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Retinal microvasculature may predict metabolic syndrome in women with gestational diabetes
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Women with gestational diabetes showing evidence of retinal venular widening are more likely to develop metabolic syndrome in the 5 years after delivery than women who had gestational diabetes but no retinal abnormalities, according to findings published in Metabolism.
In a previous study of the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort, Ling-Jun Li, MD, PhD, of the Singapore Eye Research Institute and Singapore National Eye Center, and colleagues observed that pregnant women with gestational diabetes tended to have a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle vs. those without gestational diabetes. “These findings suggest that even transient hyperglycemia during pregnancy may cause small-vessel dysfunction,” Li and colleagues wrote in the study background.
The researchers followed the GUSTO cohort during a 5-year postpartum period to study the relationship between second-trimester microvasculature and incident maternal metabolic syndrome, exploring the potential value of retinal microvasculature as a novel measure in predicting metabolic syndrome in mothers with gestational diabetes. In a hospital-based, observational, prospective follow-up study, researchers analyzed data from 142 women diagnosed with gestational diabetes at baseline and their age-, ethnicity- and BMI-matched controls from the same GUSTO cohort.
Participants underwent digital retinal photography on both eyes without pupil dilation; researchers assessed retinal vascular caliber, including retinal arteriolar narrowing and/or retinal venular widening, and retinal vascular branching angle. At the 5-year visit, researchers assessed metabolic outcomes including blood pressure, BMI, waist circumference, lipid profile, HbA1c, C-reactive protein and glycemic status via an oral glucose tolerance test. Metabolic syndrome was defined as meeting at least three of the following four components: hypertension (systolic BP 130 mm Hg and/or diastolic BP 85 mm Hg), abdominal obesity (waist circumference 88 cm), dyslipidemia (triglyceride level 1.7 mmol/L or HDL cholesterol 1.3 mmol/L) or hyperglycemia (fasting plasma glucose 6.1 mmol/L). Researchers used modified-Poisson regression analysis to study the association between second trimester retinal microvasculature and incident 5-year metabolic syndrome.
After 5 years, 9.2% of women with gestational diabetes at baseline developed metabolic syndrome. Researchers found that each 10-µm widening in retinal venular caliber was associated with an increased RR of 1.6 for developing metabolic syndrome (95% CI, 1-2.8). Results persisted after adjusting for maternal age, race, college degree, prepregnancy BMI and fasting glucose at 26 to 28 weeks’ gestation.
When analyzing the association between retinal microvasculature and individual metabolic syndrome components, researchers did not observe an association with any microvascular parameters apart from branching angle. Each 10° in retinal venular branching angle was associated with a higher risk for hyperglycemia (RR = 6.4; 95% CI, 1.9-21.8), according to researchers.
“Mothers with gestational diabetes may already have manifestations of retinal microvascular abnormalities during pregnancy and, therefore, are at higher risk of developing future metabolic syndrome,” Li told Endocrine Today. “Retinal imaging technology may be a potentially useful tool in identifying these women at risk, in addition to maternal prepregnancy BMI.”
The researchers noted that retinal venular widening is a novel predictor for incident metabolic syndrome; however, the predictive value did not appear to increase substantially when compared with traditional risk factors, such as prepregnancy BMI and second trimester fasting glucose level. – by Regina Schaffer
For more information: Ling-Jun Li, MD, PhD, can be reached at Singapore National Eye Centre, The Academia, 20 College Rd., Discovery Tower, Level 6, Singapore 169856: email: queenie.li.l.j@seri.com.sg.
Disclosures: The authors report no relevant financial disclosures.
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