Gestational diabetes mellitus and retinal microvasculature

Ling-Jun Li; Michael Kramer; Robyn J Tapp; Ryan E K Man; Ngee Lek; Shirong Cai; Fabian Yap; Peter Gluckman; Kok Hian Tan; Yap Seng Chong; Jia Yu Koh; Seang Mei Saw; Yin Bun Cheung; Tien Yin Wong

doi:10.1186/s12886-016-0398-7

Gestational diabetes mellitus and retinal microvasculature

Ling-Jun Li, Michael Kramer, Robyn J Tapp, Ryan E K Man, Ngee Lek, Shirong Cai, Fabian Yap, Peter Gluckman, Kok Hian Tan, Yap Seng Chong, Jia Yu Koh, Seang Mei Saw, Yin Bun Cheung, Tien Yin Wong

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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.

Original language	English
Article number	4
Number of pages	7
Journal	Acta Ophthalmologica
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12886-016-0398-7
Publication status	Published - 18 Jan 2017
Externally published	Yes

Bibliographical note

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keywords

Adult
Diabetes, Gestational/physiopathology
Female
Humans
Hyperglycemia/physiopathology
Microcirculation/physiology
Microvessels/physiology
Pregnancy
Pregnancy Trimester, Second/physiology
Regression Analysis
Retinal Vessels/physiopathology
Singapore
Young Adult

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Gestational diabetes mellitus and retinal microvasculature. / Li, Ling-Jun; Kramer, Michael; Tapp, Robyn J; Man, Ryan E K; Lek, Ngee; Cai, Shirong; Yap, Fabian; Gluckman, Peter; Tan, Kok Hian; Chong, Yap Seng; Koh, Jia Yu; Saw, Seang Mei; Cheung, Yin Bun; Wong, Tien Yin.

In: Acta Ophthalmologica, Vol. 17, No. 1, 4, 18.01.2017.

Research output: Contribution to journal › Article › peer-review

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title = "Gestational diabetes mellitus and retinal microvasculature",

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.",

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author = "Ling-Jun Li and Michael Kramer and Tapp, {Robyn J} and Man, {Ryan E K} and Ngee Lek and Shirong Cai and Fabian Yap and Peter Gluckman and Tan, {Kok Hian} and Chong, {Yap Seng} and Koh, {Jia Yu} and Saw, {Seang Mei} and Cheung, {Yin Bun} and Wong, {Tien Yin}",

note = "Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. ",

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doi = "10.1186/s12886-016-0398-7",

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T1 - Gestational diabetes mellitus and retinal microvasculature

AU - Li, Ling-Jun

AU - Kramer, Michael

AU - Tapp, Robyn J

AU - Man, Ryan E K

AU - Lek, Ngee

AU - Cai, Shirong

AU - Yap, Fabian

AU - Gluckman, Peter

AU - Tan, Kok Hian

AU - Chong, Yap Seng

AU - Koh, Jia Yu

AU - Saw, Seang Mei

AU - Cheung, Yin Bun

AU - Wong, Tien Yin

N1 - Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2017/1/18

Y1 - 2017/1/18

N2 - 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.

AB - 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.

KW - Adult

KW - Diabetes, Gestational/physiopathology

KW - Female

KW - Humans

KW - Hyperglycemia/physiopathology

KW - Microcirculation/physiology

KW - Microvessels/physiology

KW - Pregnancy

KW - Pregnancy Trimester, Second/physiology

KW - Regression Analysis

KW - Retinal Vessels/physiopathology

KW - Singapore

KW - Young Adult

U2 - 10.1186/s12886-016-0398-7

DO - 10.1186/s12886-016-0398-7

M3 - Article

C2 - 28100181

VL - 17

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

SN - 1755-375X

IS - 1

M1 - 4

ER -

Gestational diabetes mellitus and retinal microvasculature

Abstract

Bibliographical note

Keywords

UN SDGs

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