Abstract
Abstract: :
Aims:To evaluate the role of various vasoactive hormones in the evolution of diabetic retinopathy during pregnancy and postpartum. Methods: In a prospective study of 53 pregnant women with Type I diabetes and 9 nondiabetic pregnant women, retinopathy was graded from fundus photographs. Markers of renin–angiotensin–system (RAS) (plasma renin activity (PRA), angiotensin II (Ang II), aldosterone, natriuretic peptides (ANP, BNP, CNP), and adreonomedullin (AM) were measured during the first, and third trimester and at 3 months postpartum. The diabetic women were grouped by progression of retinopathy during pregnancy and postpartum, and by baseline retinopathy (DCCT score ≤ 3 and DCCT >3). Results: Levels of PRA (p<0.0001), and ANP (p=0.04) were significantly lower in diabetic than in nondiabetic women throughout pregnancy and postpartum. No significant differences appeared in levels of Ang II, aldosterone, AM, BNP, or CNP between the two groups. Progression of retinopathy was not associated with changes in vasoactive hormones. At baseline BNP levels were lower in those diabetic women with more severe retinopathy score compared to those with less severe (P=0.019). Conclusions: Diabetic pregnancy is associated with lower levels of PRA and ANP compared to nondiabetic pregnancy. No clear associations between the vasoactive hormones and progression of retinopathy could be detected. Keywords vasoactive hormones, natriuretic peptides, diabetic retinopathy, diabetic pregnancy, renin–angiotensin–system. Abbreviations ETDRS, Early Treatment Diabetic Retinopathy Study; DR, diabetic retinopathy; DCCT, Diabetes Control and Complications Trial; RAS, renin–angiotensin–system; PRA, plasma renin activity; Ang II, angiotensin II; AM, adrenomedullin; ANP, atrial natriuretic peptide; BNP, brain natriuretic peptide; CNP, C–type natriuretic peptide
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: outcomes/complications