Diabetic Retinopathy In Pregnancy Research Articles

Determinants of progression of diabetic retinopathy in pregnancy

AimsTo assess the rate of diabetic retinopathy (DR) progression in an Australian cohort and to identify the determinants of DR progression in pregnancy. MethodsA total of 367 pregnancies of women with Type 1 or 2 diabetes mellitus attending King Edward Memorial Hospital, Western Australia, between June 2020 and July 2023 were included. These women were screened for the presence and severity of DR in the first trimester and/or at 28–32 weeks gestation via retinal imaging with a DRS camera. ResultsDR was seen in 121 (33 %) pregnancies at baseline and DR progression was seen in 62 (17 %) pregnancies. Only 11 (4 %) women with no baseline DR developed DR and none of these progressed to more than moderate non-proliferative DR. A total of 51 (42 %) women with baseline DR had DR progression. The presence of baseline DR was the only significant predictor for DR progression on multivariate analysis (OR 9.88 (4.43–22.07), p < 0.001). ConclusionsWomen without DR at baseline are unlikely to progress to more severe forms of DR and usually do not require treatment. The presence of DR at baseline screening during pregnancy is a strong predictor of DR progression during pregnancy.

Prevalence of diabetic retinopathy in women with pregestational diabetes during pregnancy and the postpartum.

Diabetic retinopathy (DR) may be affected by pregnancy. The majority of prevalence data regarding DR in pregnancy predate the advent of contemporary guidelines for diabetes management during pregnancy. This study reports DR prevalence and associated risk factors in women with pregestational diabetes during pregnancy and the postpartum in Australia. A total of 172 pregnant women with type 1 (T1DM) or type 2 diabetes diagnosed pre-pregnancy were prospectively recruited from two obstetrics hospitals in Melbourne (November 2017-March 2020). Eye examinations were scheduled in each trimester, at 3-, 6-, and 12-months postpartum. DR severity was graded from two-field fundus photographs by an independent grader utilising the Airlie House Classification. Sight-threatening DR (STDR) was defined as the presence of diabetic macular oedema or proliferative DR. Overall, 146 (84.9%) women had at least one eye examination during pregnancy. The mean age was 33.8 years (range 19-51), median diabetes duration was 7.0 years (IQR 3.0-17.0), 71 women (48.6%) had T1DM. DR and STDR prevalence during pregnancy per 100 eyes was 24.3 (95% CI 19.7-29.6) and 9.0 (95% CI 6.1-12.9); while prevalence in the postpartum was 22.2 (95% CI 16.5-29.3) and 10.0 (95% CI 5.4-17.9), respectively. T1DM, longer diabetes duration, higher HbA1c in early pregnancy, and pre-existing nephropathy were significant risk factors. The prevalence of DR in pregnant women was similar to the non-pregnant diabetic population in Australia. One in nine participants had STDR during pregnancy and the postpartum, highlighting the need to optimise DR management guidelines in pregnancy given the significant risk of vision loss.

Diabetic Retinopathy in Pregnancy

Diabetic Retinopathy in Pregnancy

Diabetic retinopathy in pregnancy - A review.

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.

Study of progression of diabetic retinopathy in pregnancy &amp; its correlation with glycemic control in a tertiary health care center in state of Odisha

Study of progression of diabetic retinopathy in pregnancy &amp; its correlation with glycemic control in a tertiary health care center in state of Odisha

Clinical features of diabetic retinopathy in pregnancy

Pregnancy is a risk factor for progression of diabetic retinopathy (DR). Despite the common opinion about the regression of DR after childbirth, it is possible for the disease to progress aggressively, which can cause loss of visual functions when treated untimely. To present clinical cases with different course of development of DR in pregnant women with type 1 diabetes mellitus (DM1). Five pregnant women with DM1 lasting more than 8 years were examined. Glycemic level of all patients was higher than normal (glycated hemoglobin (HbA1c) of more than 6.1%). Ophthalmologic examination was carried out including fundus photography, optical coherence tomography (OCT) of the macular area, Angio-OCT. The most significant factors in the progression of DR in pregnant women are DR1 compensation, severity and stabilization of DR during the preconception period, presence of a concomitant pathology. Timely detection of signs of progression of DR and therapeutic measures taken during pregnancy, in particular laser coagulation, were shown to stabilize the course of the disease and prevent loss of vision in pregnant women with DM1. Clinical course of DR in pregnancy can vary between absence of manifestation, stabilization, and progression. Progression of DR during pregnancy is determined by a number of factors including compensation of DM during the preconception period and throughout pregnancy, severity and stabilization of retinopathy during the preconception period, and presence of a concomitant pathology. Timely detection of the signs of DR progression and its treatment, in particular laser coagulation of the retina, can help stabilize the course of the disease during pregnancy. The course of DR may be aggressive in some pregnant women involving progression in the postpartum period, which warrants active monitoring of patients with retinopathy after childbirth.

