Assisted Reproductive Technologies are Associated with Cardiovascular Remodeling in Utero that Persists Postnatally
Background—Assisted reproductive technologies (ART) have 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—A prospective cohort study including 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) vs. ART: 5.5 mm (5.1-6.1) P<0.001), impaired relaxation and dilated atria (atrial area in controls 1.46 cm2 (1.2-1.5) vs. ART 1.6 cm2 (1.3-1.8) P<0.001). Additionally, ART infants showed persistence of most cardiac changes and a significant increase in blood pressure (systolic blood pressure in controls: 74 mmHg (67-83) vs. ART: 83 mmHg (75-94) P<0.001) and aortic intima-media thickness (controls: 0.52 mm (0.45-0.56) vs. ART: 0.64 mm (0.62-0.67) P<0.001). We could not demonstrate our findings were directly caused by ART, because of their association to various confounding factors including intrauterine growth restriction or those 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.
- Received March 5, 2013.
- Revision received July 18, 2013.
- Accepted July 30, 2013.