32 Gestational hypertensive disorders and retinal microcirculation: The Generation R Study

Abstract

Introduction Gestational hypertensive disorders (GHD), such as gestational hypertension (GH) and pre-eclampsia (PE), are risk factors for cardiovascular disease (CVD) in later life. Although the exact underlying mechanisms are not clear, changes in the microcirculation have also been proposed as a potential pathway in the development of CVD. Objective We examined whether a history of GHD is related to the maternal status of the microcirculation after pregnancy, as visualized by retinal imaging. Methods This study was embedded in the Generation R Study, a population-based prospective cohort study. Data on pregnancy, including GHD, and retinal vessel calibers six years after pregnancy were available for 3391 women. Retinal arteriolar and venular calibers were measured unilaterally from digitalized retinal photographs. Results Women with a history of PE had smaller retinal arteriolar calibers than women with a normotensive pregnancy (age-adjusted difference: −0.49SDS; 95% confidence interval (CI) −0.74, −0.25)). Additional adjustment for retinal venular caliber, ethnicity, educational level, smoking and pre-pregnancy BMI did not alter these results. After including mean arterial blood pressure at the time of retinal imaging, the association attenuated (−0.22SDS; 95% CI −0.43, −0.01), but remained significant. For women with a history of GH similar trends were observed, which disappeared after including mean arterial blood pressure at the time of retinal imaging in the model (−0.001SDS; 95% CI −0.14, 0.14). With respect to retinal venular calibers, we did not observe consistent trends for women with a history of PE. However, in women with a history of GH we observed larger venular calibers (multi-variable adjusted 0.16SDS; 95% CI 0.01, 0.31) than in women with a previous normotensive pregnancy. Conclusions Women with a history of GHD show an altered state of the microcirculation as reflected by smaller retinal arteriolar vessel calibers and larger retinal venular calibers six years after index pregnancy. These microvascular changes may contribute to the development of CVD in later life.