Advanced Diabetic Eye Disease in Pregnancy

Women with pre-gestational diabetes are at risk of progression of diabetic retinopathy during the pregnancy. The adverse effects of pregnancy on retinal status persist into the first year postpartum. Diabetic eye disease may develop for the first time during pregnancy, and visual impairment at this stage has serious implications for both the patient and her family. Established sight-threatening retinopathy should be treated at an earlier stage in pregnant women compared to non-pregnant diabetics with a similar disease. This case report highlights a case of diabetic retinopathy in pregnancy which progressed rapidly and was successfully treated with timely surgical intervention resulting in good final visual outcome. J Clin Gynecol Obstet. 2018;7(3-4):72-75 doi: https://doi.org/10.14740/jcgo487w

Diabetic Retinopathy and Pregnancy

Purpose: analysis of clinical cases of different course of diabetic retinopathy in pregnancy.Patients and methods. The article presents 5 clinical cases of different course of diabetic retinopathy in pregnancy: absence of manifestation, stable course and progression to macular edema and aggressive proliferation.Results. The reasons for progression of diabetic retinopathy during pregnancy were analyzed. The most important were the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity of retinopathy, and the presence of concomitant pathology. It is emphasized that timely detection of progression signs of retinopathy and laser coagulation during pregnancy makes it possible to stabilize the course of disease and improve visual prognosis. Thus, the monitoring of pregnant women with diabetes mellitus requires an individual approach and careful dynamic observation during pregnancy and in postpartum period. Timely laser coagulation in progression of retinopathy can contribute to preservation of visual functions.Conclusions. Clinical course of diabetic retinopathy in pregnancy is variable: no manifestation, stabilization, progression. Progression of diabetic retinopathy during pregnancy is determined by many factors, in particular, the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity and stabilization of retinopathy as results of treatment in preconception period, the presence of concomitant pathology. Timely detection of signs of diabetic retinopathy progression and its treatment, particularly laser coagulation of the retina, during pregnancy allows stabilizing the course of disease. There may be an aggressive course of diabetic retinopathy with progression in postpartum period, in connection with which, active monitoring of patients with retinopathy after childbirth is required.

Diabetes and Pregnancy

Diabetes and Pregnancy

Diabetic Retinopathy in Pregnancy: A Review

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

Diabetic retinopathy in pregnancy: a review.

The prevalence of diabetes in pregnancy is increasing. Pre-existing diabetes is present in 1 in 167 pregnancies in Australia, divided equally between type 1 and type 2 diabetes. Diabetic retinopathy is a leading cause of blindness in women during their childbearing years, and pregnancy increases the short-term risk of diabetic retinopathy progression. We examine the risk factors for progression of diabetic retinopathy during pregnancy including duration of diabetes, baseline level of retinopathy, level of glycaemic control and hypertension. We also examine current screening and management guidelines and their levels of evidence, current treatment options for diabetic retinopathy and avenues for further research.

Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes.

The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks (n = 307) were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at prepregnancy care was associated with receiving adequate screening (odds ratio 6.23; CI 3.39–11.46 (P < 0.001)). Among those who received adequate evaluations (n = 185), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.01–1.06, P = 0.02) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.09–3.87, P = 0.03) significantly increased the odds of progression. A significant proportion of women continue to demonstrate retinopathy progression during pregnancy. This study highlights the role of prepregnancy care and the importance of close monitoring during pregnancy and identifies those patients at the highest risk for retinopathy progression.

