Retinal imaging in gestational diabetes mellitus: systematic review

Area of Science:

• Ophthalmology
• Maternal-Fetal Medicine
• Endocrinology

Background:

• Gestational diabetes mellitus (GDM) is a common pregnancy complication.
• Retinal changes may serve as early indicators of systemic vascular complications.

Purpose of the Study:

• To systematically review and synthesize evidence on retinal structural and vascular differences in pregnancies with GDM compared to normoglycemic controls.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, EMBASE, Cochrane Library, Scopus).
• Non-interventional studies assessing retinal structure and vasculature in GDM pregnancies were included.
• Risk of bias was assessed using the ROBINS-I V2 tool; meta-analysis was precluded by heterogeneity.

Main Results:

• Ten studies were included, utilizing optical coherence tomography (OCT), OCT angiography (OCTA), and fundus photography.
• Mixed findings were reported for retinal nerve fiber layer thickness and vessel densities.
• Some studies indicated altered arteriolar and venular parameters and reduced arteriovenous ratio in GDM pregnancies.

Conclusions:

• Current evidence on GDM-related retinal changes is inconsistent.
• Further large-scale prospective studies are necessary to validate findings and explore postpartum persistence.
• Retinal biomarkers could potentially inform cardiovascular risk stratification in GDM.