Diabetic Retinopathy in Pregnancy: A Population-Based Study of Women with Pregestational Diabetes

Abstract

The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks (n = 307) were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at prepregnancy care was associated with receiving adequate screening (odds ratio 6.23; CI 3.39–11.46 (P < 0.001)). Among those who received adequate evaluations (n = 185), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.01–1.06, P = 0.02) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.09–3.87, P = 0.03) significantly increased the odds of progression. A significant proportion of women continue to demonstrate retinopathy progression during pregnancy. This study highlights the role of prepregnancy care and the importance of close monitoring during pregnancy and identifies those patients at the highest risk for retinopathy progression.

Diabetic retinopathy in pregnancy: a review

“…32 Studies have confirmed that rapid optimization of glycaemic control after conception is a risk factor for progression of DR during pregnancy. 5,15,17,27,28,30 This is supported by the findings in the DCCT, where 53% of the conventional treatment group who were changed to intensive control in early pregnancy experienced worsening of DR during pregnancy comparedwith 40% in the initial intensive group. In this conventional treatment group, there was a significant rank correlation between initial higher HbA1c and a greater chance of DR progression, where 82% of those with a 3.1% or more decrease in HbA1c experienced progression of DR, 5 whereas improvements in HbA1c of up to 0.9% in a well-controlled cohort did not increase the risk of DR progression.…”

“…Studies have consistently shown that the longer the duration of diabetes, the more likely retinopathy is to progress during pregnancy. [15][16][17]19,21,27,28 In T1DM, DR remained stable during pregnancy where the duration of diabetes was less than 10 years but progressed in 10% of those with a 10-to 19-year duration. 22 Another study found an average duration of 13.5 years in the group whose retinopathy remained stable, compared with 19.7 years duration in those with DR progression during pregnancy.…”

“…Glucose and glycaemic control have a paradoxical role in the development of retinopathy; hyperglycaemia undoubtedly causes retinopathy, but rapid improvement towards normoglycaemia also accelerates it. Poor glycaemic control has been shown to be a risk factor for DR progression during pregnancy in women with both T1DM 16,17,27,28,30 and T2DM 15 with a lower risk of progression in those with strict glycaemic control prior to conception. 5 However, tightening glycaemic controlespecially rapid tighteningin those with pre-existing retinopathy may worsen the retinopathy.…”

Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996–2014

“…Pregestational diabetes is associated with an increased risk of adverse perinatal outcomes, including preeclampsia, 5, 6 retinopathy, 7 early fetal loss, 8, 9 stillbirth, 10 macrosomia, 11 birth injuries associated with large fetal size, and infant death. 10, 12 Given the burden of type 1 and type 2 diabetes during pregnancy, and recent changes in the racial-ethnic composition of women of reproductive age in the United States, understanding changes in the prevalence of pregestational diabetes, overall and by population subgroups, is important for informing health systems and clinicians of the resources required for the preconception and obstetric care of young women with diabetes.…”

Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes

“…Patients should also be informed that an abrupt correction of metabolic balance in diabetes might lead to worsening of retinal changes [5,6].…”