Metabolic control and serum hormone levels in relation to retinopathy in diabetic pregnancy

Abstract

Summary. The occurrence and progression of retinopathy were related to the mean blood glucose levels and the serum concentrations of prolactin, human placental lactogen, oestradiol and progesterone in 57 pregnant insulin-dependent diabetic patients. Fifteen patients had frank retinopathy, of whom eight showed a marked increase in retinopathy. The initial blood glucose levels were significantly higher in patients whose retinopathy progressed, whereas during the second and third trimester similar blood glucose levels were achieved in all groups. Serum concentrations of progesterone and human placental lactogen were significantly increased in diabetic patients during the last trimester when compared with those in normal pregnancies, and during the second trimester, patients with retinopathy showed significantly higher concentrations than those without, but no significant difference was found in oestradiol values. The eight patients with progressive retinopathy showed progesterone, human placental lactogen and oestradiol levels at or above the upper limit of the normal range. Throughout gestation, serum prolactin concentrations were significantly lower in diabetic patients than in healthy subjects. No correlation was found between serum prolactin values and the occurrence of retinopathy.Key words: Diabetes mellitus, diabetic pregnancy, diabetic retinopathy, metabolic control, human placental lactogen, progesterone, oestradiol, prolactin.Progression of diabetic retinopathy has been reported in 3%-29% of diabetic pregnancies [I, 3, 10, 11]. The main factors responsible for diabetic retinopathy are thought to be metabolic. During pregnancy, however, an increase in diabetic vasculopathy could also be related to the rapid and marked changes that occur with advancing gestation in the serum patterns of some steroid and protein hormones. In order to establish a possible correlation between progression of retinopathy, metabolic control and the hormonal status in pregnant diabetic patients, a prospective follow-up study comparing mean blood glucose levels and serum concentrations of prolactin, human placental lactogen, oestradiol and progesterone in patients with and without retinopathy, was performed. Patients and MethodsFifty-seven pregnant patients with Type 1 (insulin-dependent) diabetes treated at the I and II Departments of Obstetrics and Gynaecology of the Helsinki University Central Hospital in [1978][1979] were included in the study. In order to achieve good diabetic control, most patients were admitted to the obstetric ward for a short stay during the first trimester, usually between weeks 8 and 12 of pregnancy. All the patients were admitted to hospital during week 24, and from week 32 until delivery. Between these admissions, the patients were seen on an out-patient basis every second week and further admitted when needed.Ophthalmological examination, including direct and indirect ophthalmoscopy and colour photography of the fundus, was performed by one of the authors at the end of the first and second trimester, ...

Progression of Retinopathy in Type 1 Diabetic Women During Pregnancy

“…Placental growth hormone (PGH) is known to replace pituitary growth hormone progressively in the maternal circulation from mid-gestation [109]. During pregnancy, the circulating concentrations of progesterone and PGH have been found to be increased in patients with PDR [110]. Placental growth hormone is also known to be a major regulator of maternal IGF-1 [111].…”

Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women Treated With Insulin Lispro

“…The duration of diabetes before onset of pregnancy is the prime risk factor for the presence, severity, and progression of retinopathy during pregnancy (4). Progression of retinopathy is also associated with early onset of diabetes, high retinopathy level and suboptimal glycemic control before pregnancy, and rapid normalization of hyperglycemic blood glucose levels during pregnancy, hypertension, proteinuria, and nulliparity (5)(6)(7)(8)(9)(10).…”

Diabetic Retinopathy and Sex Hormones

“…A study by Vargas et al [31] showed that 10% of all pregnancies have complications as a result of diabetes mellitus in United States. The occurrence and progression of retinopathy were related to the mean blood glucose levels and the serum concentrations of prolactin, human placental lactogen, estradiol and progesterone in pregnant insulin-dependent diabetic patients was shown by Larinkari J et al [11]. Throughout gestation, serum prolactin concentrations were significantly lower in diabetic patients than in healthy subjects.…”