Research Article 
Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes
M. Vestgaard, L. Ringholm, C. S. Laugesen, K. L. Rasmussen, P. Damm and E. R. Mathiesen
Diabetic Medicine, 2010, 27(4), 431-435.
Abstract
Aims To determine the progression of diabetic retinopathy in pregnant women with diabetes offered tight glycaemic and blood pressure control.
Methods A prospective study of 102 (87%) out of 117 consecutive pregnant women with Type 1 diabetes for median 16years (range 1–36) and HbA1c 6.7% (4.9–10.8) in early pregnancy. Fundus photography was performed at 8 and 27weeks. Retinopathy was classified in five stages. Diabetic macular oedema was classified as present in a mild form or as clinically significant macular oedema (CSMO). Progression was defined as at least one stage of deterioration of retinopathy and/or development of macular oedema in at least one eye. Sight-threatening progression was defined as loss of visual acuity ≥0.2 on Snellen's chart or laser treatment performed during pregnancy due to proliferative retinopathy or CSMO.
Results Diabetic retinopathy was present at inclusion in at least one eye in 64 (63%) women and proliferative retinopathy and macular oedema were present in nine and 16 women, respectively. Progression of retinopathy occurred in 28 (27%) women. Sight-threatening progression occurred in six women; in three, visual acuity deteriorated and four required laser treatment. Sight-threatening progression was associated with presence of macular oedema (P=0.007), impaired visual acuity (P=0.03) and higher blood pressure (P=0.016) in early pregnancy, but not with HbA1c, decline in HbA1c, or prevalence of severe hypoglycaemia.
Conclusions 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.
ASCI-ID: 109-245
Similar Articles
Spontaneous resolution of diabetic macular oedema after discontinuation of thiazolidenediones
Diabetic Medicine, 2008, 25(7), 860-862. DOI: 10.1111/j.1464-5491.2008.02491.x
Risk factors for diabetic retinopathy in a South Indian Type 2 diabetic population—the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4Diabetic Medicine, 2008, 25(5), 536-542. DOI: 10.1111/j.1464-5491.2008.02423.x
Health utility values associated with diabetic retinopathyDiabetic Medicine, 2008, 25(5), 618-624. DOI: 10.1111/j.1464-5491.2008.02430.x
The Y402H variant of complement factor H is associated with age-related macular degeneration but not with diabetic retinal disease in the Go-DARTS studyDiabetic Medicine, 2009, 26(5), 460-465. DOI: 10.1111/j.1464-5491.2009.02719.x
Long-term impact of retinal screening on significant diabetes-related visual impairment in the working age populationDiabetic Medicine, 2009, 26(5), 489-492. DOI: 10.1111/j.1464-5491.2009.02718.x
Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programmeDiabetic Medicine, 2009, 26(10), 1040-1047. DOI: 10.1111/j.1464-5491.2009.02820.x
Is risk of diabetic retinopathy lower in Australia’s Greek-born migrants?Diabetic Medicine, 2010, 27(6), 660-665. DOI: 10.1111/j.1464-5491.2010.03005.x
Retinal microaneurysm count predicts progression and regression of diabetic retinopathy. Post-hoc results from the DIRECT ProgrammeDiabetic Medicine, 2011, 28(3), 345-351. DOI: 10.1111/j.1464-5491.2010.03210.x
Increased levels of monokine induced by interferon-γ (Mig) in the vitreous of patients with diabetic retinopathyDiabetic Medicine, 2008, 25(7), 875-877. DOI: 10.1111/j.1464-5491.2008.02466.x
Reliability of screening methods for diabetic retinopathyDiabetic Medicine, 2009, 26(8), 783-790. DOI: 10.1111/j.1464-5491.2009.02778.x
Blood pressure control and awareness among patients with diabetes and hypertension attending a tertiary ophthalmic clinicDiabetic Medicine, 2009, 26(1), 34-39. DOI: 10.1111/j.1464-5491.2008.02614.x
Diabetic retinopathy screening: a systematic review of the economic evidenceDiabetic Medicine, 2010, 27(3), 249-256. DOI: 10.1111/j.1464-5491.2009.02870.x
Socio-economic and ethnic inequalities in diabetes retinal screeningDiabetic Medicine, 2010, 27(3), 282-288. DOI: 10.1111/j.1464-5491.2010.02946.x
Association between alcohol consumption and diabetic retinopathy and visual acuity-the AdRem StudyDiabetic Medicine, 2010, 27(10), 1130-1137. DOI: 10.1111/j.1464-5491.2010.03080.x
Agreement and reasons for disagreement between photographic and hospital biomicroscopy grading of diabetic retinopathyDiabetic Medicine, 2011, 28(6), 741-746. DOI: 10.1111/j.1464-5491.2011.03273.x
Do type 2 diabetes patients without diabetic retinopathy or subjects with impaired fasting glucose have impaired colour vision? The Okubo Color Study ReportDiabetic Medicine, 2011, 28(7), 865-871. DOI: 10.1111/j.1464-5491.2011.03290.x
External quality assurance for image grading in the Scottish Diabetic Retinopathy Screening ProgrammeDiabetic Medicine, 2012, 29(6), 776-783. DOI: 10.1111/j.1464-5491.2011.03504.x
Preferences of people with diabetes for diabetic retinopathy screening: a discrete choice experimentDiabetic Medicine, 2012, 29(7), 869-877. DOI: 10.1111/j.1464-5491.2012.03636.x
Diabetic retinopathy screening: perspectives of people with diabetes, screening intervals and costs of attending screeningDiabetic Medicine, 2012, 29(7), 878-885. DOI: 10.1111/j.1464-5491.2012.03637.x
Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countriesDiabetic Medicine, 2013, 30(4), 387-398. DOI: 10.1111/dme.12119