YARDIMCI ÜREME TEKNİKLERİNİN NEONATAL KARDİYAK ANOMALİ SIKLIĞI VE SOL VENTRİKÜL FONKSİYONLARI ÜZERİNE ETKİSİ

Yıl 2020, Cilt: 53 Sayı: 1, 6 - 11, 31.03.2020

Ahmet Öktem , Fatih Atik

https://doi.org/10.20492/aeahtd.670514

Öz

Türkçe Özet:
Amaç:
Doğal üreme yöntemleriyle bebek sahibi olamayan aileler yardımcı üreme tekniklerine (IVF) başvurmaktadırlar. Bu çalışmada IVF ile doğan bebeklerle, spontan gebelik sonucu doğan bebeklerin kardiyak fonksiyon ve anomali açısından iki grup arasındaki farklılıklar araştırılmıştır.

Gereç ve Yöntem:
Çalışmaya Ufuk Üniversitesi Çocuk Kardiyoloji Bilim Dalı’nda takip edilen, IVF ile doğan 50 olgu ve spontan gebelik ile doğan 77 olgu olmak üzere toplam 127 olgu alınmıştır. Ekokakardiyografi ile tüm olgular konjenital anomali ve sol ventrikül fonksiyonları açısından değerlendirildi. Sol ventrikül duvar kalınlıkları, ventrikül çapı, ejeksiyon ve kısalma fraksiyonları hesaplandı.

Bulgular:
Çalışmaya alınan 127 hastada; IVF bebeklerin yaş ortalaması 14,46±14,8 ay; spontan gebelik ile doğan bebeklerin yaş ortalaması 4,42 ±5,7 aydı. IVF bebeklerin 25’i kız (%50), 25’i erkek (%50); spontan gebelik ile doğan bebeklerin 36’sı kız (%46,7), 41’i erkek (%53,3) idi.
Çalışmada; spontan gebelik ile doğanların 18’inde (% 23) , IVF ile doğanların ise 10’unda (%25) kardiyak anomali saptandı.
Sol ventrikül duvar kalınlıkları değerlendirildiğinde spontan gebelik ile doğan olgularla IVF ile doğan olgular arasında fark bulunmamıştır (p>0,05). Sol ventrikül sistol sonu çapı IVF ile doğan olgularda, EF ve FS değerleri spontan gebelik ile doğan olgularda tüm yaş gruplarında istatistiksel anlamlı yüksek bulunmuştur (p<0,05).

Sonuç:
Son yıllarda IVF ile doğan bebeklerde doğumsal anomali prevelansının spontan gebelik sonucu doğan bebeklerle benzer olduğunu destekleyen yayınlar mevcuttur. Bizim çalışmamızda doğumsal kardiyak anomali açısından bu verileri destekler niteliktedir. Ancak sol kalp fonksiyonları yardımcı üreme teknikleri ile doğan bebeklerde daha düşük tespit edilmiş olmakla birlikte bu bebeklerin belirli aralıklarla daha uzun süre izlenmesi gerektiğini ortaya koymuştur.

İngilizce Özet:
Purpose:
Families who cannot have babies with spontaneous pregnancy resort to assisted reproductive techniques (ART).The aim of this study was to investigate the differences of cardiac function and anomaly between babies born with ART and babies born as a result of spontaneous pregnancy.

Material and Method:
A total of 127 cases examined in Ufuk University Department of Pediatric Cardiology, including 50 cases born with ART and 77 cases born with spontaneous pregnancy, were included in the study.All patients were evaluated for congenital anomaly and left ventricular function by echocardiography.Left ventricular wall thickness, ventricular diameter, ejection and shortening fractions were calculated.

