AUTHOR=Phillipos Joseph , Luong Thao Vi , Chang Deborah , Varadarajan Suresh , Howat Paul , Hodgson Lauren , Colville Deb , Savige Judy 

TITLE=Retinal small vessel narrowing in women with gestational diabetes, pregnancy-associated hypertension, or small-for-gestational age babies

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1265555

DOI=10.3389/fmed.2023.1265555

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>Gestational diabetes, pregnancy-associated hypertension and small-for-gestational age babies are all associated with impaired placental vascularisation. This study compared the effects of these conditions the systemic small vessel calibre that was examined in the retina.</p></sec><sec id="sec2"><title>Methods</title><p>This was a cross-sectional observational study of consecutive pregnant women recruited from an antenatal clinic. Participants underwent a Glucose Tolerance Test, BP measurements, and were examined for small-for-gestational age babies as per national guidelines. They also underwent retinal photography with a non-mydriatic camera, and vessel calibres were measured with a validated semi-quantitative system at a retinal grading centre. Some participants also underwent testing of retinal vascular responsiveness to a flickering light.</p></sec><sec id="sec3"><title>Results</title><p>Women with gestational diabetes (<italic>n</italic> = 68) had a higher mean arterial pressure (85 ± 9 mm Hg) than normal pregnant women (<italic>n</italic> = 27, 80 ± 8 mmHg, <italic>p</italic> = 0.01). They also had smaller mean retinal arteriole (147.5 ± 13.6 μm and 159.7 ± 6.7 μm respectively, <italic>p</italic> &lt; 0.01) and venular calibre (221.0 ± 13.4 μm and 232.8 ± 20.1 μm respectively, <italic>p</italic> &lt; 0.01) than normal. However their babies’ mean birth weights were not different from normal (3,311 ± 558 g and 3,401 ± 600 g respectively, <italic>p</italic> = 0.48). They also demonstrated a trend to reduced retinal arteriolar dilatation (3.5 ± 1.3%, <italic>n</italic> = 23) in response to vasodilatory stimuli (4.4 ± 1.8%) (<italic>n</italic> = 11) (<italic>p</italic> = 0.08) consistent with endothelial dysfunction. Women with pregnancy-associated hypertension (<italic>n</italic> = 35) had a higher mean arterial pressure (101 ± 12 mm Hg, <italic>p</italic> &lt; 0.01), a smaller mean retinal arteriolar calibre (139.9 ± 10.6 μm, <italic>p</italic> &lt; 0.0001), and a lower baby mean birth weight than for normal pregnancies (3,095 ± 443 g, <italic>p</italic> = 0.02). Likewise, women with small-for-gestational age babies (<italic>n</italic> = 31) had a higher mean arterial pressure (89 ± 19 mm Hg, <italic>p</italic> = 0.03), a smaller mean retinal arteriolar calibre (141.6 ± 12.8 μm, <italic>p</italic> &lt; 0.01) and a lower baby mean birth weight than for normal pregnancies (2,468 ± 324 g, <italic>p</italic> &lt; 0.0001).</p></sec><sec id="sec4"><title>Conclusion</title><p>Mean retinal arterial calibre was reduced in women with gestational diabetes, pregnancy-associated hypertension or small-for-gestational age babies. The reduction in calibre was greatest in pregnancy-associated hypertension and small-for-gestational age babies. Systemic arteriole narrowing may contribute to the pathogenesis of placental vascular dysfunction in these conditions.</p></sec>