (M.S.), Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain (F.C., E.G.); Institució Catalana de Recerca i Estudis Avançats, Universitat Pompeu Fabra, Barcelona, Spain (B.B.); and Department of Pediatric Cardiovascular Surgery, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (J. Bartrons).

出版信息

Circulation. 2013 Sep 24;128(13):1442-50. doi: 10.1161/CIRCULATIONAHA.113.002428. Epub 2013 Aug 28.

DOI:10.1161/CIRCULATIONAHA.113.002428

PMID:23985787

Abstract

BACKGROUND

Assisted reproductive technologies (ARTs) have been shown to be associated with general vascular dysfunction in late childhood. However, it is unknown whether cardiac remodeling is also present and if these changes already manifest in prenatal life. Our aim was to assess fetal and infant (6 months of age) cardiovascular function in ART pregnancies.

METHODS AND RESULTS

This prospective cohort study included 100 fetuses conceived by ART and 100 control pregnancies. ART fetuses showed signs of cardiovascular remodeling, including a more globular heart with thicker myocardial walls, decreased longitudinal function (tricuspid ring displacement in controls: median, 6.5 mm [interquartile range, 6.1-7.1 mm]; tricuspid ring displacement in ART: 5.5 mm [interquartile range, 5.1-6.1]; P<0.001), impaired relaxation, and dilated atria (atrial area in controls, 1.46 cm(2) [interquartile range, 1.2-1.5 cm(2)]; atrial area in ART, 1.6 cm(2) [interquartile range, 1.3-1.8 cm(2)]; P<0.001). Additionally, ART infants showed persistence of most cardiac changes and a significant increase in blood pressure and aortic intima-media thickness (systolic blood pressure in controls, 74 mm Hg [interquartile range, 67-83 mm Hg]; systolic blood pressure in ART, 83 mm Hg [interquartile range, 75-94 mm Hg]; P<0.001; aortic intima-media thickness in controls, 0.52 mm [interquartile range, 0.45-0.56 mm]; aortic intima-media thickness in ART, 0.64 mm [interquartile range, 0.62-0.67]; P<0.001). We could not demonstrate that our findings were directly caused by ART because of their association with various confounding factors, including intrauterine growth restriction or factors related to the cause of infertility.

CONCLUSIONS

Children conceived by ART manifest cardiac and vascular remodeling that is present in fetal life and persists in postnatal life, suggesting opportunities for early detection and potential intervention. The underlying mechanisms and the effect of potential confounders such as growth restriction or prematurity remain to be elucidated.

摘要

背景

辅助生殖技术（ART）已被证明与儿童晚期的全身血管功能障碍有关。然而，目前尚不清楚是否也存在心脏重构，如果这些变化已经在产前出现。我们的目的是评估 ART 妊娠胎儿和婴儿（6 个月龄）的心血管功能。

方法和结果

这项前瞻性队列研究纳入了 100 名通过 ART 受孕的胎儿和 100 名对照妊娠的胎儿。ART 胎儿表现出心血管重塑的迹象，包括心脏更呈球形，心肌壁更厚，纵向功能下降（对照组三尖瓣环位移中位数为 6.5 毫米[四分位距 6.1-7.1 毫米]；ART 组为 5.5 毫米[四分位距 5.1-6.1 毫米]；P<0.001），舒张功能受损，心房扩张（对照组心房面积为 1.46 平方厘米[四分位距 1.2-1.5 平方厘米]；ART 组为 1.6 平方厘米[四分位距 1.3-1.8 平方厘米]；P<0.001）。此外，ART 婴儿在出生后仍存在大多数心脏变化，并表现出血压和主动脉内膜-中层厚度的显著增加（对照组收缩压为 74 毫米汞柱[四分位距 67-83 毫米汞柱]；ART 组为 83 毫米汞柱[四分位距 75-94 毫米汞柱]；P<0.001；对照组主动脉内膜-中层厚度为 0.52 毫米[四分位距 0.45-0.56 毫米]；ART 组为 0.64 毫米[四分位距 0.62-0.67 毫米]；P<0.001）。由于与宫内生长受限或与不孕原因相关的各种混杂因素相关，我们无法证明我们的发现是由 ART 直接引起的。