Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

Abstract

BackgroundChanges 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.MethodsThis 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.ResultsWomen 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.ConclusionsCompared 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0917-2) contains supplementary material, which is available to authorized users.

Maternal cardiovascular adaptation to twin pregnancy: a population-based prospective cohort study

“…This may be explained by the relative small number of women with twin pregnancies in our study. In previous studies performed in women with singleton pregnancies, we did find associations years after pregnancy in women with PE compared to women without PE [28,36]. However, it might also be that PE in women with twin pregnancies is potentially a different phenotype compared to PE in women with singleton pregnancies, independently from cardiovascular predisposition of mothers.…”

“…Therefore, 6 and 10 years after pregnancy may not be the best moments to measure cardiovascular adaptation. However, previous studies in women with singleton pregnancies did find differences for women with PE within this time period [28,36]. Data are represented as n (%), mean (SD) or as the median with the 90% range.…”

“…To assess aortic stiffness we used carotid-femoral pulse wave velocity (PWV) [26,27]. Retinal vascular calibres were assessed by taking digital retinal photographs [28].…”

Correction to: Gestational hypertensive disorders and retinal microvasculature: the Generation R Study

“…The original article [1] contained an error whereby the senior author, M. Kamran Ikram’s name was mistakenly interchanged.…”

Association between antenatal blood pressure and 5-year postpartum retinal arteriolar structural and functional changes

“…Emerging evidence has shown that hypertensive disorders of pregnancy (HDP) are associated with postpartum microvascular changes,1 2 such as retinal arteriolar narrowing and venular widening. Since antenatal blood pressure (BP) is also known to increase a series of cardiovascular (CV) risks such as insulin resistance,3 oxidative stress and endothelial dysfunction,4 it is unclear whether previous findings of antenatal BP and postpartum microvascular alteration are mediated by CV risks.…”