Benschop Laura, Schalekamp-Timmermans Sarah, Roeters van Lennep Jeanine E, Jaddoe Vincent W V, Wong Tien Yin, Cheung Carol Y, Steegers Eric A P, Ikram M Kamran
Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Department of General Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
BMC Med. 2017 Aug 14;15(1):153. doi: 10.1186/s12916-017-0917-2.
Changes in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy.
This study is part of an ongoing population-based prospective cohort study. During pregnancy and 6.2 years after the index pregnancy (90% range 5.7-7.4 years), we examined 3391 women with available information on pre-eclampsia, gestational hypertension, and retinal vascular calibers. Retinal arteriolar and venular calibers were measured in the left eye from digitized retinal photographs.
Women with pre-eclampsia had smaller retinal arteriolar calibers 6 years after pregnancy than women with a normotensive pregnancy (adjusted difference: -0.40 standard deviation score [SDS]; 95% confidence interval [CI]: -0.62, -0.19). For women with previous gestational hypertension, similar trends were observed (-0.20 SDS; 95% CI: -0.34, -0.05). With respect to retinal venular calibers, we did not observe consistent trends for women with previous pre-eclampsia. However, in women with previous gestational hypertension, we observed larger venular calibers (0.22 SDS; 95% CI: 0.07-0.36) than in women with a previous normotensive pregnancy. The association of gestational hypertensive disorders with retinal vessel calibers was mediated through mean arterial pressure at the time of retinal imaging.
Compared to women with a previous normotensive pregnancy, women with pre-eclampsia and gestational hypertension show an altered status of the microvasculature 6 years after the index pregnancy. This is reflected by smaller retinal arteriolar calibers and wider retinal venular calibers. These microvascular changes may possibly contribute to the development of cardiovascular disease in later life.
与子痫前期和妊娠期高血压相关的微血管变化被认为是心血管疾病发生发展的潜在途径。我们研究了子痫前期和妊娠期高血压等妊娠期高血压疾病是否与产后母亲视网膜微血管状态相关。
本研究是一项正在进行的基于人群的前瞻性队列研究的一部分。在孕期及本次妊娠后6.2年（90%的范围为5.7 - 7.4年），我们对3391名有子痫前期、妊娠期高血压和视网膜血管管径相关信息的女性进行了检查。通过数字化视网膜照片测量左眼的视网膜小动脉和小静脉管径。
子痫前期女性在产后6年的视网膜小动脉管径比血压正常妊娠的女性小（校正差异：-0.40标准差评分[SDS]；95%置信区间[CI]：-0.62，-0.19）。对于既往有妊娠期高血压的女性，观察到类似趋势（-0.20 SDS；95% CI：-0.34，-0.05）。关于视网膜小静脉管径，我们未观察到既往有子痫前期女性的一致趋势。然而，既往有妊娠期高血压的女性，其小静脉管径比既往血压正常妊娠的女性大（0.22 SDS；95% CI：0.07 - 0.36）。妊娠期高血压疾病与视网膜血管管径的关联是通过视网膜成像时的平均动脉压介导的。
与既往血压正常妊娠的女性相比，子痫前期和妊娠期高血压女性在本次妊娠后6年显示微血管状态改变。这表现为视网膜小动脉管径变小和视网膜小静脉管径变宽。这些微血管变化可能会导致日后心血管疾病的发生。
