From fetal life to adulthood: cardiometabolic health of offspring conceived by assisted reproductive technologies, a systematic review.

内容摘要

The number of children conceived through assisted reproductive technologies (ART) continues to increase worldwide, raising questions regarding their long-term cardiometabolic health. Both ART procedures and parental infertility may contribute to developmental programming of cardiometabolic outcomes. To systematically evaluate cardiometabolic health in ART-conceived offspring across developmental stages, assess the impact of specific ART procedures, and examine the contribution of parental infertility. Following PRISMA guidelines and PROSPERO registration (CRD420251145460), PubMed and Embase were searched through April 30, 2026, for studies evaluating cardiometabolic outcomes in ART-conceived offspring. Due to substantial heterogeneity, findings were synthesized narratively according to developmental stage, ART modality, and outcome category. Fifty-five studies met the inclusion criteria. From fetal life through adolescence, ART-conceived offspring frequently exhibited subtle cardiovascular differences, including mild cardiac remodeling, modest elevations in blood pressure, and early endothelial dysfunction. Metabolic findings, including insulin resistance and adiposity, were less consistent. Although several cohorts reported higher blood pressure values and vascular alterations in ART offspring, these differences were generally modest and remained within normal physiological ranges. A large multicohort analysis found no overall differences in blood pressure, heart rate, triglycerides, or insulin resistance traits, although higher childhood LDL-cholesterol concentrations and adiposity attenuated with age. By adulthood, most cardiometabolic parameters appeared comparable between ART-conceived offspring and offspring conceived without ART. No consistent adverse long-term effects were identified for intracytoplasmic sperm injection, frozen embryo transfer, or preimplantation genetic testing. Similar cardiometabolic profiles were reported in offspring of subfertile parents conceived without ART and in ART-conceived offspring, supporting an independent contribution of parental infertility. This review found no evidence of a major adverse cardiometabolic effect of ART in offspring. However, subtle cardiovascular differences have been reported from fetal life through adolescence, whereas metabolic findings remain less consistent. These alterations are generally mild, age-dependent, and often remain within normal physiological ranges, although their long-term clinical significance remains uncertain. Future studies should include offspring of subfertile parents conceived without ART and extend follow-up into adulthood to clarify whether early-life differences represent transient developmental adaptations or markers of increased cardiovascular susceptibility later in life.