研究结果不一致地观察到，通过 IVF 或 ICSI 受孕的孩子与非 ART 受孕的孩子相比，血压较高。目的是对 ART 受孕的后代和自然受孕的后代的血压测量值进行系统回顾和荟萃分析。消除 ART 作为高血压风险因素的怀疑，进而引发心脏病，具有公共卫生和临床意义。一位生物医学图书馆员搜索了 Embase、PubMed 和 Web of Science 数据库。检索仅限于 1978 年以来以英文出版的记录。检索灰色文献。纳入标准是通过不孕症治疗（与未治疗）出生并接受血压评估的人。排除标准是非人类参与者、非定量研究、缺乏对照组和特殊人群（例如仅限癌症患者）。两名评审员使用 Covidence 独立筛选每条记录的标题、摘要和全文，使用 Excel 提取数据，并使用国家心肺血液研究所的队列研究质量评估工具评估偏倚。在确定的 5082 条记录中，有 79 条包含在系统评价，36 例被纳入 ART 和非 ART 组收缩压 (SBP) 和舒张压 (DBP) 的荟萃分析。总体而言，34 份报告（包括来自 25 个独特队列的 40 个效应量）比较了 ART（N = 5229）和非 ART（N = 8509，参考）组之间的血压，没有进行协变量调整。未发现治疗引起的 SBP（每 SD mmHg 0.06，95% CI = -0.05, 0.18）或 DBP（0.11，95% CI = -0.04, 0.25）的标准化平均差异（SMD），但异质性相当大（对于 SBP，I2=76%；对于 DBP，I2=87%）。 12 份报告中提出了调整后的分析，代表了 21 个独特队列的 28 种效应大小（N = 2242 治疗组 vs N = 37 590 未治疗组）。研究调整了各种协变量，包括母亲（例如年龄、教育程度、体重指数、吸烟、妊娠并发症）、儿童（例如性别、年龄、体力活动、BMI、身高）和出生特征（例如出生体重和胎龄）。调整后的结果同样显示 SBP（-0.03，95% CI = -0.13，0.08）或 DBP（0.02，95% CI = -0.12，0.16）没有 SMD，但异质性仍然很高（I2 = 64% 和 86%）。漏斗图表明存在轻微的发表偏差，但修剪和填充方法表明没有遗漏研究。删除五项调整出生结果的研究（可能过度调整中介因素）没有产生实质性差异。治疗类型（例如 IVF 与 ICSI）、按出生年份划分的期间影响（≤2000 与 >2000）、后代年龄组（<8、8-14、15）或研究地点（例如欧洲）不会改变结果。总之，在荟萃分析中，ART 受孕与后代血压无关，尽管观察到相当大的异质性。鉴于使用抗逆转录病毒疗法出生的儿童数量不断增加，持续存在血压差异将意味着在人口水平上对许多儿童/成人进行不必要的风险筛查。在临床层面，考虑这些生殖技术的夫妇可以放心，没有证据表明所使用的技术会导致强烈的血管“编程”。PROSPERO 编号 CRD42022374232。由牛津大学出版社代表欧洲人类生殖和胚胎学会出版2024 年。

Studies have inconsistently observed that children conceived by IVF or ICSI have higher blood pressure compared to children not conceived by these ARTs.The aim was to perform a systematic review and meta-analysis of blood pressure measures of offspring conceived by ART and those conceived naturally. Resolving the suspicion of ART as a risk factor of higher blood pressure, and therefore of heart disease, has public health and clinical implications.A biomedical librarian searched the Embase, PubMed, and Web of Science databases. Searches were limited to records published in English since 1978. Grey literature was searched. Inclusion criteria were humans born via infertility treatment (vs no treatment) who underwent a blood pressure assessment. Exclusion criteria were non-human participants, non-quantitative studies, absence of a control group, and specialty populations (e.g. cancer patients only). Two reviewers independently screened each record's title and abstract and full text using Covidence, extracted data using Excel, and assessed bias using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for cohort studies.Of 5082 records identified, 79 were included in the systematic review and 36 were included in the meta-analysis of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in ART and non-ART groups. Overall, 34 reports including 40 effect sizes from 25 unique cohorts, compared blood pressure between ART (N = 5229) and non-ART (N = 8509, reference) groups with no covariate adjustment. No standardized mean differences (SMD) in SBP (0.06 per SD of mmHg, 95% CI = -0.05, 0.18) or DBP (0.11, 95% CI = -0.04, 0.25) by treatment were found, but the heterogeneity was considerable (I2=76% for SBP and 87% for DBP). Adjusted analyses were presented in 12 reports, representing 28 effect sizes from 21 unique cohorts (N = 2242 treatment vs N = 37 590 non-treatment). Studies adjusted for varied covariates including maternal (e.g. age, education, body mass index, smoking, pregnancy complications), child (e.g. sex, age, physical activity, BMI, height), and birth characteristics (e.g. birth weight and gestational age). Adjusted results similarly showed no SMD for SBP (-0.03, 95% CI = -0.13, 0.08) or DBP (0.02, 95% CI = -0.12, 0.16), though heterogeneity remained high (I2 = 64% and 86%). Funnel plots indicated a slight publication bias, but the trim and fill approach suggested no missing studies. Removal of five studies which adjusted for birth outcomes (potentially over-adjusting for mediators) made no material difference. Type of treatment (e.g. IVF vs ICSI), period effects by birth year (≤2000 vs >2000), offspring age group (<8, 8-14, 15+), or study location (e.g. Europe) did not modify the results.In conclusion, conception by ART was not associated with offspring blood pressure in a meta-analysis, although considerable heterogeneity was observed. Given the increasing number of children born using ART, perpetuating a difference in blood pressure would mean unnecessary risk screening for many children/adults on a population level. At a clinical level, couples considering these reproductive technologies have some reassurance that there is no evidence of strong vascular 'programming' due to the techniques used.PROSPERO No. CRD42022374232.Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology 2024.