Diabetologia

, 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
Article

Abstract

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 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.

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.

Keywords

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

Abbreviations

GDM

Gestational diabetes mellitus

GUSTO

Growing Up in Singapore Towards Healthy Outcomes

IADSPG

International Association of the Diabetes and Pregnancy Study Groups

IQR

Inter-quartile range

IVF

In vitro fertilisation

KKH

KK Women’s and Children’s Hospital

NUH

National University Hospital

SIVA

Singapore I Vessel Assessment

SBP

Systolic BP

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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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