What does this research mean for the field?

Gestational diabetes mellitus (GDM) is associated with higher choroidal vascularity index and choriocapillaris plexus vascular density compared to pregnant controls and non-pregnant controls, particularly in older women or those with longer axial lengths. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to characterize choroidal microcirculatory changes in women with gestational diabetes mellitus using a new volumetric index.

February 25, 2026BMC Pregnancy and Childbirth0 citationsOpen Access

Quantitative evaluation of the topographical maps of three-dimensional choroidal vascularity index in gestational diabetes mellitus: a cross-sectional observational study

LJLiping JiangTongji University YJYimei JiQuzhou City People's Hospital XJXin JiangQuzhou College of Technology

Key Points

This study aims to characterize choroidal microcirculatory changes in women with gestational diabetes mellitus using a new volumetric index.
Utilized ultra-widefield swept-source OCTA for imaging.
Applied a 3 × 3 grid to assess choroidal regions of interest.
QQuantified vascular density, choroidal thickness, and 3D-CVI using automated algorithms.
Performed statistical analyses, including one-way ANOVA and correlation assessments.
Significant differences in choriocapillaris vascular density between groups, with GDM showing higher values than controls at certain ages.
3D-CVI was lower in GDM compared to non-pregnant controls but not significantly different from pregnant controls.
Age negatively correlated with vascular measures, indicating age-related reductions in choroidal health.

Abstract

Gestational diabetes mellitus (GDM) may be associated with occult abnormalities in choroidal microcirculation.This study utilizes ultra-widefield swept-source OCTA (SS-OCTA) and introduces the three-dimensional choroidal vascularity index (3D-CVI) as a volumetric quantitative parameter to systematically characterize the choroidal microcirculatory characteristics in GDM. This cross-sectional study utilized SS-OCTA with a 24 × 20 mm scan range. A 3 × 3 grid (9 regions) was applied to assess an effective area of interest measuring 17 × 17 mm. Built-in automated algorithms quantified choriocapillaris plexus vascular density (CCP VD), 3D-CVI, and choroidal thickness (CT). Statistical analyses included one-way ANOVA and general linear models, with Pearson/Spearman correlation for association analysis. 138 women were enrolled (n = 46/group), comprising the GDM, pregnant controls (PC), and non-pregnant controls (NC), with mean ages of 31.98 ± 4.43, 30.74 ± 3.66, and 31.00 ± 4.26 years.Significant differences were observed in macular grid CCP VD among the three groups (46.26 ± 1.41%, 46.28 ± 1.43%, and 45.41 ± 1.85%; P = 0.012), after adjusting for age and axial length(AL), at Age = 35.38 years, GDM was higher than both PC and NC (P = 0.005,P 0.05).Correlation analysis showed inverse associations of age with mean CCP VD, 3D-CVI, and CT (r = − 0.56/−0.49/−0.47,all P 0.05). Macular grid CCP-VD increased overall in pregnancy versus NC.In pregnancy, GDM exceeded PC at higher age or AL.3D-CVI differed only in macular grid and nasal-superior, lower in GDM than NC yet not from PC.Given the structural differences between mild-to-moderate GDM and PC may be subtle.3D-CVI may serve as an auxiliary indicator for regional choroidal remodeling, and combined with CCP, it can comprehensively assess the choroidal pathophysiology in GDM.Longitudinal gestation-to-postpartum follow-up is needed.

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