Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

Lupton, Samantha J.; Chiu, Christine L; Hodgson, Lauren; Tooher, Jane; Lujic, Sanja; Ogle, Robert; Wong, Tien‐Yin; Hennessy, Annemarie; Lind, Joanne M.

doi:10.1161/hypertensionaha.111.00698

Cited by 26 publications

(24 citation statements)

References 29 publications

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“…We have previously described retinal microvascular and blood pressure changes throughout healthy pregnancy in the same cohort. 17 In healthy pregnancy, dilatation of the retinal arterioles and venules was observed between weeks 13 and 19, and this occurred concurrently with a decrease in MAP. Combining these measurements as the cCRAE and the cCRVE, respectively, allowed quantification of the decrease in peripheral resistance experienced within the maternal circulation during gestation.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Because blood pressure is known to affect retinal vascular caliber, 16 retinal vascular measures were corrected for MAP by dividing the CRAE and CRVE by MAP to produce the cCRAE and cCRVE, respectively. 17 Retinal image graders were blinded to the pregnancy outcome. To determine intergrader reliability, a subset of 40 retinal images were randomly selected and independently measured by 2 graders.…”

Section: Retinal Image Analysismentioning

confidence: 99%

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Changes in Retinal Microvascular Caliber Precede the Clinical Onset of Preeclampsia

et al. 2013

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Preeclampsia is a hypertensive disorder of pregnancy, affecting 3% to 5% of all pregnancies, and is one of the leading causes of maternal mortality and morbidity.1 Signs of preeclampsia include de novo hypertension after 20 weeks of gestation, proteinuria, peripheral edema, and liver dysfunction. Preeclampsia can lead to more serious complications including eclampsia, wherein the mother experiences seizures and possibly hemorrhagic stroke, 2 and it is associated with a higher likelihood of remote maternal hypertension and stroke.3 Although changes to the placental vasculature have been examined in vitro, the nature and the degree of maternal cardiovascular dysfunction present in preeclampsia have yet to be quantified via direct visualization of the microvascular caliber, which can be measured from retinal images.An increase in peripheral vascular resistance, partly from systemic endothelial activation, has been suggested to play a key role in the pathogenesis of preeclampsia.4 Activation of the endothelium causes the release of vasoactive factors, resulting in vasoconstriction throughout the microvasculature, increased peripheral resistance, and hypertension. 5 Many attempts have been made to quantify the degree of peripheral vascular resistance, endothelial dysfunction, and microvascular constriction indirectly, including measuring the amount of vasoactive molecules present in maternal blood. 6 However, a direct method of visualizing and measuring microvascular changes during pregnancy may improve understanding of preeclampsia development and aid clinical risk stratification in pregnancy.Retinal imaging is a novel method allowing in vivo examination of the microcirculation. The retina is an ideal candidate for directly and objectively assessing microvascular changes in pregnancy that occur because of volume and vasoactive factors because both the placental and the retinal blood vessels lack innervation by the sympathetic nervous system, which is upregulated in preeclampsia. 7,8 The aim of this study was to prospectively characterize changes in the retinal microvascular caliber throughout pregnancy between women who subsequently developed preeclampsia and those who had a normotensive pregnancy. Material and Methods Study DesignWe performed a prospective cohort study. Ethical approval for this study was obtained from the Sydney South West Area Health Service Abstract-Preeclampsia is a leading cause of maternal morbidity and mortality. The degree of maternal cardiovascular dysfunction that precedes the onset of preeclampsia is largely unknown. This prospective cohort study aimed to characterize differences in vivo in retinal microvascular caliber and blood pressure throughout pregnancy in relation to preeclampsia development. Women were recruited from Royal Prince Alfred Hospital, Sydney, Australia, of which 92 women were included in the study. Retinal images and blood pressures were collected at 13, 19, 29, and 38 weeks of gestation. Retinal vessels were analyzed as the central retinal arteriolar equivalent corre...

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Section: Discussionmentioning

confidence: 99%

Section: Retinal Image Analysismentioning

confidence: 99%

Changes in Retinal Microvascular Caliber Precede the Clinical Onset of Preeclampsia

et al. 2013

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“…Several papers have been published on the physiological changes in fundus retinal vascular caliber [5]. A cohort study of patients with normal pregnancies reported that fundus imaging allowed observation of retinal vascular calibers over time and in the 2nd trimester of pregnancy, blood vessel caliber increases showed negative correlations with mean arterial pressures (MAP) [5].…”

