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Lingjun Li, Carol Cheung, Mohammad Ikram, Seang-Mei Saw, Tien Wong; Gestational Diabetes Mellitus (GDM) and Changes in Retinal Microvasculature 6 months after Delivery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1561.
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Gestational diabetes mellitus (GDM) is associated with long-term risk of diabetes in pregnant women. Although the exact mechanisms are unknown, a role for the microcirculation has been implicated. We examined mid-pregnancy GDM and changes in the retinal microvasculature in a cohort of Singapore pregnant women 6 months after delivery.
Pregnant women aged 18-46 years were recruited during their early pregnancy from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study and followed up 6 months after delivery. Blood pressure, anthropometric measurements, fasting plasma glucose level, 2-hr plasma glucose level were measured at the 26 weeks gestation week following a standardized protocol. Questionnaires on socio-economic status and life style were ascertained by trained clinic staff. GDM were diagnosed if fasting plasma glucose was >or=7.0 mmol/l or 2h plasma glucose was >or=7.8 mmol/l, by using OGTT data according to WHO guideline,. Retinal photography was examined at 26 weeks gestation and 6 months after delivery. Quantitative retinal vascular parameters were assessed by a semi-automated computer program (Singapore I Vessel Assessment [SIVA], version 3.0). Changes of retinal vascular parameters are defined as percentage changes in retinal vascular parameters between 6 months after delivery and 26 weeks gestation.
Among the 280 pregnant women who included in this study, 47 (16.8%) were diagnosed as GDM at 26 weeks gestation. In multivariate analysis, GDM patients tended to have more changes in retinal arteriolar widening than non-GDM subjects (35.16% vs. 31.48%, p trend <0 0.01). Even though GDM was associated with 26 weeks smaller retinal arteriolar fractal dimension (1.206 vs. 1.228 Df, p trend < 0.01) and smaller retinal venular fractal dimension (1.210 vs. 1.227 Df, p trend = 0.02) than non-GDM subjects, these associations were attenuated after delivery.
GDM was associated with postnatal early retinal vascular changes consistent with risk of type 2 diabetes. Our finding suggested a possible impact of GDM on the microcirculation during pregnancy, which may be a pathophysiologic pathway for evidence on the development of future metabolic diseases in women.
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