Results:
127 patients included in the study; The mean age of ART babies was 14.46 ± 14.8 months; The mean age of the babies born with spontaneous pregnancy was 4.42 ± 5.7 months.
25 were female (50%) and 25 were male (50%) in ART group; 36 were female (46.7%) and 41 were male (53.3%) in spontaneous pregnancy group.18 (23%) cardiac anomalieswere detected in spontaneous pregnancy group and 10 (25%)cardiac anomalieswere detectedin ART group.
When the left ventricular wall thicknesses were evaluated, no difference was found between the cases born with spontaneous pregnancy and ART (p> 0.05).
In all age groups, left ventricular end-systolic diameter was found to be significantly higher in ART group, EF and FS values were found to be significantly higher in spontaneous pregnancy group (p <0.05).

Conclusion:
Recent studies suggest that the prevalence of congenital anomaly in infants born with ART is similar to those born with spontaneous pregnancy.Our study supports these data about congenital cardiac anomaly.However, although left heart functions were found to be lower in babies born with ART, it was shown that these babies should be monitored for longer periods at regular intervals.

Anahtar Kelimeler

IVF Gebelik, Spontan gebelik, Sol kalp fonksiyonları, Kardiyak anomali

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

Bu çalışmanın önerisi ve planlanması sürecinde tüm desteği için merhum Sayın Prof. Dr. Enver Ekici'ye teşekkür ederiz.

