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 languageEnglish
Article number4
Number of pages7
JournalActa Ophthalmologica
Volume17
Issue number1
DOIs
Publication statusPublished - 18 Jan 2017
Externally publishedYes

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

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  • Cite this

    Li, L-J., Kramer, M., Tapp, R. J., Man, R. E. K., Lek, N., Cai, S., ... Wong, T. Y. (2017). Gestational diabetes mellitus and retinal microvasculature. Acta Ophthalmologica, 17(1), [4]. https://doi.org/10.1186/s12886-016-0398-7