Section: Introductionmentioning

confidence: 99%

“…A cohort study of patients with normal pregnancies reported that fundus imaging allowed observation of retinal vascular calibers over time and in the 2nd trimester of pregnancy, blood vessel caliber increases showed negative correlations with mean arterial pressures (MAP) [5]. Moreover, narrowing of retinal microvascular calibers has been reported to precede the onset of preeclampsia and increases in blood pressure [6].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes of ocular blood flow using laser speckle flowgraphy during normal pregnancy

et al. 2017

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PurposeInnovative laser speckle flowgraphy (LSFG) enables noninvasive evaluation of retinal microcirculation and the usefulness has been reported in the field of ophthalmology. LSFG has allowed us to measure the real time changes of retinal blood flow without pupillary dilatations and contrast media. Herein, we investigated the change of retinal blood flow in normal pregnant women during gestation using LSFG.MethodsA prospective cohort study was conducted in 53 pregnant women who visited our institution between January, 2013 and July, 2014. Finally, a total of 41 participants without any obstetric complications were available for evaluation. Retinal blood flow was measured with LSFG in a total of 4 times during pregnancy (T1. 11–13 weeks, T2. 19–21 weeks, T3. 28–30 weeks, T4. 34–36 weeks) and mean blur rate (MBR), blowout score (BOS), flow acceleration index (FAI), and resistive index (RI) are analyzed from these measurements. Relations between LSFG parameters and mean arterial blood pressure (MAP) are determined throughout pregnancy.ResultsMBR showed no significant changes throughout pregnancy. BOS showed a tendency to increase in the 3rd trimester. FAI values showed a slight increase from the 1st to 2nd trimester while a significant decrease was noted in the 3rd trimester. RI exhibited no changes between the 1st and 2nd trimesters, values decreased significantly after the 3rd trimester. MAP was positively correlated with BOS, and negatively correlated with FAI and RI.ConclusionThe present study clearly demonstrated that profiles of LSFG parameters demonstrated a decrease of resistance in retinal blood vessels. These changes in indices provide a highly sensitive reflection of physiological changes in vascular resistance due to pregnancy. Thus, LSFG may be useful, as a non-invasive, diagnostic tool to detect pregnancy related disorders such as preeclampsia.

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“…Cross-sectional results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study support these adaptations, showing that each 10 mmHg increase in MAP during pregnancy was associated with a significant reduction in retinal arteriolar caliber, especially for MAP ≥90 mmHg [ 28 ]. Another study, using retinal images obtained throughout pregnancy and 6 months after pregnancy of 53 normotensive women, also demonstrated changes in the retinal microvasculature over the course of a normotensive pregnancy in conjunction with blood pressure adaptations [ 29 ]. During mid-pregnancy, when blood pressure shows a physiologic decrease, retinal arteriolar and retinal venular calibers increased significantly.…”

Section: Discussionmentioning

confidence: 99%

Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

Benschop

Schalekamp‐Timmermans

Lennep

et al. 2017

BMC Med

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BackgroundChanges in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy.MethodsThis study is part of an ongoing population-based prospective cohort study. During pregnancy and 6.2 years after the index pregnancy (90% range 5.7–7.4 years), we examined 3391 women with available information on pre-eclampsia, gestational hypertension, and retinal vascular calibers. Retinal arteriolar and venular calibers were measured in the left eye from digitized retinal photographs.ResultsWomen with pre-eclampsia had smaller retinal arteriolar calibers 6 years after pregnancy than women with a normotensive pregnancy (adjusted difference: –0.40 standard deviation score [SDS]; 95% confidence interval [CI]: –0.62, –0.19). For women with previous gestational hypertension, similar trends were observed (–0.20 SDS; 95% CI: –0.34, –0.05). With respect to retinal venular calibers, we did not observe consistent trends for women with previous pre-eclampsia. However, in women with previous gestational hypertension, we observed larger venular calibers (0.22 SDS; 95% CI: 0.07–0.36) than in women with a previous normotensive pregnancy. The association of gestational hypertensive disorders with retinal vessel calibers was mediated through mean arterial pressure at the time of retinal imaging.ConclusionsCompared to women with a previous normotensive pregnancy, women with pre-eclampsia and gestational hypertension show an altered status of the microvasculature 6 years after the index pregnancy. This is reflected by smaller retinal arteriolar calibers and wider retinal venular calibers. These microvascular changes may possibly contribute to the development of cardiovascular disease in later life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0917-2) contains supplementary material, which is available to authorized users.

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Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

Cited by 26 publications

References 29 publications

Changes in Retinal Microvascular Caliber Precede the Clinical Onset of Preeclampsia

Changes in Retinal Microvascular Caliber Precede the Clinical Onset of Preeclampsia

Longitudinal changes of ocular blood flow using laser speckle flowgraphy during normal pregnancy

Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

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