Diabetic retinopathy in pregnancy

Price, John; Hadden, David R.; Archer, D. B.; Harley, J. M. G.

doi:10.1111/j.1471-0528.1984.tb05272.x

Cited by 49 publications

(31 citation statements)

References 5 publications

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“…The prevalence of diabetic retinopathy in pregnancy has variously been reported at between 27% and 10% in the past five years. The availability of laser photocoagulation therapy has made it difficult further to test the hypothesis that the retinopathy is worsened by the pregnancy, but there is no doubt that progression may occur and that frequent ophthalmic assessment and treatment may be needed [38]. The good visual results of this treatment mean that retinopathy alone, even in a proliferative phase, is not an indication for termination of pregnancy, although it certainly remains a significant fetal risk factor.…”

Section: Obstetrical Aspectsmentioning

confidence: 99%

Diabetes in pregnancy 1985

Hadden

1986

Diabetologia

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The art of obstetrics is not a subject which is often discussed in the pages of Diabetologia. However, as the care of the diabetic mother and her offspring is rightly an interdisciplinary responsibility between obstetrician, diabetologist and neonatologist, it is important that each has a close understanding of the various problems. Dr. M. I. Drury (Dublin), speaking as an internist, raises a question on the optimum time and method of delivery of the baby; this has more than purely obstetrical implications. Drs. L. Molsted-Pedersen (Copenhagen) and C. K~ihl (Copenhagen and Klampenborg), obstetrician and internist from the longest-established joint obstetric/diabetic service in the world, present a Scandinavian view on the management of pregnancy. Both centres have distinguished records in the management of diabetic pregnancy. The different viewpoints in Denmark and in Ireland are clear -in Copenhagen, therapeutic abortion is practiced in a pregnancy at risk of severe congenital malformation; in Dublin it is not. Dr. Drury quotes a perinatal loss of 13 of 285 pregnancies (4.5%) in the past 5 years, but does not include the recognised spontaneous abortions which, on his overall figures, are about 10% of conceptions. Dr. Molsted-Pedersen reports a perinatal loss of 3 of 201 infants (1.5%), excluding 17 spontaneous and 9 induced abortions. If these 9 aborted pregnancies, which were performed due to a risk of severe congenital malformation, were included as fatalities, the Copenhagen figure would be 12 of 210 (5.5%). Of course, we do not know if all those 9 fetuses were affected. The spontaneous abortion rate was 17 of 223 (8.0%). Thus, if total fetal loss is taken as the index, there appears to be little difference between the two centres. The clinical controversy on the timing and method of birth in the different centres will continue --pundits can be conservative as well as radical, and, as Dr. Drury remarks, the truth probably lies somewhere in between.The bottom line in reports on the management of diabetes in pregnancy used to be the perinatal mortality (from 28 weeks gestation to the end of the first week of life). With the continuing improvement in neonatal care, more babies who would have died during the perinatal period are surviving beyond the seventh day of life. As a result, their subsequent deaths are not recorded in many publications. Even greater emphasis will fall on the quality of life for those infants surviving with a major congenital abnormality (heart and neural tube defect) which produces profound childhood morbidity. Prevention of these congenital abnormalities is the most important aim of pre-and early conceptional care of the diabetic mother. Both centres which report their recent results in this issue would agree that there has been an improvement even in the past 5 years -the problem is to define exactly which developments account for the change for the better, and which previously-trusted techniques can safely be allowed to fall by the wayside.

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Section: Obstetrical Aspectsmentioning

confidence: 99%

Diabetes in pregnancy 1985

Hadden

1986

Diabetologia

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“…It is well documented that retinopathy can progress during pregnancy in type 1 diabetic women with reported rates ranging from 17% to 70% [1][2][3]. Poor glycaemic control, longer duration of diabetes, greater fall in blood glucose in early pregnancy and raised blood pressure have previously been identified as risk factors for progression of retinopathy during pregnancy [4,5].…”

Section: Introductionmentioning

confidence: 99%

Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes

Arun

Taylor

2008

Diabetologia

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Aims/hypothesis Pregnancy in type 1 diabetic women is associated with risk of worsening of retinopathy. It has been reported that deterioration continues in the months after delivery, but direct data are lacking. It is also unclear what impact pregnancy has on the long-term progression of retinopathy. Methods We studied 59 women with type 1 diabetes who had retinal photographs before pregnancy and yearly for 5 years post pregnancy. These photographs were graded using the EURODIAB retinopathy grading system. Results The mean duration of diabetes was 14.4±8.2 years and mean age at pregnancy was 29.8±5.5 years. Mean HbA 1c was 8.2±2.0% before pregnancy with tighter control during pregnancy itself. This value was high despite efforts to improve take-up of pre-conception care. Mean HbA 1c was 8.6±1.5 during the follow-up period. At baseline, 43 (72.9%) women were free of retinopathy, 15 had nonproliferative retinopathy and one woman had previously had laser therapy. During pregnancy four women required laser therapy. Over the next 5 years none required laser therapy, although retinopathy worsened in 14 women. Tenyear follow-up data were available on 22 women, one of whom required laser therapy 8 years after pregnancy. Baseline retinopathy status was the only independent risk factor which predicted progression of retinopathy. Conclusions/interpretation Pregnancy is not associated with post-partum worsening of retinopathy.

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“…Existe ainda uma associação no aumento do risco de perda fetal e outras complicações obstétricas (23)(24)(25) . Estudos de longo período sugerem que a retinopatia não aparenta ser mais grave em pacientes nulíparas que nas multíparas (26)(27) , portanto o nú-mero de partos não eleva o risco de piora da retinopatia (28) , sendo que a retinopatia é menos grave em mulheres com duas ou mais gestações (28) .…”

Section: A -Retinopatia Diabéticaunclassified