Clinical assessment of blood pressure in 60 girls with Turner syndrome compared to 1888 healthy Danish girls

Kjaer, Anna Sophie L; Petersen, Jørgen Holm; Wang, Amanda Cleemann; Juul, Klaus; Schmidt, Ida Maria; Main, Katharina M.; Juul, Anders; Jensen, Rikke Beck

doi:10.1111/cen.14669

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Pubertal onset is earlier in girls than boys and puberty causes an accelerated increase in BP ( Kjaer et al , 2022 ). Therefore, comparing boys and girls at the same age is challenging.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure and lipid profiles in children born after ART with frozen embryo transfer

Asserhøj,

Mizrak,

Lebech Kjaer

et al. 2024

Human Reproduction Open

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STUDY QUESTION Are blood pressure (BP) and lipid profiles different between children conceived after ART with frozen embryo transfer (FET), fresh embryo transfer (fresh-ET), and natural conception (NC)? SUMMARY ANSWER Girls conceived after FET had significantly higher systolic BP and heart rate compared with girls born after fresh-ET; boys conceived after FET had a slightly more favourable lipid profile compared with boys born after fresh-ET and NC. WHAT IS KNOWN ALREADY Children conceived after ART with FET are more often born large for gestational age (LGA). LGA in general increases the risk of obesity, diabetes, and cardiovascular disease later in life. Studies on mice and humans on the whole ART population have raised concerns about premature vascular aging and higher BP. The cardiovascular health of children born after FET is scarcely explored and the results are diverging. STUDY DESIGN, SIZE, DURATION This study was part of the cohort study “Health in Childhood following Assisted Reproductive Technology” (HiCART) which included 606 singletons (292 boys) born between December 2009 and December 2013: 200 children were conceived after FET; 203 children were conceived after fresh-ET; and 203 children were conceived naturally and matched for birth year and sex. The study period lasted from January 2019 to September 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The included children were 7-10 years of age at examination and underwent a clinical examination with anthropometric measurements, pubertal staging, and BP measurement. Additionally, a fasting blood sample was collected and analysed for cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides. Systolic and diastolic BP were converted to standard deviation scores (SDS) using an appropriate reference and accounting for height (SDS) of the child. The three study groups were compared pairwise using a univariate linear regression model. Mean differences were adjusted for confounders using multiple linear regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE Girls and boys conceived after FET had significantly higher birthweight (SDS) compared with naturally conceived peers (mean difference: girls: 0.35, 95% CI (0.06; 0.64), boys: 0.35, 95% CI (0.03; 0.68)). Girls conceived after FET had significantly higher systolic BP (SDS) and heart rate compared with girls conceived after fresh-ET (adjusted mean difference: systolic BP (SDS): 0.25 SDS, 95% CI (0.03; 0.47), heart rate: 4.53, 95% CI (0.94; 8.13)). Regarding lipid profile, no significant differences were found between the three groups of girls. For the boys, no significant differences were found for BP and heart rate. Lipid profiles were more favourable in boys born after FET compared with both boys conceived after fresh-ET and NC. All outcomes were adjusted for parity, maternal BMI at early pregnancy, smoking during pregnancy, educational level, birthweight, breastfeeding, child age at examination, and onset of puberty. LIMITATIONS, REASONS FOR CAUTION The participation rate varied from 18 to 42% in the three groups, and therefore selection bias cannot be excluded. However, extensive non-participant analyses were performed that showed almost no differences in background characteristics between participants and non-participants in the three groups, making selection bias less likely. WIDER IMPLICATIONS OF THE FINDINGS The higher birthweight in children conceived after FET was associated with increased systolic BP (SDS) and heart rate in girls conceived after FET compared with fresh-ET. This may be an early indicator of compromised long-term cardiovascular health in this group. The study was not powered to investigate these outcomes and further studies are therefore warranted to confirm the findings. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Novo Nordisk Foundation (grant number: NNF18OC0034092, NFF19OC0054340) and Rigshospitalets Forskningsfond. The authors have no conflict of interests to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT03719703

