, Volume 60, Issue 12, pp 2368–2376 | Cite as

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

  • Ling-Jun Li
  • Kok Hian Tan
  • Izzuddin M. Aris
  • Yap Seng Chong
  • Seang Mei Saw
  • Peter Gluckman
  • Jie Jin Wang
  • Tien Yin Wong



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.


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 HbA1c 5.7–6.4% [39–46 mmol/mol]) and diabetes diagnosed at the 5 year follow-up visit (n = 84), according to WHO guidelines.


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.


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.


Abnormal glucose metabolism Gestational diabetes mellitus Postpartum Prediabetes Retinal microvasculature Type 2 diabetes 



Gestational diabetes mellitus


Growing Up in Singapore Towards Healthy Outcomes


International Association of the Diabetes and Pregnancy Study Groups


Inter-quartile range


In vitro fertilisation


KK Women’s and Children’s Hospital


National University Hospital


Singapore I Vessel Assessment


Systolic BP



We thank all the mothers who participated in this study, and all the clinic and research staff involved in running this study.

Data availability

The research data are available on request from the corresponding author.


This study, entitled ‘Gestational Diabetes Mellitus and Risk of Postpartum Metabolic Syndrome’, is funded by the Singapore National Medical Council (NMRC/CNIG/1114/2013). L-JL is funded by a Singapore National Medical Council Transition Award (NMRC/TA/0027/2014). The GUSTO cohort, under the Translational Clinical Research (TCR) Flagship Program on Developmental Pathways to Metabolic Disease, is funded by the Singapore National Research Foundation (NRF) and administered by the Singapore National Medical Research Council (NMRC/TCR/004-NUS/2008).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

L-JL designed the study, conducted the whole study, performed data analyses and wrote the manuscript. KHT designed the study and reviewed and edited the manuscript. IMA interpreted the data and reviewed and edited the manuscript. YSC designed the study, reviewed the manuscript and provided research data. SMS designed the study, provided research data, reviewed the study proposal and reviewed the manuscript. PG designed the study, provided research data, reviewed the study proposal and reviewed the manuscript. JJW took part in data analyses, reviewed the manuscript and contributed to the discussion and editing of the manuscript. TYW designed the study and reviewed the manuscript. All authors gave their final approval of the version to be submitted for publication. L-JL is responsible for the integrity of the work as a whole.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Ling-Jun Li
    • 1
    • 2
  • Kok Hian Tan
    • 2
    • 3
  • Izzuddin M. Aris
    • 4
  • Yap Seng Chong
    • 4
    • 5
  • Seang Mei Saw
    • 1
    • 2
  • Peter Gluckman
    • 4
  • Jie Jin Wang
    • 2
  • Tien Yin Wong
    • 1
    • 2
  1. 1.Singapore Eye Research Institute, Singapore National Eye Centre, The AcademiaSingaporeSingapore
  2. 2.Academic Medicine Research InstituteDuke-NUS Medical SchoolSingaporeSingapore
  3. 3.Division of Obstetrics and GynecologyKK Women’s and Children’s HospitalSingaporeSingapore
  4. 4.Growth, Development and Metabolism, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR)SingaporeSingapore
  5. 5.Department of Obstetrics and Gynecology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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