Antenatal Mental Health and Retinal Vascular Caliber in Pregnant Women

Abstract

Purpose: Depression, anxiety, and poor sleep are associated with increased risks of cardiovascular diseases. Previous studies have demonstrated the relationship between negative emotion and retinal microvascular changes among adults, yet no study has been done in pregnant women so far. This study aims to examine the association of antenatal mental health and retinal vascular caliber among Asian pregnant women.

Methods: Nine hundred and fifty two Asian pregnant women aged 18 to 46 years were included in this study, who were recruited from two Singapore cohort studies, the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study and the In Vitro Fertilization (IVF) study conducted from 2009 onwards. A total of 835 Asian pregnant women underwent retinal photography at 26 weeks follow up, of whom 800 had gradable photographs. Symptoms of depression, anxiety, and sleep quality were assessed with self-administered questionnaires.

Results: In multiple linear regression models adjusted for age, ethnicity, household income, pregnancy outcome history, means of conception, hypertension history, diabetes history, cigarette smoking history, mean arterial blood pressure, body mass index, and spherical equivalent, each standard deviation (SD) increase in the Edinburgh Postnatal Depression Scale (EPDS) (4.49 scores) and in the Pittsburgh Sleep Quality Index (PSQI) (2.90 scores) was associated with a 0.80 μm (P = 0.03) and a 1.22 μm (P = 0.01) widening in retinal arteriolar caliber, respectively.

Conclusions: Our study demonstrates relationships of antenatal depressive symptoms and poor sleep quality with retinal arteriolar widening in pregnant women.

Translational relevance: We speculate that this might possibly indicate an effect of antenatal depression and poor sleep on the microcirculation during pregnancy.

Keywords: antenatal depression; antenatal mental health; poor sleep quality; pregnancy; retinal vascular caliber.

Figure.

Retinal vessel measurements are performed 0.5- to 2.0-disc diameters away from the optic disc margin (zone C) by SIVA software, shown as a green line in the Figure. Estimates of central retinal arteriolar equivalent and central retinal venular equivalent, which represented the average diameters of retinal arterioles and retinal venules, were calculated by the revised Knudtson-Parr-Hubbard formula. Arterioles are marked in red and venules are marked in blue.