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“…Pubertal onset is earlier in girls than boys and puberty causes an accelerated increase in BP ( Kjaer et al , 2022 ). Therefore, comparing boys and girls at the same age is challenging.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure and lipid profiles in children born after ART with frozen embryo transfer

Asserhøj,

Mizrak,

Lebech Kjaer

et al. 2024

Human Reproduction Open

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“…Turner syndrome (TS) associates with an increased prevalence of congenital left‐sided heart disease along with an increased incidence and mortality from aortic dissection 1 . Aortic dilation is a key risk marker for aortic dissection in TS with the risk especially increased with coexisting 45,X karyotype, left‐sided congenital heart disease such as bicuspid aortic valves and aortic coarctation, hypertension and pregnancy 2–6 . Nevertheless, risk stratification is fraught in TS because not all aortic dissections are predicted by these risk factors, and an increased understanding of the underlying disease mechanisms may help identify new and improved markers of the risk of aortic dissection.…”

Section: Introductionmentioning

confidence: 99%

The TGFβ system and TIMP1 and 3 genotypes in Turner syndrome—Relation with aortic congenital malformations

Ridder

Stochholm

Mortensen

et al. 2023

Clinical Endocrinology

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ObjectiveCardiovascular complications and congenital malformations are known traits in Turner syndrome (TS), which increases mortality. Women with TS have varying phenotype and cardiovascular risks. A biomarker assessing the risk for cardiovascular complications could potentially reduce mortality in high‐risk TS and reduce screening in TS participants with low cardiovascular risk.Design, Patients, Participants and MeasurementsAs part of a study initiated in 2002, 87 TS participants and 64 controls were invited to magnetic resonance imaging of the aorta, anthropometry, and biochemical markers. TS participants were re‐examined thrice lastly in 2016. The focus of this paper is the additional measurements of transforming growth factor beta (TGFβ), matrix metalloproteinase (MMP's), tissue inhibitor of matrix metalloproteinase (TIMP), peripheral blood DNA and their associations with TS and the cardiovascular risk and congenital heart disease.ResultsTS participants had lower TGFβ1 and TGFβ2 values compared to controls. snp11547635 heterozygosity was not associated with any biomarkers but was associated with increased risk of aortic regurgitation. TIMP4 and TGFβ1 were correlated with the aortic diameter at several measuring positions. During follow‐up, the antihypertensive treatment decreased the descending aortic diameter and increased TGFβ1 and TGFβ2 levels in TS.ConclusionTGFβ and TIMP's are altered in TS and may play a role in the development of coarctation and dilated aorta. snp11547635 heterozygosity was not found to impact biochemical markers. Further studies should investigate these biomarkers to further unravel the pathogenesis of the increased cardiovascular risk in TS participants.

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Clinical practice guidelines for the care of girls and women with Turner syndrome

Gravholt,

Andersen,

Christin-Maitre

et al. 2024

European Journal of Endocrinology

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Turner syndrome affects 50 per 100,000 females, affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and US culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: 1) diagnosis and genetics, 2) growth, 3) puberty and estrogen treatment, 4) cardiovascular health, 5) transition, 6) fertility assessment, monitoring, and counselling, 7) health surveillance for comorbidities throughout the lifespan, and 8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting.

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Clinical assessment of blood pressure in 60 girls with Turner syndrome compared to 1888 healthy Danish girls

Cited by 3 publications

References 36 publications

Blood pressure and lipid profiles in children born after ART with frozen embryo transfer

Blood pressure and lipid profiles in children born after ART with frozen embryo transfer

The TGFβ system and TIMP1 and 3 genotypes in Turner syndrome—Relation with aortic congenital malformations

Clinical practice guidelines for the care of girls and women with Turner syndrome

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