Blood Pressure and Retinal Microvascular Characteristics During Pregnancy

Li, Lingjun; Cheung, Carol Y.; Ikram, M. Kamran; Gluckman, Peter; Meaney, Michael J.; Chong, Yap Seng; Kwek, Kenneth; Wong, Tien‐Yin; Saw, Seang‐Mei

doi:10.1161/hypertensionaha.112.195404

Cited by 45 publications

(46 citation statements)

References 43 publications

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“…It has previously been reported by some of these authors and their colleagues that blood pressure affects retinal microvasculature calibers at 26-week gestation, independent of pregnancy outcome, 31 a finding that is similar to results in the general population. 9,14 The study by Li et al 31 measured…”

Section: Discussionsupporting

confidence: 86%

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

et al. 2013

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The microvasculature plays an important role in regulating cardiovascular changes in pregnancy, but changes in microvasculature have been difficult to document in vivo. This study objectively quantifies changes in the maternal retinal arteriolar and venular caliber over the course of healthy pregnancy. Healthy pregnant women (n=53) were recruited from Royal Prince Alfred Hospital, Sydney, Australia. Retinal images and mean arterial blood pressures (MAP) were collected at 13, 19, 29, and 38 weeks of gestation and at 6-month postpartum. Retinal vessels were analyzed and summarized as the central retinal arteriolar equivalent and central retinal venular equivalent. Central retinal arteriolar equivalent and central retinal venular equivalent were corrected for MAP. Paired t tests were performed comparing consecutive time points, with a significance level of P <0.01. There was a decrease in MAP between 13- and 19-week gestation ( P =0.001) followed by a return to baseline from 19 weeks to delivery. This was correlated by an increase in vessel caliber between 13- and 19-week gestation (central retinal arteriolar equivalent: P <0.001, central retinal venular equivalent: P =0.007) and a return to baseline from 19 weeks to delivery. There were no differences in the central retinal arteriolar equivalent or central retinal venular equivalent (both uncorrected and corrected for MAP) between nulliparous and parous women. The pattern of dilatation and constriction in the microvasculature mirrored the changes in MAP throughout pregnancy, reflecting changes in peripheral resistance. This study provides insights into physiological changes in the microvasculature throughout a healthy pregnancy. These results can be used as a baseline with which to compare the changes observed in pathological conditions of pregnancy.

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Section: Discussionsupporting

confidence: 86%

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

et al. 2013

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“…Intra-grader reliability was assessed in 10% ( n = 54) of randomly selected retinal photographs from our study, and the intra-class correlation coefficient was above 0.80 for all retinal vascular measures as previously reported [10–12]. …”

Section: Methodsmentioning

confidence: 69%

“…Our group has recently investigated retinal microvasculature changes during pregnancy, with findings suggesting abnormal retinal vascular morphological changes associated with elevated blood pressure, maternal obesity, antenatal depression, and poor sleep quality [10–12]. In this study, we studied the relationship between GDM and retinal vascular changes in expectant mothers, a proxy for small-vessel dysfunction, at 26–28 weeks of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Gestational diabetes mellitus and retinal microvasculature

et al. 2017

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BackgroundSmall-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.MethodsA 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.ResultsIn 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°).ConclusionsGDM 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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“…Retinal photographs were assessed by trained graders using a semi-automated computer-based program (Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters were measured quantitatively from 0.5 to 2.0 disc diameters (zone C) away from the optic disc margin. [9] Retinal vascular caliber, branching angle, tortuosity and fractal dimension were assessed according to standard protocol, which have been described in detail in previous publications [9]. Intra-grader reliability was assessed in 10% ( n = 6) of randomly selected retinal photographs from our study.…”

Section: Methodsmentioning

confidence: 99%

Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study

2017

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BackgroundPoor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up.MethodsThis is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women’s and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c <8%). Retinal photography was taken at diabetes annual screening and images were graded by trained graders using a semi-automated computer-based program (Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters.ResultsThere was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: −0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control.ConclusionsOur findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year’s poor glycemic control. Such morphological abnormalities may lead to future development of microvascular complications among T1D pediatric patients with poor glycemic control.

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Blood Pressure and Retinal Microvascular Characteristics During Pregnancy

Cited by 45 publications

References 43 publications

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

Gestational diabetes mellitus and retinal microvasculature

Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study

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