Diabetic Retinopathy In Pregnancy Research Articles

Fetal weight and progression of diabetic retinopathy

Objective: To test the hypothesis that progression of diabetic retinopathy in pregnancy is associated with reduced fetal growth and related neonatal morbidity. Methods: Women with type 1 diabetes ( n = 205) were enrolled before 14 weeks’ gestation in a prospective study of diabetes in pregnancy and treated with intensive insulin therapy. They had serial ophthalmologic evaluations before 20 weeks’ gestation and in late gestation or postpartum. Subjects were divided into two groups based on whether retinopathy progressed (progression group) or remained unchanged (no progression group). Results: Retinopathy progressed in 59 of 205 women (29%) and was associated with advanced White classification ( P = .001): three (5%) were class B, 14 (23%) class C, 24 (41%) class D, and 18 (30%) class F-RF. Reduced fetal growth was associated with progression of retinopathy. Mean birth weight was lower ( P = .02), and more infants were small for gestational age ( P = .02) and had low birth weights ( P = .02) in the progression group. More large-for-gestational-age infants were noted in the no-progression group ( P = .04). Birth weight percentile distributions showed a shift of the curve to the left in the progression group ( P = .03). There were no differences in gestational age at delivery, macrosomia, preterm delivery, respiratory distress syndrome, neonatal hypoglycemia, or neonatal death. Small for gestational age was associated with chronic hypertension (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.5, 27.9) and retinopathy progression (OR 4.7; 95% CI 1.2, 23.8). Conclusion: Development and progression of diabetic retinopathy during pregnancy were associated with reduced fetal growth manifested as increased rate of small-for-gestational-age and low-birth-weight infants.

Diabetic retinopathy in pregnancy during tight metabolic control

The relation between retinopathy and the parameters: 24-h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin-dependent diabetes mellitus on tight metabolic control during pregnancy. Prospective study of 112 pregnant women with insulin-dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Arhus University Hospital. Changes in retinopathy were related to 24-h blood pressure, blood glucose, albuminuria, and adverse perinatal outcome. There was an association between grade of retinopathy and HbAlc before (Spearman's rho=0.49, p<0.04) and after pregnancy (Spearman's rho=0.42, p<0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14+/-8 years, range 1-27) than those women with improvement or no progression of retinopathy (19+/-8 years, range 1-36, p<0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied. Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.

Diabetic retinopathy in pregnancy during tight metabolic control

Diabetic retinopathy in pregnancy during tight metabolic control

Plasma levels of endothelin-1 in diabetic retinopathy in pregnancy.

Raised circulating levels of the potent vasoconstrictor endothelin-1 (ET-1) have been demonstrated in diabetes and pregnancy-induced hypertension. Pregnant women with diabetic retinopathy are known to be at a higher risk of developing pregnancy-induced hypertension than those without retinopathy. To examine the association between ET-1, pregnancy, diabetes and diabetic retinopathy, circulating ET-1 levels were measured in each trimester in a cohort of women with and without diabetes during pregnancy. A cohort of women with diabetes (n = 13) and normal controls (n = 8) were followed throughout pregnancy. Detailed clinical and fundoscopic examinations were carried out according to ETDRS protocols. Plasma ET-1 levels were measured in each trimester using a sensitive radioimmunoassay. Those with diabetes were further divided into those with retinopathy (n = 7) and those without (n = 6). Plasma levels of ET-1 increased progressively during normal pregnancy and peaked in the third trimester. Women with diabetes had significantly higher levels of plasma ET-1 (14.0 vs 4.6 pg/ml in the first trimester, 14.0 vs 4.8 pg/ml in the second trimester and 15.8 vs 7.2 pg/ml in the third trimester) compared with those without diabetes. These were no significant differences in plasma ET-1 levels between women with diabetes who had pre-existing diabetic retinopathy and those without. This study has shown that ET-1 levels rise during normal pregnancy, and are higher in women with diabetes, which may reflect pre-existing endothelial damage. Although no association could be demonstrated between diabetic retinopathy and serum ET-1 levels, this may reflect the small sample size in this study.

Diabetic Retinopathy in Pregnancy: Effects on the Natural Course

Pregnancy can cause changes in the functioning of the eye in health and in disease and also affect preexisting ocular conditions, such as diabetic retinopathy. Progression of retinopathy in pregnancy depends on a variety of factors, including severity of retinopathy at conception, adequacy of treatment, duration of diabetes, metabolic control before pregnancy, and the presence of additional vascular damage (ie, preexisting or concomitant hypertensive disorder). Developments in medical, obstetrical, and ophthalmologic management of the pregnant diabetic have greatly improved the prognosis for successful pregnancies and maintaining vision.

Diabetic retinopathy in pregnancy. An overview

Diabetic retinopathy in pregnancy. An overview

A case of severe diabetic retinopathy in pregnancy

Proliferative retinopathy is a recognized long-term complication of diabetes and the commonest cause of blindness in young people. There is, however, some uncertainty regarding counselling given on the continuation of pregnancy when it is complicated by retinopathy. This case is used to highlight this difficulty and to discuss management based on literature review.

