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Assisted reproductive technologies are associated with an increased cardiovascular risk

Eduard Gratacós, professor of Obstetrics and Gynecology at the Faculty of Medicine.

Eduard Gratacós, professor of Obstetrics and Gynecology at the Faculty of Medicine.

Juan Balasch, professor of Obstetrics and Gynecology at the Faculty of Medicine.

Juan Balasch, professor of Obstetrics and Gynecology at the Faculty of Medicine.



A research led by researchers Eduard Gratacós and Juan Balasch, professors of Obstetrics and Gynecology at the Faculty of Medicine of the UB, shows that fetuses conceived by assisted reproductive technologies present changes in their heart and arteries even before their birth. These changes are similar to those in children with diabetes or severe obesity, and they mean a significant increase in cardiovascular risk in adulthood. The study, published in Circulation, is extremely important as it represents an opportunity to reverse this situation from the beginning of life.

The research was coordinated at Hospital Clínic - IDIBAPS by doctors Gratacós and Balasch, also researchers at the Institute of Gynecology, Obstetrics and Neonatology (ICGON) and the Fetal Medicine Research Centre, and its first authors are researchers Brenda Valenzuela and Fátima Crispi. It is an ambitious study that involves the Service of Perinatal Medicine and Gynecology at Hospital Clínic, the services of Cardiology at Hospital Clínic and Hospital Sant Joan de Déu, and researchers from Pompeu Fabra University. The research has been supported by Obra Social La Caixa.

The effect of subtle changes over children’s long-term health began to be studied just a few years ago. In a three-year study, the research group analyzed 100 in vitro fertilization pregnancies and 100 normal ones during almost one year, from mid-pregnancy fetal life until six months after the birth. An ambitious research design and a group of engineers and doctors specialized in different areas enabled to apply modern techniques in order to evaluate the movement and deformation of the heart and arteries in both fetal life and first months of life.

Results were conclusive: significant changes in the shape and function of the fetal heart were observed in the womb, and they persisted after birth, being associated to hypertension and an increase in the thickness of arteries. Observed changes in children are considered markers of increased cardiovascular risk in the future, including hypertension and arteriosclerosis. Therefore, once evaluated by experts and accepted, the journal Circulation, the official journal of the American Heart Association which is considered the most influential one in cardiovascular medicine, has published the article together with an editorial.

Experts and researchers asked by Circulation agreed that changes observed in fetuses and children are not due to a direct effect of assisted reproductive techniques; probably, they are due to riskier pregnancies. It is also possible that the problem that caused infertility may also influenced the fetus later.

Results are extremely positive as they mean an opportunity for public health. First, there is growing data supporting the fact that a heart-healthy diet may protect the cardiovascular system and even reverse many changes due to intrauterine diseases. In a recent study, the research group has proved its evidence in fetuses suffering intra uterus problems. Second, the group has developed new methods based on fetal echocardiography to select fetuses with increased cardiovascular risk. Thus, it is unnecessary to alarm parents because it is possible to select those cases that will benefit from a closer monitoring of blood pressure and simple measures, for example avoiding childhood obesity, and adopting a diet that promotes cardiovascular health.

Fetal Medicine Research Centre

The Fetal Medicine Research Centre is affiliated with the Hospital Clínic, the Hospital Sant Joan de Déu and the University of Barcelona. It is a national and international referral center; it is among the few institutions in Europe with a stable programme in fetal surgery, with over 100 cases a year.

Recently, it has been recognized by the European Commission to coordinate the first Erasmus Mundus Joint Doctorate in Fetal and Perinatal Medicine (Fetalmed-PhD), offered by the UB together with other European universities.


Valenzuela-Alcaraz B, Crispi F, Bijnens B, Cruz-Lemini M, Creus M, Sitges M, Bartrons J, Civico S, Balasch J, Gratacós E. "Assisted Reproductive Technologies are Associated with Cardiovascular Remodeling in Utero that Persists Postnatally". Circulation, August 2013. DOI: 10.1161/​CIRCULATIONAHA.113.002428



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