Author + information
- Naga Venkata Pothineni, MD∗ (, )
- Swathi Kovelamudi, MD and
- Suma Kantipudi, MD, DGO
- ↵∗Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, #532, Little Rock, Arkansas 72205
We read with great interest the study by Meister et al. (1) in a recent issue of the Journal. In this longitudinal study of children conceived by assisted reproductive techniques (ART), the investigators detected signs of premature vascular aging and also a significant 6-fold increase in risk of hypertension detected by ambulatory blood pressure monitoring in adolescence. These results are striking given the ever increasing use of ART. We congratulate the investigators for recruiting a majority of the previously described cohort for follow-up evaluation. In our opinion, 2 other factors may confound the current results.
First, the majority (39 of 54) of the children in the ART group were conceived by the intracytoplasmic sperm injection (ICSI) technique, which may be associated with an increased risk of gamete damage due to micro manipulation. This technique is currently primarily used for male infertility, and it is perplexing to see a majority of cases in the study conceived through ICSI. With the advent of novel ART techniques that minimize gamete manipulation, it may be plausible that we would minimize long-term adverse effects on the fetus.
Second, a very prevalent factor that we encounter in clinical practice of infertility is the degree of maternal stress, both before conception and during gestation. The inability to conceive poses a huge social and mental stress on parents in various cultures and could affect epigenetic expression of gametes with long-lasting effects on the cardiovascular health of the fetus. We believe that factors such as the number of attempts at ART, etiology of infertility, and hormonal milieu of the mother would all influence the cardiovascular phenotype of the fetus. Stress on the fetus secondary to maternal stress and elevated cortisol levels could increase adult-onset cardiovascular disease in accordance with the Barker’s hypothesis of fetal origins of adult disease (2). Although both groups in this study were matched for maternal health characteristics, factors such as maternal stress levels could not be accounted for and may significantly affect long-term vascular risk.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2019 American College of Cardiology Foundation