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. 2017 Jan 18;17(1):4.
doi: 10.1186/s12886-016-0398-7.

Gestational diabetes mellitus and retinal microvasculature

Ling-Jun Li  1   2 , Michael Kramer  3   4 , Robyn J Tapp  1 , Ryan E K Man  1 , Ngee Lek  2   5 , Shirong Cai  6 , Fabian Yap  5 , Peter Gluckman  6 , Kok Hian Tan  5 , Yap Seng Chong  6   7 , Jia Yu Koh  1 , Seang Mei Saw  1   8 , Yin Bun Cheung  9   10 , Tien Yin Wong  11   12
Affiliations

Gestational diabetes mellitus and retinal microvasculature

Ling-Jun Li et al. BMC Ophthalmol. .

Abstract

Background: 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.

Methods: A 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.

Results: In 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°).

Conclusions: GDM 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.

Keywords: Gestational diabetes mellitus; Pregnancy outcomes; Retinal imaging; Retinal microvascular measures; Retinal microvasculature.

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Figures

Fig. 1
Fig. 1
Image of SIVA grading platform. Retinal microvasculature assessment on the grading platform. A screenshot of a computer-assisted program for measurement of new geometrical retinal vascular parameters from retinal fundus photograph. Zone C is marked in SIVA software by 0.5 to 2.0 optic disc diameter away from the margin of optic disc, respectively. All retinal arterioles and venules larger than 25 µm are marked and assessed within zone C
Fig. 2
Fig. 2
Comparison of retinal vasculature between a GDM (a) and a non-GDM GUSTO mother (b). Red arrows indicate retinal arterioles. Angle highlighted in red lines indicate retinal arteriolar branching angle. Black-and-white images on the right indicate retinal arteriolar fractal dimension. This GDM mother has narrower retinal arteriolar caliber (116.6 vs. 125.4 µm), narrower retinal arteriolar branching angle (1.26 vs. 1.31 Df), and lower retinal arteriolar fractal dimension (98.0 vs. 74.3 degrees) than the non-GDM mother
See this image and copyright information in PMC

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