Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore.
Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore.
Diabetologia. 2017 Dec;60(12):2368-2376. doi: 10.1007/s00125-017-4441-x. Epub 2017 Sep 22.
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.
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 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.
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.
目的/假设：视网膜微血管的变化可能反映胰岛素抵抗。我们在基线和产后 5 年检查了一组母亲的视网膜微血管变化与随后发生异常葡萄糖代谢的相关性。
在新加坡出生队列（新加坡走向健康结局的成长[GUSTO]）的参与者中，有 276 名母亲参加了基线（妊娠 26-28 周）和随访（产后 5 年）检查。在基线时，我们进行了视网膜摄影，并使用经过验证的分级系统评估了视网膜微血管变量。在随访时，我们使用 75g OGTT 评估了葡萄糖耐量。如果参与者：（1）在随后的 5 年随访期间发生妊娠糖尿病（GDM）（n=103），或（2）根据世界卫生组织（WHO）指南，在 5 年随访时诊断为糖尿病前期（空腹血糖受损、葡萄糖耐量受损或 HbA 5.7-6.4%[39-46mmol/mol]）（n=84），则定义为异常葡萄糖代谢。
随后妊娠中 GDM 的发生率和产后 5 年的异常葡萄糖代谢发生率分别为 25.2%和 30.4%。视网膜静脉口径每增宽 10μm，与产后异常葡萄糖代谢的风险显著相关（RR 1.2[95%CI 1.0,1.5]），与母亲年龄、大学教育程度、种族、孕前 BMI 和基线 GDM 无关。基线时视网膜小动脉口径较窄和静脉分支角较窄，与随访时胰岛素抵抗指数较高相关（分别为 1.4[95%CI 1.1,1.7]和 1.3[95%CI 1.1,1.6]）。
结论/解释：孕妇的视网膜微血管与产后 5 年的异常葡萄糖代谢有关。妊娠期间微血管结构的改变可能预示着糖尿病前期和糖尿病发展的亚临床变化。
