Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

Eric A P Steegers,Sarah Schalekamp–Timmermans,M Kamran Ikram,Laura Benschop,Jeanine E Roeters Van Lennep,Tien Yin Wong,Carol Y Cheung,Vincent W V Jaddoe

doi:10.1186/s12916-017-0917-2

Abstract

BackgroundChanges in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy.MethodsThis study is part of an ongoing population-based prospective cohort study. During pregnancy and 6.2 years after the index pregnancy (90% range 5.7–7.4 years), we examined 3391 women with available information on pre-eclampsia, gestational hypertension, and retinal vascular calibers. Retinal arteriolar and venular calibers were measured in the left eye from digitized retinal photographs.ResultsWomen with pre-eclampsia had smaller retinal arteriolar calibers 6 years after pregnancy than women with a normotensive pregnancy (adjusted difference: –0.40 standard deviation score [SDS]; 95% confidence interval [CI]: –0.62, –0.19). For women with previous gestational hypertension, similar trends were observed (–0.20 SDS; 95% CI: –0.34, –0.05). With respect to retinal venular calibers, we did not observe consistent trends for women with previous pre-eclampsia. However, in women with previous gestational hypertension, we observed larger venular calibers (0.22 SDS; 95% CI: 0.07–0.36) than in women with a previous normotensive pregnancy. The association of gestational hypertensive disorders with retinal vessel calibers was mediated through mean arterial pressure at the time of retinal imaging.ConclusionsCompared to women with a previous normotensive pregnancy, women with pre-eclampsia and gestational hypertension show an altered status of the microvasculature 6 years after the index pregnancy. This is reflected by smaller retinal arteriolar calibers and wider retinal venular calibers. These microvascular changes may possibly contribute to the development of cardiovascular disease in later life.

Highlights

Changes in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease
In the current study we investigated the association between a history of Gestational hypertensive disorders (GHD) and the status of the microvasculature 6 years after the index pregnancy, as reflected by retinal vascular calibers, in women between the ages of 24 to 36 years
The linear regression model included covariates selected based on their associations with the outcome of interest based on previous studies or a change in effect estimate of >10%

Summary

Introduction

Changes in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy. Gestational hypertensive disorders (GHD) (e.g., preeclampsia [PE] and gestational hypertension [GH]) affect 7% of pregnancies today [1, 2]. Retinal vascular imaging has emerged as a non-invasive technique to visualize the microvasculature [5,6,7]. Using this technique in individuals over 50 years of age, several studies have shown that microvascular pathology is an independent contributor to the development of CVD in later life, especially in women [8]. Examining the retinal microvasculature may provide further insight into why women with previous GHD have an increased risk for developing CVD later in life

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