Diabetic retinopathy in pregnancy - A review

Abstract

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.

Potential Protective Function of Adiponectin in Diabetic Retinopathy

“…Serum APN level in early pregnancy may be a strong predictor of GDM [ 113 ] with moderate predictive accuracy [ 114 ], and the serum Ficolin-3/APN ratio may also be a predictor of GDM [ 115 ]. Gestational diabetes can worsen DR in pregnant patients with pre-existing diabetes [ 116 ], but it does not raise the risk of DR during pregnancy. To our knowledge, there are no studies that correlate APN with GDM retinopathy and associated mechanisms.…”

Risk factors for the development or progression of diabetic retinopathy in pregnancy: Meta‐analysis and systematic review

“…To our knowledge, this is the largest meta‐analysis and review addressing all these factors with data compiled from all available literature. Unlike other similar studies, 56 researchers utilised studies from all countries that had published data, not solely limited to the country of publication. This allowed for a larger number of patients and further strengthens the validity of our findings.…”

Pregnancy and the eye: What do we need to watch out for? A review

“…retinopathy (Figure 2). 43 DR can also occur in patients who develop gestational diabetes, however this is less common and patients with gestational diabetes may not require regular ophthalmologic examination.…”

“…DR has also been shown to worsen in women with type 1 diabetes compared to women with type 2 diabetes. 43 DR that occurs during pregnancy tends to regress during the postpartum period. Diabetic macular oedema may also develop or worsen during pregnancy, particularly in patients with proteinuria or hypertension associated with diabetes.…”