Blood pressure and anthropometrics of 4-y-old children born after preimplantation genetic screening: follow-up of a unique, moderately sized, randomized controlled trial

Abstract

Background: Recent studies suggest that in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are associated with suboptimal cardiometabolic outcome in offspring. It is unknown whether preimplantation genetic screening (PGS), which involves embryo biopsy, affects blood pressure (BP), anthropometrics, and the frequency of received medical care. Methods: In this prospective multicenter follow-up study, we assessed BP, anthropometrics, and received medical care of 4-y-old children born to women who were randomly assigned to IVF/ICSI with PGS (n = 49) or without PGS (controls; n = 64). We applied linear and generalized linear mixed-effects models to investigate possible effects of PGS. results: BP in the PGS and control groups was similar: 102/64 and 100/64 mm Hg, respectively. Main anthropometric outcomes in the PGS vs. control group were: BMI: 16.1 vs. 15.8; triceps skinfold: 108 vs. 98 mm; and subscapular skinfold: 54 vs. 53 mm (all P values > 0.05). More PGS children than controls had received paramedical care (speech, physical, or occupational therapy: 14 (29%) vs. 9 (14%); P = 0.03 in multivariable analysis). The frequency of medicial treatment was comparable. conclusion: PGS does not seem to affect BP or anthropometrics in 4-y-old children. The higher frequency of received paramedical care after PGS may suggest an effect of PGS on subtle developmental parameters. W orldwide, the number of couples undergoing in vitro fertilization (IVF), with or without intracytoplasmic sperm injection (ICSI), is gradually increasing (1). Nevertheless, pregnancy rates after IVF/ICSI are lower than desired. To enhance efficiency of IVF/ICSI, new techniques such as preimplantation genetic screening (PGS) have been developed.In PGS, embryos are biopsied, and one or two blastomeres are aspirated and screened for aneuploidies. Only embryos with a normal chromosomal constitution are selected for transfer to the uterus (2). However, randomized controlled trials have indicated that PGS is not associated with higher pregnancy rates. As a matter of fact, reduced pregnancy rates after PGS are described for women of advanced maternal age (3,4). As a consequence, PGS is no longer recommended.Nevertheless, evaluation of the health of children born following PGS is relevant as it may reveal valuable information on long-term consequences of embryo biopsy. This is important as embryo biopsy is increasingly applied in the form of preimplantation genetic diagnosis (PGD). Little is known about the health outcome of children born following PGS. In this respect, it is noteworthy that recent reports indicated that IVF/ICSI by itself is associated with increased blood pressure (BP), altered body fat distribution, and vascular dysfunctions in offspring (5-9). Taking into account the general notion that the early environment shapes an individual's physical health later in life (10), it is conceivable that PGS, which includes more extensive embryo manipulation, introduces extra risks for adverse cardiometabolic outcome in offspring. T...

Body composition and blood pressure in 6-year-old singletons born after pre-implantation genetic testing for monogenic and structural chromosomal aberrations: a matched cohort study

“…In this study, where only singletons born after PGT-M and PGT-SR but not after PGT-A were included, we did not find any difference in BMI at the age of 6 years. Only one other research group described anthropometric and blood pressure measurements at childhood ages in children born after embryo biopsy in a smaller study: at 4 and 9 years of age they found no differences between 43 children (29 singletons, 14 twins) born after IVF/ICSI with PGT-A and 56 children born after IVF/ICSI without PGT-A (Seggers et al , 2013; Kuiper et al , 2017). However, although embryo biopsy was also performed at Day 3 in the latter studies, outcomes in PGT-A children may not be extrapolated to PGT-M and PGT-SR children given the dissimilar indications and parental reproductive background.…”

“…But parents who opt for PGT-M or for PGT-SR are not necessarily infertile. Although data on outcomes after PGT-A are not directly transferable, Dutch reseachers reported that blood pressure and anthropometry in children conceived after IVF/ICSI with or without PGT-A did not differ at the age 4 and 9 years (Seggers et al , 2013; Kuiper et al , 2017).…”

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

“…Currently, data on developmental status and health of PGT‐A offspring is scarce (Figure ). From the paper by Mastenbroek et al, six prospective, assessor‐blinded follow‐up studies were derived on children born to women undergone PGT‐A or not, to evaluate neurodevelopmental outcomes at 18 months, 2, 4 and 9 years . In these studies, no statistically significant differences in mental, psychomotor, neurological and behavioral outcomes were reported between children born after PGT‐A and those born without PGT‐A.…”

“…From the paper by Mastenbroek et al, 1 six prospective, assessor-blinded follow-up studies were derived on children born to women undergone PGT-A or not, to evaluate neurodevelopmental outcomes at 18 months, 2, 4 and 9 years. [85][86][87][88][89][90] In these studies, no statistically significant differences in mental, psychomotor, neurological and behavioral outcomes were reported between children born after PGT-A and those born without PGT-A. Unfortunately, the power calculation of the original RCT was based on the number of women needed to detect an increase in ongoing pregnancy rates and not on the number of children to be followed-up.…”

Neurodevelopmental and cardiometabolic outcome in 4-year-old twins and singletons born after IVF

“…All participating children were born to subfertile parents, i.e., couples who were not able to conceive after 12 months of unprotected sexual intercourse. Fouryear-old outcomes of the Groningen assisted reproduction technique cohort singletons born after ovarian stimulation and IVF and that of the PGS singletons conceived without PGS have been reported previously Seggers et al, 2013Seggers et al, , 2014.…”