Screening for diabetic retinopathy in pregnancy using photographic review clinics

To assess the efficacy and value of the National Institute for Health and Clinical Excellence guidelines for digital photographic screening for diabetic retinopathy in pregnancy using photographic review clinics. Pregnant patients (n = 186) with known diabetes were screened at first antenatal visit and at 28 weeks' gestation, if no retinopathy was noted at first visit, or at other intervals if retinopathy was present. Two 45° images (disc-centred and macula-centred views) were taken in both eyes and graded by trained graders and by an ophthalmologist. Ninety-three patients (50%) remained free of diabetic retinopathy throughout pregnancy. Eighteen (10%) presented with sight-threatening retinopathy at their first antenatal screen and were referred to the hospital eye service. Fifty patients (27%) were shown to have relatively stable retinopathy throughout pregnancy, with only two patients deteriorating and requiring referral to hospital eye service. Twenty-three (12%) failed to complete the screening protocol after their first screen. The study showed that pregnant patients screened for retinopathy in an ophthalmic photographic diabetic review clinic achieved National Institute for Health and Clinical Excellence guidelines in the majority and were clinically safe. Only 1% of patients required referral to ophthalmology after their initial screen, thus avoiding unnecessary hospital eye service appointments.

Monitoring diabetic retinopathy in pregnancy: meeting the NICE guidelines

Monitoring diabetic retinopathy in pregnancy: meeting the NICE guidelines

Diabetic Retinopathy in Pregnancy

Pregnancy in a diabetic woman brings about many changes that can lead to the development of diabetic retinopathy (DR) or worsening of pre-existing disease. In some patients this may develop into sight threatening disease which, if not treated adequately, can cause devastating visual impairment. There is a lack of established 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 pre-existing 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 existing literature we suggest guidelines for diabetic retinopathy screening for women during pregnancy. Established sight-threatening retinopathy should be treated at an earlier stage in pregnant women compared to non-pregnant diabetics with a similar disease.

Progression of retinopathy during pregnancy in type 1 diabetes mellitus

The incidence and risk factors for progression of retinopathy during pregnancy in women with type 1 diabetes mellitus were retrospectively evaluated. Fifty-four insulin-dependent diabetic patients at a teaching hospital in Saudi Arabia were followed throughout the pregnancy/puerperium with serial ophthalmic examination. Dilated fundus examination was performed in each trimester and puerperium. Progression of diabetic retinopathy in the study occurred in 13/54 (24%) patients--2/22 (9.1%) patients had no diabetic retinopathy initially, 4/20 (20%) had non-proliferative diabetic retinopathy (NPDR) and 7/12 (58.3%) had proliferative diabetic retinopathy (PDR). Of the eight patients with PDR who had no laser treatment before pregnancy, six (75%) showed progression but only one of the four patients who had PDR and laser treatment prior to pregnancy experienced progression of retinopathy. Eight patients in total received panretinal photocoagulation to arrest the progression of retinal disease during pregnancy and only one of them had laser treatment prior to pregnancy. Laser photocoagulation for severe NPDR or early PDR prior to pregnancy may protect against rapid progression of PDR. Visual impairment resulting from progression of PDR can be prevented by aggressive laser treatment during pregnancy. Duration of diabetes>15 years, poor glycaemic control and hypertension are high-risk factors in the progression of diabetic retinopathy in pregnancy.

