Abstract
BackgroundSmall-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26–28 weeks of pregnancy.MethodsA total of 1136 pregnant women with singleton pregnancies were recruited during their first trimester at two major Singapore maternity hospitals in an on-going birth cohort study. Participants underwent an oral glucose tolerance test and retinal imaging at 26–28 weeks gestation (n = 542). We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose. Retinal microvasculature was measured using computer software (Singapore I Vessel Analyzer, SIVA version 3.0, Singapore Eye Research Institute, Singapore) from the retinal photographs.ResultsIn a multiple linear regression model adjusting for age, ethnicity and maternal education, mothers with GDM had narrower arteriolar caliber (−1.6 μm; 95% Confidence Interval [CI]: −3.1 μm, −0.2 μm), reduced arteriolar fractal dimension (−0.01 Df; 95% CI: −0.02 Df, −0.001 Df;), and larger arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than mothers without GDM. After further adjusting for traditional risks of GDM, arteriolar branching angle remained significantly larger in mothers with GDM than those without GDM (2.0°; 95% CI: 0.5°, 3.6°).ConclusionsGDM was associated with a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle, suggesting that transient hyperglycemia during pregnancy may cause small-vessel dysfunction.
Highlights
Small-vessel dysfunction may be an important consequence of chronic hyperglycemia
None of the 542 participants had a history of pre-pregnancy diabetes
In multiple linear regression after adjusted for social demographic confounders including age, ethnicity, and maternal education (Table 3; Model 1), gestational diabetes mellitus (GDM) subjects had narrower retinal arteriolar caliber (1.6 μm; 95% Confidence interval (CI): –3.1 μm, –0.2 μm), reduced retinal arteriolar fractal dimension (–0.01 Df; 95% CI: –0.02 Df, –0.001Df ), and larger retinal arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than non-GDM subjects
Summary
Small-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26–28 weeks of pregnancy. Women with GDM are at risk of short-term pregnancy complications such as pre-eclampsia, and have increased long-term risk of obesity, dyslipdemia and type 2 diabetes mellitus (T2DM) [1, 2] The latter conditions, in turn, are major risk factors for cardiovascular disease [3, 4], perhaps through endothelial and small-vessel dysfunction [5, 6]. T2DM has been linked to a series of abnormalities in retinal vascular measures such as retinal arteriolar narrowing, retinal venular widening, greater retinal vascular tortuosity, and retinal vascular fractal dimension reduction [8] Such evidence suggests that small-vessel disease might be an important consequence of insulin resistance and chronic hyperglycemia.
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