Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study

Chew, Emily Y.; Mills, James L.; Metzger, Boyd E.; Remaley, Nancy A.; Jovanovic‐Peterson, Lois; Knopp, Robert H.; Conley, Mary; Rand, Lawrence I.; Simpson, Joe Leigh; Holmes, Lewis B.; Aarons, Jerome H.

doi:10.2337/diacare.18.5.631

Cited by 361 publications

(140 citation statements)

References 17 publications

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“…This might be due to the relatively small material giving a high risk of type 2 error; it could also be due to the fact that the included women had sufficiently tight glycaemic control in early pregnancy to prevent this association from becoming evident. In women with type 1 diabetes an association of high levels of HbA 1c and blood pressure with pregnancyinduced progression of retinopathy is well described [16,17], but in a study with sufficiently strict glycaemic control this was not found [18]. Optimising glycaemic control before pregnancy in type 1 diabetes is associated with a tendency towards less progression compared with non-optimising of glycaemic control until pregnancy is confirmed [19].…”

Section: Discussionmentioning

confidence: 99%

Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

et al. 2010

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Aims/hypothesis We studied the progression of diabetic retinopathy during pregnancy in women with type 2 diabetes. Methods Fundus photography was performed at median 10 (range 6-21) and 28 (27-37) gestational weeks in 80 of 110 (73%) consecutively referred pregnant women with type 2 diabetes. Diabetic retinopathy was classified in five stages.Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of macular oedema on at least one eye between the two examinations. Macular oedema was defined as retinal thickening and/or hard exudates within a diameter of 1,500 µm in the macula area. Results Diabetic retinopathy, mainly mild, was present in 11 (14%) women in early pregnancy. Median duration of diabetes was 3 years (range 0-16 years). At baseline, HbA 1c was 6.4% (1.0) (mean [SD]), systolic BP 121 (13) and diastolic BP 72 (9) mmHg. Prior to pregnancy, 22 (28%) women had been on insulin treatment. During pregnancy 74 women (93%) were treated with insulin and 11 (14%) with antihypertensive medication. Progression of diabetic retinopathy was observed in 11 (14%) women. Progression was mainly mild, but one woman with poor glycaemic control and uncontrolled hypertension progressed from mild retinopathy to sight-threatening retinopathy with proliferations, clinically significant macular oedema and impaired vision in both eyes. Progression of diabetic retinopathy was associated with a longer duration of diabetes (p=0.03) and insulin treatment before pregnancy (p=0.004). Conclusions/interpretation Despite a low risk of progression of retinopathy in pregnant women with type 2 diabetes, sight-threatening deterioration did occur.

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Section: Discussionmentioning

confidence: 99%

Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

et al. 2010

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

Section: Ocular Examinationmentioning

confidence: 99%

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

et al. 2018

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“…It is also important that diabetic women who may become pregnant establish good glucose control before conception. 12 The value of prepregnancy counselling regarding the potential risks and consequences to vision should not be overlooked and greater patient education would be beneficial.…”

Section: Eyementioning

confidence: 99%

“…5,6 However, the exact mechanism responsible for progression of diabetic retinopathy during pregnancy is still not entirely clear. Factors thought to be of significance include poor metabolic control, 7 long duration of diabetes, 8,9 severity of retinopathy at baseline, 10 rapid normalisation of glycaemic control, 11,12 hypertension, 4,13 and changes in retinal blood flow. 14 A study by Phelps et al 7 and the Diabetes in Early Pregnancy Study (DIEP) 10 found that patients in whom retinopathy was most likely to progress had both the poorest control at baseline and the largest improvement during early pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Management and outcome of sight-threatening diabetic retinopathy in pregnancy

Chan

Lim

Quinn

et al. 2004

Eye

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Aims To report the management and outcomes of sight-threatening diabetic retinopathy in pregnancy. Methods A retrospective review of 8 diabetic females who developed pregnancy related sight-threatening diabetic retinopathy requiring treatment over a 12-year period. Results In total, 16 eyes of eight patients were included in this series. The mean age of the patients at presentation was 30.75 years 73.8 SD and the mean duration of diabetes was 21.0 years 75.1 SD. The mean follow-up period was 46.75 months 747.2 SD. A total of 87.5% of patients showed progression of diabetic retinopathy during pregnancy, 71% of which were in the sight-threatening proliferative category. In the postpartum period, 81% of patients continued to progress to proliferative diabetic retinopathy, requiring panretinal photocoagulation and multiple other surgical procedures. In all, 69% of eyes retained visual acuity equal to or better than 0.3 logMAR units (6/12). Conclusion Sight-threatening diabetic retinopathy in pregnancy is a rare disease, but it can have devastating consequences for mother and child. Laser photocoagulation should be considered for pregnant women with severe preproliferative diabetic retinopathy. Proliferative diabetic retinopathy may not regress postpartum. Close followup should be extended in the postpartum period in this group of patients until the retinopathy is stabilised. The presence of combined rhegmatogenous and tractional retinal detachment and neovascular glaucoma were associated with the worst outcome.

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Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study

Cited by 361 publications

References 17 publications

Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes

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

Management and outcome of sight-threatening diabetic retinopathy in pregnancy

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