The periconception maternal cardiovascular risk profile influences human embryonic growth trajectories in IVF/ICSI pregnancies

• Published in: Human reproduction (Oxford) 2016-06, Vol.31 (6), p.1173-1181
• Main Authors: Wijnands, K.P.J., van Uitert, E.M., Roeters van Lennep, J.E., Koning, A.H.J., Mulders, A.G.M.G.J., Laven, J.S.E., Steegers, E.A.P., Steegers-Theunissen, R.P.M.
• Format: Article
• Language: English
• Subjects: Body Mass Index; Cardiovascular Diseases - complications; Crown-Rump Length; Diet; Embryonic Development; Female; Fertilization in Vitro; Fetal Development; Humans; Hypertension - complications; Maternal Age; Prospective Studies; Risk Assessment; Risk Factors; Smoking
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/dew060

Abstract STUDY QUESTION Is the maternal cardiovascular (CV) risk profile associated with human embryonic growth trajectories and does the mode of conception affect this association? SUMMARY ANSWER This small study suggests that the maternal CV risk profile is inversely associated with first trimester embryonic growth trajectories in in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) pregnancies, but not in spontaneously conceived pregnancies. WHAT IS KNOWN ALREADY Maternal high-blood pressure and smoking affect placental function, accompanied by increased risk of fetal growth restriction and low-birthweight. Mothers who experience pregnancies complicated by fetal growth restriction are at increased risk of CV disease in later life. STUDY DESIGN, SIZE, DURATION In a prospective periconception birth cohort conducted in a tertiary hospital, 111 singleton ongoing pregnancies with reliable pregnancy dating, no pre-existing maternal disease and no malformed live borns were investigated. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Spontaneously conceived pregnancies with a reliable first day of the last menstrual period and a regular menstrual cycle of 25–31 days only (n = 66) and IVF/ICSI pregnancies (n = 45) were included. Women underwent weekly three-dimensional ultrasound scans (3D US) from 6- to 13-week gestational age. To estimate embryonic growth, serial crown-rump length (CRL) measurements were performed using the V-Scope software in a BARCO I-Space. Maternal characteristics and CV risk factors were collected by self-administered questionnaires. The CV risk profile was created based on a score of risk factors, including maternal age, body-mass index, CV disease in the family, diet and smoking. Quartiles of the CV risk score were calculated. Associations between the CV risk score and embryonic growth were assessed using square root transformed CRL in multivariable linear mixed model analyses. MAIN RESULTS AND THE ROLE OF CHANCE From the 111 included pregnancies, 696 3D US data sets were obtained of which 637 (91.5%) CRLs could be measured. In the total group, The CV risk score was inversely, but not significantly associated with embryonic growth (−0.03√mm; P = 0.291). Stratified by mode of conception, the CV risk score was inversely and significantly associated with embryonic growth (β = −0.04√mm; P = 0.025, adjusted for possible confounders) in the IVF/ICSI group. Compared with the first quartile, embryos in the upper quartile were 10.4%