Kaynakça

• 1. LeonSperoff, Marc A. Fritz. Yardımla üreme teknolojileri. ClinicalGynecologicEndokrinologyandInfertility. Yedinci Baskı Türkçe Çevirisi. Philadelphia: USA, 2007:1215-1275.
• 2. Bernstein D. Congenitalheartdisease. In: Behrman RE, Kliegman RM, Jenson HB (Eds.). Nelson textbook of pediatrics. 17th ed. United States of America: Saunders; 2004: 1499-1554.
• 3. Candan İ, Oral D.Kardiyoloji. Ankara: Antıp AŞ-Baran ofset, 2002: 1065–1084.
• 4. Rudolph AM, Hoffman JIE, Rudolph CD. Rudolph’s Pediatrics.20th ed. The United States of America: PrenticeHallİnternational, 1996: 1457-1471.
• 5. Mone SM, et al. Effects of EnvironmentalExposures on theCardiovascularSystem: Prenatal Period Through Adolescence. Pediatrics, 113. 2004; 4: pp. 1058-1069.
• 6. Kallen K, Maternal smokingandcongenitalheartdefects. Eur J Epidemiol 15 (1999), pp. 731–737.
• 7. Hansen M, Colvin L, Petterson B, Kurinczuk JJ, de Klerk N, Bower C. Twinsbornfollowingassistedreproductivetechnology: perinatal outcomeandadmissiontohospital. Hum Reprod. 2009 Sep;24(9):2321-2331.
• 8. Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, OtterbladOlausson P. Trends in deliveryand neonatal outcomeafter in vitrofertilization in Sweden: data for 25 years. Hum Reprod. 2010 Apr;25(4):1026-1034.
• 9. Bonduelle M, Wennerholm UB, Loft A, Tarlatzis BC, Peters C, Henriet S, Mau C, Victorin-Cederquist A, Van Steirteghem A, Balaska A, Emberson JR, Sutcliffe AG. A multi-centrecohortstudy of thephysicalhealth of 5-year-old childrenconceivedafterintracytoplasmic sperm injection, in vitrofertilizationandnaturalconception. Hum Reprod. 2005 Feb;20(2):413-419.
• 10. Friedler S, Mashiach S, Laufer N. Births in Israelresultingfrom in-vitrofertilization/embryo transfer, 1982-1989: NationalRegistry of theIsraeliAssociationforFertilityResearch. Hum Reprod. 1992 Sep;7(8):1159-1163.
• 11. Pellestor F, Andréo B, Arnal F, Humeau C, Demaille J. Maternal agingandchromosomalabnormalities: new data drawnfrom in vitrounfertilizedhumanoocytes. Hum Genet. 2003 Feb;112(2):195-203.
• 12. Wennerholm UB, Bergh C, Hamberger L, Lundin K, Nilsson L, Wikland M, Källén B. Incidence of congenitalmalformations in childrenbornafter ICSI. Hum Reprod. 2000 Apr;15(4):944-948.
• 13. Pinborg A, Loft A, Rasmussen S, Schmidt L, Langhoff-Roos J, Greisen G, Andersen AN. Neonatal outcome in a Danishnationalcohort of 3438 IVF/ICSI and 10,362 non-IVF/ICSI twinsbornbetween 1995 and 2000. Hum Reprod. 2004 Feb;19(2):435-441.
• 14. Ferencz C, Loffredo CA, Correa-Villansenor AC, et al. Geneticandenvironmental risk factors of majorcardiovascularmalformations. The Baltimore- Washington infantstudy: 1981-1989. Armonk NY: Futura 1997.
• 15. Ferencz C, Rubin JD, Loffredo CA, et al. Epidemiology of congenitalheartdisease: The Baltimore- Washington infantheartstudy: 1981-1989. MountKisco, NY:Futura 1993.
• 16. Koivurova S, Hartikainen AL, Gissler M, Hemminki E, Sovio U, Järvelin MR. Neonatal outcomeandcongenitalmalformations in childrenbornafter in-vitrofertilization. Hum Reprod. 2002 May;17(5):1391-1398.
• 17. Westergaard HB, Johansen AM, Erb K, Andersen AN. DanishNationalIn- Vitro FertilizationRegistry 1994 and 1995: a controlledstudy of births, malformationsandcytogeneticfindings. Hum Reprod. 1999 Jul;14(7):1896- 1902.
• 18. Koudstaal J, Bruinse HW, Helmerhorst FM, Vermeiden JP, Willemsen WN, Visser GH. Obstetricoutcome of twinpregnanciesafter in-vitrofertilization: a matchedcontrolstudy in fourDutchuniversityhospitals. Hum Reprod. 2000 Apr;15(4):935-940.
• 19. Bonduelle M, Liebaers I, Deketelaere V, Derde MP, Camus M, Devroey P, Van Steirteghem A. Neonatal data on a cohort of 2889 infantsbornafter ICSI (1991-1999) and of 2995 infantsbornafter IVF (1983-1999). Hum Reprod. 2002 Mar;17(3):671-694.
• 20. Pinborg A, Loft A, Schmidt L, Andersen AN. Morbidity in a Danishnationalcohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI twinsand 634 IVF/ICSI singletons: health-relatedandsocialimplicationsforthechildrenandtheirfamilies. Hum Reprod. 2003 Jun;18(6):1234-1243.
• 21. Ericson A, Källén B. Congenitalmalformations in infantsbornafter IVF: a population-basedstudy.HumReprod. 2001 Mar;16(3):504-509.
• 22. Halliday JL, Ukoumunne OC, Baker HW, Breheny S, Jaques AM, Garrett C, Healy D, Amor D. Increased risk of blastogenesisbirthdefects, arising in thefirst 4 weeks of pregnancy, afterassistedreproductivetechnologies. Hum Reprod. 2010 Jan;25(1):59-65.
• 23. Anthony S, Buitendijk SE, Dorrepaal CA, Lindner K, Braat DD, den Ouden AL. Congenitalmalformations in 4224 childrenconceivedafter IVF. Hum Reprod. 2002 Aug;17(8):2089-2095.
• 24. Bonduelle M, Legein J, Buysse A, Van Assche E, Wisanto A, Devroey P, Van Steirteghem AC, Liebaers I. Prospectivefollow-upstudy of 423 childrenbornafterintracytoplasmic sperm injection. Hum Reprod. 1996 Jul;11(7):1558-1564.
• 25. Giussani DA, Forhead AJ, Gardner DS, Fletcher AJ, Allen WR, Fowden AL.Postnatal cardiovascular function afte rmanipulation of fetal growth by embryo transfer in the horse. J Physiol. 2003 Feb 15;547(Pt 1):67-76.
• 26. Guo XY, Liu XM, Jin L, Wang TT, Ullah K, Sheng JZ, Huang HF. Cardiovascular and metabolic profiles of offspring conceived by assisted reproductive technologies: a systematic review and meta-analysis. Fertil Steril. 2017Mar;107(3):622-631