Maternal Optical Coherence Tomography Angiography Changes Related to Small for Gestational Age Pregnancies

Abstract

To study maternal retinal changes in pregnancies that resulted in a small for gestational age (SGA) infant. Methods: Pregnant women with SGA infants at birth and age-matched pregnant women with appropriate for gestational age (AGA) infants at birth (controls) were enrolled. All subjects underwent spectral domain optical coherent tomography angiography (OCTA) imaging using a 10°× 10°scan pattern centered on the fovea. Vessel density (VD) and vessel length density (VLD) of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were analyzed and compared between the two groups. Results: Twelve eyes of eight subjects with SGA infants and 64 eyes of 44 age-matched subjects with AGA infants were included in this study. There was no significant difference in chronic hypertension (P = 1.0), gestational hypertension (P = 1.0), type 1/2 diabetes (P = 1.0), gestational diabetes (P = 0.97), or preeclampsia (P = 0.50) between the SGA group and AGA group. There were significant increases in both VD and VLD in the SCP and ICP layers when comparing the SGA group with the AGA group (P < 0.05). Conclusions: In this pilot study, subjects with SGA infants had increases in selective retinal vasculature layers that may represent systemic perfusion changes compensating for placental insufficiency. Translational Relevance: Additional assessment of maternal retinal changes in pregnancy using OCTA could prove the technology useful as a biomarker of fetal morbidity.

Assessment of Maternal Retinal Microvasculature in Preterm Pregnancy Using OCT-Angiography: a Cross-Sectional Study

“…Due to physiologic differences in hydrostatic pressure, structure and function between the SCP and DCP, it may be plausible that they would be affected in a different way during pregnancy (29,30). Recently, Su and co-authors found that women with small for gestational age infants had increases in selective retinal vascular layers, hypothesizing that these compensatory increases in microcirculation parameters were possibly related to placental insufficiency (20). Since preterm pregnancy is characterized by maternal vascular hypoperfusion, we could assume that a common pathophysiological basis in both cases would account for an apparent increase in vascular density and blood flow (20,26).…”

“…Recently, Su and co-authors found that women with small for gestational age infants had increases in selective retinal vascular layers, hypothesizing that these compensatory increases in microcirculation parameters were possibly related to placental insufficiency (20). Since preterm pregnancy is characterized by maternal vascular hypoperfusion, we could assume that a common pathophysiological basis in both cases would account for an apparent increase in vascular density and blood flow (20,26). As previously supported, this mechanism could involve the retinal blood flow autoregulation through the release of vasoactive mediating molecules that lead to capillaries adaptations to alterations in the perfusion pressure and metabolic demands of the tissue (31,32).…”

“…To date, there is limited evidence concerning retinal vasculature in normal and pathologic pregnancy (16)(17)(18)(19)(20). Conceivably, this information may be considered relevant for clinical practice, as blood flow changes could serve as a predicting factor for the prognostication of the status of systemic circulation and the possibility of a premature birth.…”

“…To date, there is limited evidence concerning retinal vasculature in normal and pathologic pregnancy, while the aspect of retinal microvasculature postpartum remains largely unexplored. Based on recent evidence, increased circulatory demands and hormonal changes during the transient state of pregnancy seem to result in retinal capillary dilation (16)(17)(18)(19)(20). Nonetheless, it is unknown whether further retinal vascular modifications may occur in terms of prematurity.…”

Assessment of Retinal Vessel Tortuosity Index in Patients with Fabry Disease Using Optical Coherence Tomography Angiography (OCTA)

“…Retinal imaging allows an accessible way to analyze the vascular network, allowing it to be a time and cost-efficient examination modality [34,35]. The eye itself, with its fragile microvasculature, has been shown to be affected by systemic vascular dysregulation, hence reflecting vascular damage of systemic origin [36][37][38]. Thereby, it stands to reason that changes in retinal vasculature, as mentioned above, can be used as an imaging parameter to detect and observe systemic vascular diseases.…”