Assessing cardiovascular remodelling in fetuses and infants conceived by assisted reproductive technologies: a prospective observational cohort study protocol

Abstract

IntroductionAssisted reproductive technologies (ART), namely in vitro fertilisation and intracytoplasmic sperm injection, have become widely used to treat infertility. Although the use of ART is generally considered favourable, there are ongoing concerns about the prenatal and perinatal risks as well as long-term risks for the child. Epidemiological studies have demonstrated an association between pathological events during fetal development and future cardiovascular risk, raising concerns about cardiovascular remodelling in fetuses conceived by ART. The authors hypothesise fetuses conceived by ART present signs of cardioventricular dysfunction, which can be detected by deformation analysis. To address these issues, we will assess comprehensive cardiovascular structure and function in ART offspring and explore the role of speckle-tracking in myocardial deformation.Methods and analysisThis prospective observational cohort study will include 100 singleton pregnancies conceived by ART and 100 controls identified in fetal life and followed up to 6 months old. At inclusion, a baseline assessment of the mothers and ART characteristics will be recorded by interview and review of medical records. Between 28 and 32 weeks gestation, a detailed fetal echography will be performed, including an assessment of estimated fetal weight, fetoplacental Doppler, fetal echocardiography and fetal abdominal artery ultrasound. On delivery, maternal and neonatal characteristics will be assessed. Within 60 days of birth, the first postnatal cardiovascular assessment will be conducted which will include echocardiography and abdominal artery ultrasound. At 6 months of age, the second infants’ follow-up evaluation will include the weight and length of the infant, echocardiography and abdominal artery ultrasound. Data will be presented as mean±SD, median or percentages where appropriate. A p<0.05 will be considered statistically significant.Ethics and disseminationEthical approval has been obtained from the Ethics Committee of Shengjing Hospital of China Medical University. Findings will be disseminated through scientific publications and conference presentations.Trial registration numberChiCTR1900021672.

Subjects Conceived through Assisted Reproductive Technologies Display Normal Arterial Stiffness

“…The available data on long-term consequences is sparse, but neurodevelopmental deficits, abnormalities in glucose metabolism and the early development of metabolic syndrome are named as potential adverse health outcomes [ 11 , 15 , 37 ]. In the literature, cardiovascular remodeling within the ART offspring is assumed [ 16 , 18 , 39 ]. A well-known Swiss study reported generalized endothelial dysfunction, increased intima-media thickness and elevated arterial stiffness in a cohort of 65 ART singletons compared to 57 spontaneously conceived controls [ 17 , 33 ].…”

The association between assisted reproductive technology and cardiac remodeling in fetuses and early infants: a prospective cohort study

“…This was a prospective and observational cohort study; the detailed protocol was published previously [17]. Initially, we recruited 111 fetuses that had been conceived by ART and 106 controls at the gestational age of 28 +0 to 32 +6 weeks between December 2017 and April 2019 at the Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.…”

“…Initially, we recruited 111 fetuses that had been conceived by ART and 106 controls at the gestational age of 28 +0 to 32 +6 weeks between December 2017 and April 2019 at the Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China. All participants were singletons, and without any structural or chromosomal anomalies, evidence of infection, or any maternal medical diseases [17]. Twenty-three ART fetuses and 21 controls were excluded due to prematurity, smoking during pregnancy, or small/large-for-gestational age (Fig.…”

“…During prenatal evaluation, two-dimensional fetal ultrasound examinations were performed with an EPIQ 7C ultrasound system (Philips Ultrasound, Inc., Bothell, Washington) equipped with 3-5 MHz curved-array (C5-1) and 1-5 MHz sector-array (S5-1) probes. The same experienced operator (B-WJ) conducted all examinations, including the assessment of estimated fetal weight, placental Doppler, and fetal echocardiography [17].…”

“…Fetal echocardiography included a comprehensive examination to assess structural heart integrity, cardiac morphometry, and function, the latter was evaluated by both conventional echocardiography and STE analysis [17]. For STE, we acquired videos for offline analysis, including the apical or basal 4-chamber, longaxis, and 2-chamber views, as well as basal-, mid-, and apical-short-axis views.…”