Gestational retinal microvasculature and the risk of 5 year postpartum abnormal glucose metabolism

• Published in: Diabetologia 2017-12, Vol.60 (12), p.2368-2376
• Main Authors: Li, Ling-Jun, Tan, Kok Hian, Aris, Izzuddin M., Chong, Yap Seng, Saw, Seang Mei, Gluckman, Peter, Wang, Jie Jin, Wong, Tien Yin
• Format: Article
• Language: English
• Subjects: Blood Glucose - metabolism; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - physiopathology; Diabetes, Gestational - metabolism; Diabetes, Gestational - physiopathology; Female; Gestation; Gestational diabetes; Glucose; Glucose Intolerance - metabolism; Glucose Intolerance - physiopathology; Glucose metabolism; Glucose tolerance; Glucose Tolerance Test; Glycated Hemoglobin A - metabolism; Human Physiology; Humans; Insulin; Insulin resistance; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Microvasculature; Microvessels - metabolism; Microvessels - physiopathology; Minority & ethnic groups; Photography; Postpartum; Postpartum Period; Prediabetic State - metabolism; Prediabetic State - physiopathology; Pregnancy; Retina; Retina - metabolism; Retina - physiopathology
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-017-4441-x

Aims/hypothesis Changes in retinal microvasculature may reflect insulin resistance. We examined the association of changes in retinal microvasculature during pregnancy and risk of subsequent abnormal glucose metabolism in a cohort of mothers at baseline and 5 years postpartum. Methods Of the participants from the Singapore birth cohort (Growing Up in Singapore Towards Healthy Outcomes [GUSTO]), 276 mothers attended both baseline (at 26–28 weeks of gestation) and follow-up (5 year postpartum) visits. At baseline we performed retinal photography and assessed retinal microvascular variables using a validated grading system. At follow-up, we assessed glucose tolerance using a 75 g OGTT. We defined abnormal glucose metabolism if participants: (1) had onset of gestational diabetes mellitus (GDM) in subsequent pregnancies within a 5 year follow-up period ( n  = 103) or (2) had prediabetes (impaired fasting glucose, impaired glucose tolerance or HbA 1c 5.7–6.4% [39–46 mmol/mol]) and diabetes diagnosed at the 5 year follow-up visit ( n  = 84), according to WHO guidelines. Results The incidence of GDM in subsequent pregnancy and abnormal glucose metabolism 5 years postpartum was 25.2% and 30.4%, respectively. Each 10 μm widening in retinal venular calibre was associated with a significant risk of postpartum abnormal glucose metabolism (RR 1.2 [95% CI 1.0, 1.5]), independent of maternal age, college education, ethnicity, pre-pregnancy BMI and GDM at baseline. Narrower retinal arteriolar calibre and venular branching angle at baseline was associated with a higher insulin resistance index (1.4 [95% CI 1.1, 1.7] and 1.3 [95% CI 1.1, 1.6], respectively) at follow-up. Conclusions/interpretation Retinal microvasculature in pregnant women was associated with abnormal glucose metabolism 5 years postpartum. Alteration of microvascular structure during pregnancy may signal subclinical changes that underlie the development of prediabetes and diabetes.