Abstract
Objective: Investigate how pregnancy-induced hormonal and hemodynamic changes affect retinal vessels caliber dynamic and the course of diabetic retinopathy. Methods: Retinopathy grading and vessel diameter measurement using digital fundus photographs in women with diabetes type 1 taken no more than one year before conception, during week 10 and/or 22, week 34, and within one year after delivery. Calibers were measured using a custom-developed semi-automated computer algorithm which identified the six largest arteries and six largest veins and calculated the central retinal artery equivalent (CRAE) and central vein equivalent (CRVE) diameters. Glycemic control was assessed quarterly by HbA1c. Systolic and diastolic blood pressure was assessed at week 10, 22 and 34. Results: Photographs at baseline, weeks 10, 22, 34 and after delivery were available in 28 patients, of whom 24 did not progress in retinopathy. For those whose level of retinopathy remained stable CRAE constricted from 138.80 ± 21.27 μm at baseline to 129.88 ± 13.97 μm at week 10 (p = 0.0379) CRVE constricted from 195.16 ± 24.98 μm at baseline to 185.97 ± 21.96 μm at week 10 (p = 0.0400). The patients with retinopathy progression had a CRAE of 131.67 ± 13.37 μm at baseline and 132.08 ± 11.07 μm at week 10 (p = 0.34) while CRVE was 195.33 ± 24.92 μm at baseline and 204.27 ± 10.18 μm at week 10 (p = 0.16). Progressors had higher blood pressures at week 10. Conclusion: Retinal vessels constricted between prepregnancy and first trimester in women who did not experience diabetic retinopathy progression. The study suggests that the vessels constriction seen in early pregnancy contributes to reduce the risk of gestational microvascular complications and progression of diabetes in the eye.
Highlights
Pregnancy is associated with increased short-term risk of development and progression of retinopathy in diabetic patients [1], an effect that may be related to pregnancy as such and the accompanying changes in circulation, blood pressure and hormone levels, or to some other factor, such as iatrogenic changes in glycemia directed at optimizing metabolic control and securing a favourable outcome of the pregnancy
CI95 Ninety-five per cent confidence interval; P Paired, t-test comparing data from week 10 and after delivery to values before pregnancy (n = 24). This exploratory study examined retinopathy and retinal vessel diameters before, during and after pregnancy in women with type 1 diabetes and found that women who experienced retinopathy progression were characterized by absence of retinal vessel contraction during pregnancy
Women with retinopathy progression experienced a reduction in arterial blood pressure related to intensification of antihypertensive therapy between gestational weeks 10 and 22
Summary
Pregnancy is associated with increased short-term risk of development and progression of retinopathy in diabetic patients [1], an effect that may be related to pregnancy as such and the accompanying changes in circulation, blood pressure and hormone levels, or to some other factor, such as iatrogenic changes in glycemia directed at optimizing metabolic control and securing a favourable outcome of the pregnancy. Visual loss is associated with microvascular lesions of the retina and these lesions are associated with retinal trunk vessel characteristics [2,3]. The physiological perturbations that occur provide an opportunity to observe dynamic changes in retinopathy and large retinal vessel. We assessed retinal artery and vein diameters before, during and after pregnancy in women with type 1 diabetes
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