Changes in Diabetic Retinopathy During Pregnancy Correlations With Regulation of Hyperglycemia

Phelps, Richard; Sakol, Peter; Metzger, Boyd E.; Jampol, Lee M.; Freinkel, Norbert

doi:10.1001/archopht.1986.01050240080044

Cited by 127 publications

(65 citation statements)

References 15 publications

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“…It is well established that strict metabolic control prevents progression of retinopathy in type 1 [24] and type 2 diabetes [25]. However, it has been reported that a minority of diabetic patients with type 1 diabetes can develop significant sight-threatening deterioration of diabetic retinopathy in association with initiation of strict glycaemic control in the pregnant [26] and in the non-pregnant state [27]. In the long run, it seems that even these patients with early worsening of retinopathy benefit from strict metabolic control [28].…”

Section: Discussionsupporting

confidence: 40%

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: Discussionsupporting

confidence: 40%

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

et al. 2010

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“…Values are n (%) a Changes regressed in one patient after the first year b All patients who received laser therapy had early NPDR at baseline Diabetic retinopathy may be adversely affected during pregnancy by major changes in distribution of blood flow, an increase in cardiac output as well as hormonal changes including increased IGF-1 levels [17,18]. In addition, sudden improvement in glycaemic control induces a decrease in retinal blood flow, secondary hypoxia and thus worsening of retinopathy [19,20].…”

Section: Discussionmentioning

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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“…22 In addition, sudden improvement in glycaemia control induces a decrease in the retinal blood flow, with resultant hypoxia and worsening of retinopathy. 23,24 Intensive therapy is associated with a better perinatal outcome; but it may cause worsening of the retinopathy. But it is stated in NICE guideline that Diabetic retinopathy should not be considered a contraindication to rapid optimization of glycaemic control in women who present with a high HbA1c in early pregnancy.…”

Section: Metabolic Controlmentioning

confidence: 44%

Diabetic Retinopathy in Pregnancy: A Review

Ruman

Afrin

Chowdhury

et al. 2016

Bangladesh J Obstet Gynaecol

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Pregnancy in a diabetic woman brings about many changes that can lead to the development of diabetic retinopathy (DR) or worsening of pre-exi ing disease. In some patients this may develop into sight threatening disease, which if not treated adequately, can cause deva ating visual impairment. There is a lack of e ablished guidelines for screening these patients during pregnancy. In this article we discuss the physiological changes during pregnancy that contribute to worsening of diabetic retinopathy and review the relative contribution of risk factors to the underlying pathological processes. It is important to identify and treat any preexi ing retinopathy in diabetic women considering pregnancy and optimise glycaemic control prior to conception. Rapid tightening of glycaemic control after conception is associated with a less favourable outcome. Based on the exi ing literature we sugge guidelines for diabetic retinopathy screening for women during pregnancy. E ablished sight-threatening retinopathy should be treated at an earlier age in pregnant women compared to non-pregnant diabetics with a similar disease.Bangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 37-42

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Changes in Diabetic Retinopathy During Pregnancy Correlations With Regulation of Hyperglycemia

Cited by 127 publications

References 15 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

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

Diabetic Retinopathy in Pregnancy: A Review

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