Share This Article:

Retinal Vessels Diameter Changes during Pregnancy in Type 1 Diabetes

Abstract Full-Text HTML Download Download as PDF (Size:256KB) PP. 27-32
DOI: 10.4236/ojoph.2013.32008    2,543 Downloads   3,998 Views  


Objective: Investigate how pregnancy-induced hormonal and hemodynamic changes affect retinal vessels caliber dynamic and the course of diabetic retinopathy. Methods: Retinopathy grading and vessel diameter measurement using digital fundus photographs in women with diabetes type 1 taken no more than one year before conception, during week 10 and/or 22, week 34, and within one year after delivery. Calibers were measured using a custom-developed semi-automated computer algorithm which identified the six largest arteries and six largest veins and calculated the central retinal artery equivalent (CRAE) and central vein equivalent (CRVE) diameters. Glycemic control was assessed quarterly by HbA1c. Systolic and diastolic blood pressure was assessed at week 10, 22 and 34. Results: Photographs at baseline, weeks 10, 22, 34 and after delivery were available in 28 patients, of whom 24 did not progress in retinopathy. For those whose level of retinopathy remained stable CRAE constricted from 138.80 ± 21.27 μm at baseline to 129.88 ± 13.97 μm at week 10 (p = 0.0379) CRVE constricted from 195.16 ± 24.98 μm at baseline to 185.97 ± 21.96 μm at week 10 (p = 0.0400). The patients with retinopathy progression had a CRAE of 131.67 ± 13.37 μm at baseline and 132.08 ± 11.07 μm at week 10 (p = 0.34) while CRVE was 195.33 ± 24.92 μm at baseline and 204.27 ± 10.18 μm at week 10 (p = 0.16). Progressors had higher blood pressures at week 10. Conclusion: Retinal vessels constricted between prepregnancy and first trimester in women who did not experience diabetic retinopathy progression. The study suggests that the vessels constriction seen in early pregnancy contributes to reduce the risk of gestational microvascular complications and progression of diabetes in the eye.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

A. Mensah, A. Ahmadzadeh, A. Svanbom, L. Ringholm, B. Sander, H. Lund-Andersen, E. Mathiesen and M. Larsen, "Retinal Vessels Diameter Changes during Pregnancy in Type 1 Diabetes," Open Journal of Ophthalmology, Vol. 3 No. 2, 2013, pp. 27-32. doi: 10.4236/ojoph.2013.32008.


