Background: Pregnancy may adversely affect the progression of diabetic retinopathy and can have serious implications for the pregnant women.
Aim: To asses the impact of pregnancy on the progression of diabetic retinopathy in women with type 1 and type 2 diabetes mellitus and to identify risk factors for the progression of retinopathy during pregnancy.
Methods: 306 diabetic women, 229 (75.4%) with type 1 and 77 (23.9%) with type 2 diabetes, referred to the Diabetes and Pregnancy Unit of the Hospital Virgen del Rocio from January 1995 through February 2004 were studied retrospectively. Dilated fundal examination was performed at booking, second and third trimester. At early postpartum was performed fluorescein angiographies.
Results: Retinopathy at booking was seen in 54 (17.6%). Any women without retinopathy at booking developed retinopathy during pregnancy or in early postpartum. Progression to proliferative retinopathy was seen in one patient (0.32%), while progression to moderate or severe non proliferative retinopathy was found in eight (2.6%). One women developed during pregnancy macular edema (0.32%). Progression of retinopathy was significantly increased in women with duration of diabetes >10 years (6.9% vs 0%, P<0.05). Laser therapy was needed in four (1.3%). Although glycaemic haemoglobin A1C (HbA1c) at booking was higher (7.95±1.81 vs 7.02±1.27) and the fall in HbA1c between booking and 16 weeks was greater (1.66±1.33 vs 1.34±1.08) in those women showing progression of retinopathy, these changes were not significant.
Conclusions: Progression of retinopathy in pregnancy was uncommon, but significantly more frequent in women with duration of diabetes more than 10 years. Laser therapy was necessary in one percent of pregnancies, which is much lower than reported in earlier studies.