Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes.
OBJECTIVE
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 microm 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
Despite a low risk of progression of retinopathy in pregnant women with type 2 diabetes, sight-threatening deterioration did occur.
Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark. katrinespostkasse@gmail.com
K L
KL
Rasmussen
C S
CS
Laugesen
L
L
Ringholm
M
M
Vestgaard
P
P
Damm
E R
ER
Mathiesen
D000328:Adult; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D012720:Severity of Illness Index; D014792:Visual Acuity