Progression of Retinopathy in Type 1 Diabetic Women During Pregnancy

Abstract

Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. The pathogenetic mechanisms of DR progression during pregnancy are not fully understood. Several factors related to metabolic changes (hyperglycaemia), diabetes itself (duration of diabetes before conception, baseline status of DR), pregnancy physiology (hypervolaemia and hypercoagulation, impaired retinal autoregulation) and pregnancy complications (pre-eclampsia) seem to play important roles in the progression of DR during pregnancy. On the other hand, systemic angiopoietic and vasoactive factors seem to have minor role in the deterioration of DR during that time period. Good glycaemic control, normotension, lack of nephropathy as well as lack of pre-proliferative/proliferative changes of DR are good prognostic factors as regards the progression of DR during pregnancy. However, pregnancy seems to have no long-term detrimental effects as regards the progression of DR unless it has proceeded to pre-proliferative and proliferative phases.

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

“…The pathophysiological factors involved in pregnancyinduced progression of retinopathy [1] are probably similar in type 1 and type 2 diabetes.…”

“…Pregnancy-induced deterioration of diabetic retinopathy is well described in type 1 diabetes [1]. The risk of progression of diabetic retinopathy during pregnancy is generally regarded to be similar for type 1 and type 2 diabetic patients, but data supporting this assumption are few.…”

Maternal immune system adaptation to pregnancy - a potential influence on the course of diabetic retinopathy

“…Numerous studies have formerly demonstrated a deterioration of retinopathy in diabetic women during pregnancy [2-4]. Although many researchers have succeeded to clarify the connection between retinopathy development and gestation, the exact mechanism responsible for this is still not entirely clear [2-9]. The consensus is that this mechanism is multifactorial with important contributory factors including hyperglycaemia [3,4,7,8], duration of diabetes before conception [3,4], baseline status of retinopathy [3,4,8], rapid control of blood glucose during pregnancy [3,8], coexisting hypertension [2], preeclampsia [9] and changes in retinal blood flow [9].…”

“…Several studies have been conducted in order to explain the mechanisms underlying the progression of diabetic retinopathy during pregnancy [2-9]. After adjusting to the duration of diabetes, preexisting retinopathy prior to conception, glycaemic and blood pressure control, current pregnancy was found to be an important risk factor in retinopathy progression.…”

“…After adjusting to the duration of diabetes, preexisting retinopathy prior to conception, glycaemic and blood pressure control, current pregnancy was found to be an important risk factor in retinopathy progression. However, the exact mechanism by which this progression occurs is not entirely clear [2-9]. Capillary occlusion represents a characteristic pathologic feature in early diabetic retinopathy and is presumed to cause capillary non-perfusion, endothelial cell damage and initiate a blood-retinal barrier breakdown as well as neovascularisation [20] [Figure 1].…”