Abstract
Abstract: :
Purpose:To examine the relation between pregnancy–induced systemic and ocular circulatory changes in diabetic women. Methods: This was a post–hoc analysis of a prospective study of cardiovascular function in 45 women with type 1 diabetes and six healthy pregnant women, from the first trimester of pregnancy until 6 months after delivery. Retinal trunk vessel diameters were analyzed by computerized image analysis of digitized color fundus photographs. Results: In diabetic women, an increase in mean arterial blood pressure from 90.7±11.8 mmHg (mean±SD) to 102.4±17.4 mmHg from the first to the third trimester was accompanied by retinal arteriolar constriction, from 93.6±14.0 µm to 90.1±15.8 µm (p = 0.003). In healthy, non–smoking women a similar increase in blood pressure was accompanied by a lack of significant change in retinal arteriolar diameter, from 88.5 µm in the first trimester to 91.6 µm in the third trimester (p=0.563). In 38 diabetic women who did not smoke, the constriction was more prominent, from 96.6 µm in the 1st trimester to 92.4 µm in the 3rd trimester (p=0.001). In contrast, no significant change was found in diabetic women who smoked, their mean retinal arteriolar diameter being 88.9 µm in the first trimester and 91.8 µm in the third trimester (p= 0.375; Wilcoxon). After delivery, retinal vascular diameters returned to the range observed in the first trimester for all subgroups. No significant correlation could be demonstrated between changes during pregnancy in retinal vessel diameter, arterial blood pressure, HbA1c or the level of diabetic retinopathy for any of the groups. Diabetic smokers tended to have narrower arterioles at baseline than diabetic women who did not smoke, but the difference was not significant (p>0.05). Conclusions: From the first to the third trimester of pregnancy, blood pressure increased in both diabetic and healthy women and retinal arteriolar diameter decreased in both groups. Subgroup analysis demonstrated that the 1st to 3rd trimester arteriolar constriction that accompanied the increase in blood pressure was absent in smokers. Smokers were found only among the diabetic women.
Keywords: diabetic retinopathy • imaging/image analysis: clinical • image processing