No abstract

Preeclampsia is a hypertensive disorder of pregnancy, affecting 3% to 5% of all pregnancies, and is one of the leading causes of maternal mortality and morbidity.1 Signs of preeclampsia include de novo hypertension after 20 weeks of gestation, proteinuria, peripheral edema, and liver dysfunction. Preeclampsia can lead to more serious complications including eclampsia, wherein the mother experiences seizures and possibly hemorrhagic stroke, 2 and it is associated with a higher likelihood of remote maternal hypertension and stroke.3 Although changes to the placental vasculature have been examined in vitro, the nature and the degree of maternal cardiovascular dysfunction present in preeclampsia have yet to be quantified via direct visualization of the microvascular caliber, which can be measured from retinal images.An increase in peripheral vascular resistance, partly from systemic endothelial activation, has been suggested to play a key role in the pathogenesis of preeclampsia.4 Activation of the endothelium causes the release of vasoactive factors, resulting in vasoconstriction throughout the microvasculature, increased peripheral resistance, and hypertension. 5 Many attempts have been made to quantify the degree of peripheral vascular resistance, endothelial dysfunction, and microvascular constriction indirectly, including measuring the amount of vasoactive molecules present in maternal blood. 6 However, a direct method of visualizing and measuring microvascular changes during pregnancy may improve understanding of preeclampsia development and aid clinical risk stratification in pregnancy.Retinal imaging is a novel method allowing in vivo examination of the microcirculation. The retina is an ideal candidate for directly and objectively assessing microvascular changes in pregnancy that occur because of volume and vasoactive factors because both the placental and the retinal blood vessels lack innervation by the sympathetic nervous system, which is upregulated in preeclampsia. 7,8 The aim of this study was to prospectively characterize changes in the retinal microvascular caliber throughout pregnancy between women who subsequently developed preeclampsia and those who had a normotensive pregnancy. Material and Methods Study DesignWe performed a prospective cohort study. Ethical approval for this study was obtained from the Sydney South West Area Health Service Abstract-Preeclampsia is a leading cause of maternal morbidity and mortality. The degree of maternal cardiovascular dysfunction that precedes the onset of preeclampsia is largely unknown. This prospective cohort study aimed to characterize differences in vivo in retinal microvascular caliber and blood pressure throughout pregnancy in relation to preeclampsia development. Women were recruited from Royal Prince Alfred Hospital, Sydney, Australia, of which 92 women were included in the study. Retinal images and blood pressures were collected at 13, 19, 29, and 38 weeks of gestation. Retinal vessels were analyzed as the central retinal arteriolar equivalent corre...