This issue of Acta

This issue of Acta emphasizes retinal disease, with a particular focus on the development of new treatment modalities. Two editorials − by Morten la Cour and Anders Kvanta, respectively − deal with emerging new treatments. Our review article is a critical appraisal of new therapies for neovascular age-related macular degeneration and is written by Italian and American ophthalmologists. The cover figure shows a magnetic resonance image of a large inclusion cyst in the orbit (see Hussin et al.). Martin Vinten and colleagues, in Copenhagen, report that intravitreal triamcinolone constricts the retinal blood vessels. This pharmacological effect of triamcinolone may be important in its mechanism of action in diabetic macular oedema and other diseases. Ålborg's Knudsen documents the thickness of the macular region in normal subjects and those with diabetes with and without macular oedema and demonstrates that thickness measurements can indeed be used to diagnose diffuse macular oedema. Neubauer et al., based in Munich and Thessaloniki, describe findings of a correlation between fluorescein leakage and retinal thickening on optical coherence tomography in patients with diabetic macular oedema. Eydís Ólafsdottir and associates, in Iceland and Sweden, report on the diabetes population in the Laxå community in Sweden, where screening for both diabetes mellitus and diabetic eye disease has created an optimal situation for the prevention of diabetic blindness. Helsinki's Sirpa Loukovaara et al. continue their study on diabetic retinopathy in pregnancy and find that progression of retinopathy is associated with a low concentration of glycodelin, a glycoprotein secreted from endometrial glands and involved with the immune response. Parodi et al., Trieste, describe atrophic changes in the retinal pigment epithelium following photodynamic therapy in myopic individuals. Osaka-based Arimura et al. have developed novel charts to evaluate metamorphopsia and claim to be able to quantify metamorphopsia in patients with macular hole. The letters to the editor include a description from German authors Spandau et al. of the use of intravitreal bevacizumab (Avastin®) for branch retinal vein occlusion and age-related macular degeneration. Meanwhile, Kernt et al., Munich, find intravitreal bevacizumab to be safe in terms of intraocular and blood pressure. Writing from Odense, Pedersen et al. report a case of choroidal metastasis in multiple endocrine neoplasia. Helsinki-based Raivio et al. used transscleral cyclocoagulation combined with anterior retinal cryocoagulation in patients with neovascular glaucoma with good results. Bjärnhall et al., in Uppsala and Hiroshima, measured the mean transit time of fluorescein in the retinal circulation of patients with primary open-angle glaucoma and normal-tension glaucoma. They report findings of a correlation between neuronal atrophy and circulation that was similar in both types of glaucoma. Spanish authors Ferreras et al. continue the search for the optimum diagnostic criteria in glaucoma and suggest that frequency doubling perimetry may be helpful. Ozturk et al., writing from Turkey, report their findings that brimatoprost and Cosopt® are similar in their ability to lower intraocular pressure and both are well tolerated. Thomas Olsen, in Århus, finds that the optical coherence interferometry of the Zeiss IOLMaster increases the accuracy of intraocular lens (IOL) power calculations. Budapest's Kovács et al. deal with IOL power calculation in combined cataract and vitreous operations and point out that macular thickness must be taken into account in preoperative calculations. Langenbucher et al., of Erlangen-Nürnberg, may provide more mathematics than most readers of Acta enjoy, but present a comprehensive calculation scheme for retinal image size after implantation of toric (IOLs). Japanese authors Miyata et al. suggest that sharp IOL edges are required to prevent posterior capsular opacification and do not induce anterior capsular contraction. Writing from Sweden, Fagerholm et al. describe a new type of corneal opacities in a small Swedish family. Fernández de Castro and associates, South Carolina, USA, report that ocular wavefront aberrations vary greatly from subject to subject and treatment must be carefully individualized. Denmark-based Sirbikaite and Ehlers' letter to the editor points out the usefulness of Lacrytest® for semiquantitative diagnosis of ocular allergens. Ziylan et al., in Turkey, highlight the risk of isoamitropic amblyopia in highly hyperopic children and describe the use of spectacles for treatment. Lübeck's von Buelow et al. describe a case of systemic bevacizumab (Avastin®) treatment for a retinal haemangioma.

Increased serum IGF-I during pregnancy is associated with progression of diabetic retinopathy.

The IGF system has been associated with development and progression of diabetic retinopathy. We examined whether a simple measurement of the IGF system (serum total IGF-I) correlated with progression of diabetic retinopathy in pregnancy in type 1 diabetes. A prospective observational study was performed in 103 pregnant women with type 1 diabetes. Serum IGF-I was measured in maternal serum from week 14, every fourth week until week 30, and every second week until delivery. Twenty-four-hour blood pressure was measured with a portable oscillometry monitor. The women had visual acuity testing and fundus photography before pregnancy, once in each trimester, and 4 months after birth. Each eye was assigned an overall retinopathy grade on a scale from 1 to 6 independently by two experienced graders. During pregnancy, serum IGF-I increased with increasing gestational age until a plateau was reached in week 32. Progression of retinopathy was significantly associated with a higher level of IGF-I (P < 0.01). Serum IGF-I increased with increasing progression of retinopathy. Change of retinopathy was significantly associated with level of IGF-I (P < 0.01). During pregnancy, serum IGF-I increased with increasing birth weight until a plateau was reached in week 32. Birth weight was significantly associated with a higher level of serum IGF-I (P < 0.01).

Fetal Weight and Progression of Diabetic Retinopathy

In Brief 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. Progression of diabetic retinopathy during pregnancy was associated with reduced fetal growth.

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.