[1] R. Axer-Siegel, M. Hod, A. Fink-Cohen, M. Kramer, D. Weinberger, B. Schindel, et al., “Diabetic Retinopathy during Pregnancy,” Ophthalmology, Vol. 103, No. 11, 1996, pp. 1815-1819.
[2] R. Klein, B. E. Klein, S. E. Moss, et al., “Wisconsin Epidemiologic Study of Diabetic Retinopathy, the Relation of Vessel Caliber to the Incidence and Progression of Diabetic Retinopathy,” Archives of Ophthalmology, Vol. 122, No. 1, 2004, pp. 76-83. doi:10.1001/archopht.122.1.76
[3] N. Cheung, S. L. Rogers, K. C. Donaghue, A. J. Jenkins, G. Tikellis and T. Y. Wong, “Retinal Arteriolar Dilatation Predicts Retinopathy in Adolescent with Type 1 Diabetes,” Diabetes Care, Vol. 31, No. 9, 2008, pp. 1842-1846. doi:10.2337/dc08-0189
[4] P. K. Kofoed, B. Sander, G. Zubieta-Calleja, L. Kessel and M. Larsen, “Retinal Vessel Diameters in Relation to Hematocrit Variation during Acclimatization of Highlanders to Sea Level Altitude,” Investigative Ophthalmology & Visual Science, Vol. 50, No. 8, 2009, pp. 39603963. doi:10.1167/iovs.08-3217
[5] N. C. Taarnhoj, M. Larsen, B. Sander, K. O. Kyvik, L. Kessel, J. L. Hougaard and T. I. Sorensen, “Heritability of Retinal Vessel Diameters and Blood Pressure: A Twin Study,” Investigative Ophthalmology & Visual Science, Vol. 47, No. 8, 2006, pp. 3539-3544. doi:10.1167/iovs.05-1372
[6] Early Treatment Diabetic Retinopathy Study Research Group, “Grading Diabetic Retinopathy from Stereoscopic Color Fundus Photographs an Extension of the Modified Airlie House Classification,” Ophthalmology, Vol. 98, No. 5, 1991, pp. 786-806.
[7] Early Treatment Diabetic Retinopathy Study Research Group, “Fundus Photographic Risk Factors for Progression of Diabetic Retinopathy,” Ophthalmology, Vol. 98, No. 5, 1991, pp. 823-833.
[8] C. P. Wilkinson, F. L. Ferris 3rd, R. E. Klein, P. P. Lee, C. D. Agardh, M. Davis, D. Dills, A. Kampik, R. Pararajasegaram, J. T. Verdaguer and Global Diabetic Retinopathy Project Group, “Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales,” Ophthalmology, Vol. 110, No. 9, 2003, pp. 1677-1682.
[9] M. D. Knudson, K. E. Lee, L. D. Hubbard, T. Y. Wong, R. Klein and B. E. Klein, “Revised Formulas for Summarizing Retinal Vessel Diameters,” Current Eye Research, Vol. 27, No. 3, 2003, pp. 143-149. doi:10.1076/ceyr.
[10] The Diabetes Control and Complications Trial Research Group, “Effect of Pregnancy in Microvascular Complications in the Diabetes Control and Complication Trial,” Diabetes Care, Vol. 23, No. 8, 2000, pp. 1084-1091. doi:10.2337/diacare.23.8.1084
[11] M. Horvat, H. Maclean, L. Goldberg and G. W. Crock, “Diabetic Retinopathy in Pregnancy: A 12 Years Prospective Survey,” British Journal of Ophthalmology, Vol. 64, No. 6, 1980, pp. 398-403.
[12] F. Islam, T. Nguyen, J. Wang, et al., “Quantitative Retinal Vascular Calibre Changes in Diabetes and Retinopathy: The Singapore Malay Eye Study,” Eye, Vol. 23, No. 8, 2009, pp. 1719-1724. doi:10.1038/eye.2008.362
[13] A. Mandecka, J. Dawczynski, M. Blum, et al., “Influence of Flickering on the Retinal Vessels in Diabetic Patients,” Diabetes Care, Vol. 32, No. 11, 2007, pp. 3048-3052. doi:10.2337/dc07-0927
[14] S. Loukovaara, R. Kaaja and I. Immonen, “Macular Capillary Blood Flow Velocity by Blue-Field Entoptoscopy in Diabetic and Healthy Women during Pregnancy and the Postpartum Period,” Graefe’s Archive for Clinical and Experimental Ophthalmology, Vol. 240, No. 12, 2002, pp. 977-982. doi:10.1007/s00417-002-0590-8
[15] S. Loukovaara, M. Harju, R. Kaaja and I. Immonen, “Retinal Capillary Blood Flow in Diabetic and Nondiabetic Women during Pregnancy and Postpartum Period,” Investigative Ophthalmology & Visual Science, Vol. 44, No. 4, 2003, pp. 1486-1491. doi:10.1167/iovs.02-0293
[16] E. Stefansson, M. D. Landers III and M. L. Wolbarsht, “Oxygenation and Vasodilatation in Relation to Diabetic and Other Proliferative Retinopathies,” Ophthalmic Surgery, Vol. 14, No. 3, 1983, pp. 209-226.
[17] A. Kifley, J. J. Wang, S. Cugati, T. Y. Wong and P. Mitchell, “Retinal Vascular Caliber, Diabetes and Retinopathy,” American Journal of Ophthalmology, Vol. 143, No. 6, 2007, pp. 1024-1026. doi:10.1016/j.ajo.2007.01.034
[18] F. J. De Jong, M. W. Vernooij, M. K. Ikram, et al., “Arteriolar Oxygen Saturation, Cerebral Blood Flow and Retinal Vessel Diameters: The Rotterdam Study,” Ophthalmology, Vol. 115, No. 5, 2008, pp. 887-892. doi:10.1016/j.ophtha.2007.06.036
[19] H. C. Chen, S. B. Newsom, V. Patel, J. Cassar, H. Mather and E. H. Kohner, “Retinal Blood Flow Changes during Pregnancy in Women with Diabetes,” Investigative Ophthalmology & Visual Science, Vol. 35, 1994, pp. 31993209.
[20] M. Larsen, L. B. Colmorn, M. Bonnelycke, R. Kaaja, I. Immonen, B. Sander and S. Loukovaara, “Retinal Artery and Vein Diameters during Pregnancy in Diabetic Women,” Investigative Ophthalmology & Visual Science, Vol. 46, No. 2, 2005, pp. 709-713. doi:10.1167/iovs.04-0604
[21] M. Vestgaard, L. Ringholm, C. S. Laugesen, K. L. Rasmussen, P. Damm and E. Mathiesen, “Pregnancy-Induced Sight-Threatening Diabetic Retinopathy in Women with Type 1 Diabetes,” Diabetic Medicine, Vol. 27, 2010, pp. 1-5. doi:10.1111/j.1464-5491.2010.02958.x
[22] The Diabetes Control and Complications Trial Research Group, “Retinopathy and Nephropathy in Patients with Type 1 Diabetes Four Years after a Trial of Intensive Therapy,” The New England Journal of Medicine, Vol. 342, No. 6, 2000, pp. 381-389. doi:10.1056/NEJM200002103420603
[23] R. C. Temple, V. A. Aldridge, M. J. Sampson, R. H. Greenwood, P. J. Heyburn and A. Glenn, “Impact of Pregnancy on the Progression of Diabetic Retinopathy in Type 1 Diabetes,” Diabetic Medicine, Vol. 18, No. 7, 2001, pp. 573-577. doi:10.1046/j.1464-5491.2001.00535.x
[24] G. T. Higgins, K. Khan and E. A. Pearce, “Glycemic Control and Control of Risk Factors in Diabetic Patients in an Ophthalmology Clinic: What Lessons Have We Learned from the UKPDS and DCCT Studies?” Acta Ophthalmologica Scandinavica, Vol. 85, No. 7, 2007, pp. 772-726. doi:10.1111/j.1600-0420.2007.00944.x

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.