Electrophysiologic monitoring of diabetic retinopathy in pregnancy.

The authors studied the correlations between electroretinographic, ophthalmologic, and clinical parameters in 30 pregnant women (20 with diabetes and 10 control subjects). Diabetic patients were divided into two groups: group 1 included 11 cases of insulin-dependent diabetes (IDDM); and group 2 included 6 cases of noninsulin-dependent diabetes (NIDDM) and 3 cases of gestational diabetes (GDM). Adapto-electroretinography (AERG) was used as the main monitoring parameter, and in particular, the relationship between the cone-mediated (b1) and rod-mediated (b2) components of the b wave (b2/b1 ratio) 7 minutes after photobleaching was studied. The results indicate that the b2/b1 ratio can detect functional modifications before the onset of ophthalmoscopically detectable retinopathy. Significant statistical correlations were demonstrated both between the type of diabetes and AERG responses, and between metabolic control (HbA1c values) and AERG alterations. A higher maternofetal complication rate in those patients with severe and frequent AERG alterations during pregnancy also was found.

Progression of diabetic retinopathy in pregnancy: Association with hypertension in pregnancy

International Journal of Gynecology & ObstetricsVolume 39, Issue 4 p. 368-369 Citations from the literature pregnancy and delivery Progression of diabetic retinopathy in pregnancy: Association with hypertension in pregnancy B. Rosenn, B. RosennSearch for more papers by this authorM. Miodovnik, M. MiodovnikSearch for more papers by this authorG. Kranias, G. KraniasSearch for more papers by this authorJ. Khoury, J. KhourySearch for more papers by this authorC.A. Combs, C.A. CombsSearch for more papers by this authorF. Mimouni, F. MimouniSearch for more papers by this authorT.A. Siddiqi, T.A. SiddiqiSearch for more papers by this authorM.J. Lipman, M.J. LipmanSearch for more papers by this author B. Rosenn, B. RosennSearch for more papers by this authorM. Miodovnik, M. MiodovnikSearch for more papers by this authorG. Kranias, G. KraniasSearch for more papers by this authorJ. Khoury, J. KhourySearch for more papers by this authorC.A. Combs, C.A. CombsSearch for more papers by this authorF. Mimouni, F. MimouniSearch for more papers by this authorT.A. Siddiqi, T.A. SiddiqiSearch for more papers by this authorM.J. Lipman, M.J. LipmanSearch for more papers by this author First published: December 1992 https://doi.org/10.1016/0020-7292(92)90313-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume39, Issue4December 1992Pages 368-369 RelatedInformation

Progression of diabetic retinopathy in pregnancy: Association with hypertension in pregnancy

To test the hypothesis that women with insulin-dependent diabetes and chronic or pregnancy-induced hypertensive disorders are at increased risk for developing retinopathic complications during pregnancy. One hundred fifty-four women with insulin-dependent diabetes were prospectively followed in an intensive program of diabetes in pregnancy. Ophthalmologic evaluations were obtained through pregnancy and at 6 to 12 weeks post partum, and findings were graded by a standard scale. Association of retinopathic progression with risk factors was tested with chi 2 and multiple logistic regression analysis. Fifty-one women had progression of retinopathy during pregnancy; postpartum regression was observed in 13 women. Changes in glycemic control early in pregnancy, chronic hypertension, and pregnancy-induced hypertension were significantly associated with progression of retinopathy. Women with insulin-dependent diabetes who have hypertensive disorders in pregnancy are at increased risk for progression of retinopathy.

Diabetic retinopathy in pregnancy

Diabetic retinopathy in pregnancy

122 Diabetic retinopathy in pregnancy: Association with early glycemic control and hypertensive disorders

122 Diabetic retinopathy in pregnancy: Association with early glycemic control and hypertensive disorders

Diabetic retinopathy in pregnancy: A review

Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and follow-up are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months postpartum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy.

Diabetic retinopathy in pregnancy.

The records of 23 insulin-dependent diabetics who had serial ophthalmological examinations during pregnancy and afterwards were reviewed. Fourteen pregnancies occurred in 10 patients with no retinopathy; 30% of these patients had obstetric complications. The mean birthweight was 3.5 kg. Ophthalmological status was unchanged in this group. In eight patients with background retinopathy during 10 pregnancies the obstetric complication rate was 70% and mean birthweight 3.3 kg. During pregnancy there was no evidence of progression of retinopathy. One patient developed proliferative retinopathy 4 years later. Five patients had proliferative retinopathy. The mean age (32 years) and duration of diabetes at index pregnancy (18 years) was greater than for the other groups. All patients developed pre-eclampsia and mean birthweight was 2.8 kg. Four of these patients required argon laser photocoagulation in association with pregnancy for progressive retinopathy; one died subsequently from end-stage diabetic nephropathy; the other four have maintained their pre-pregnancy visual acuity from 4 to 10 years.

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy