Pregnancy‐induced sight‐threatening diabetic retinopathy in women with Type 1 diabetes

Vestgaard, Marianne; Ringholm, Lene; Laugesen, Caroline Schmidt; Rasmussen, Kirsten; Damm, Peter; Mathiesen, Elisabeth R.

doi:10.1111/j.1464-5491.2010.02958.x

Cited by 106 publications

(102 citation statements)

References 27 publications

(61 reference statements)

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“…In early pregnancy the majority of women had no or mild retinal changes, which is comparable to previous reports on women with type 1 diabetes with similar duration of diabetes [14,15]. The risk of progression of diabetic retinopathy in women with type 2 diabetes in the current study seems to be lower than in women with type 1 diabetes [15].…”

Section: Discussionsupporting

confidence: 76%

“…Presence of macular oedema in early pregnancy in women with type 1 diabetes has been associated with sight-threatening deterioration of retinopathy during pregnancy [14]. It is therefore surprising that the two women with macular oedema in early pregnancy in the current study regressed during pregnancy.…”

Section: Discussioncontrasting

confidence: 40%

“…This relation to diabetes duration is also seen in type 1 diabetes [18,29,30]. Taking into account that the known duration of diabetes was shorter in this population of pregnant women with type 2 diabetes and comparing the retinopathy data of a population of pregnant women with type 1 diabetes investigated by the same method in the same centre [14], we estimate that the risk of progression of diabetic retinopathy is comparable in type 1 and type 2 diabetes.…”

Section: Discussionmentioning

confidence: 86%

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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: 76%

Section: Discussioncontrasting

confidence: 40%

Section: Discussionmentioning

confidence: 86%

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

et al. 2010

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“…Presence of diabetic retinopathy at inclusion was routinely assessed by photo screening, which was evaluated by one experienced ophthalmologist [7].…”

Section: Methodsmentioning

confidence: 99%

A high concentration of prorenin in early pregnancy is associated with development of pre-eclampsia in women with type 1 diabetes

et al. 2011

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Aims/hypothesis The aim of this study was to investigate whether components of the renin-angiotensin system and semicarbazide-sensitive amine oxidase (SSAO) are associated with the development of pre-eclampsia in women with type 1 diabetes. , p=0.06) at 8 weeks compared with women without pre-eclampsia. Levels of renin, angiotensinogen and ACE did not differ in the two groups. Throughout pregnancy, prorenin and SSAO levels were 30% (p=0.004) and 16% (p=0.04) higher, respectively, in women developing pre-eclampsia. Using multivariate logistic regression analysis, prorenin concentration at 8 weeks was associated with pre-eclampsia .0], p=0.007), i.e. an increase of prorenin of 100 ng angiotensin I ml −1 h −1 implies a 4.4 times higher risk of subsequent pre-eclampsia. Conclusions/interpretation In type 1 diabetic women with pre-eclampsia, a higher concentration of prorenin in early pregnancy and higher levels of prorenin and SSAO throughout pregnancy were seen.

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“…In addition to protecting kidney function, focus on diabetic retinopathy is important in these women because progression to severe diabetic retinopathy is prevalent during pregnancy (61,62). Notably, higher BP and diabetic nephropathy in early pregnancy may be associated with progression to sight-threatening diabetic retinopathy (62).…”

Section: Diabetic Retinopathymentioning

confidence: 99%

Obstetric Nephrology

Mathiesen

Ringholm

Feldt‐Rasmussen

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryThis review highlights factors of importance for the clinical care of pregnant women with pregestational diabetes and microalbuminuria or diabetic nephropathy with particular focus on the role of intensive antihypertensive treatment during pregnancy. Most information in the literature comes from women with type 1 diabetes and diabetic nephropathy, but this is probably also valid for women with type 2 diabetes. Careful counseling of women with diabetic nephropathy before pregnancy with estimation of the risk for the mother and fetus is important. Pregnancy does not result in worsening of kidney function in women with diabetic nephropathy and normal serum creatinine, but pregnancy complications such as pre-eclampsia and preterm delivery are common. Intensive metabolic control before and during pregnancy, low-dose aspirin from 12 gestational weeks onward, and intensive antihypertensive treatment are important. Methyldopa, labetalol, and nifedipine are regarded safe in pregnancy, whereas angiotensin converting enzyme inhibitors, AngII antagonists, or statins should be paused before pregnancy. Case series and pathophysiological studies support the use of a stringent goal for BP and albumin excretion in pregnant women with diabetic nephropathy. Screening for diabetic retinopathy before and during pregnancy is mandatory and laser treatment should be performed if indicated. Pregnancy outcome in women with diabetic nephropathy has improved considerably with a take-home-baby rate of approximately 95%. Further research on the benefits and risks of intensive antihypertensive treatment in this population is needed.

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Pregnancy‐induced sight‐threatening diabetic retinopathy in women with Type 1 diabetes

Abstract: Loss of visual acuity and the need for laser treatment during diabetic pregnancy remain clinical problems associated with presence of macular oedema, visual impairment and higher blood pressure in early pregnancy.

Cited by 106 publications

References 27 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

A high concentration of prorenin in early pregnancy is associated with development of pre-eclampsia in women with type 1 diabetes

Obstetric Nephrology

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