title: Association of vaginal delivery efforts with retinal disease in women with type I diabetes.
abstract: OBJECTIVE
  To determine whether the second stage of labor affects the progression of retinopathy in women with type I diabetes mellitus (DM). RESEARCH AND DESIGN: The study is a secondary analysis of 192 pregnant women with type I DM who participated in an interdisciplinary diabetes in pregnancy intervention program between 1978 and 1993. Evaluation for diabetic retinopathy (DR) was performed each trimester and 6-12 weeks postpartum by the same two ophthalmologists. Women were divided into three groups: (i) elective cesarean delivery (n = 60), (ii) cesarean delivery prior to the second stage of labor (n = 69) and (iii) vaginal or cesarean delivery in the second stage (n = 63). Progression of DR during pregnancy and between pregnancy and postpartum was compared among the groups.
  
  
  RESULTS
  Maternal demographics, glycemic control and pregnancy complications were similar among groups. Progression of retinopathy from early and late pregnancy to postpartum did not differ between the three groups.
  
  
  CONCLUSIONS
  With close follow-up and good glycemic control, expulsive efforts in the second stage of labor do not affect the progression of retinopathy in women with type I DM. Our data support the premise that pregnant women with type I DM and stable retinopathy should not be denied vaginal delivery, if otherwise not contraindicated.
authors.affiliation: Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC 20010, USA. maisafeghali@gmail.com
authors.forename: Maisa
authors.initials: M
authors.lastname: Feghali
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.forename: David
authors.initials: D
authors.lastname: Shveiky
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002585:Cesarean Section; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000628:therapy; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D012166:Retinal Hemorrhage / Q000209:etiology; D014636:Valsalva Maneuver / Q000502:physiology; D014823:Vitreous Hemorrhage / Q000209:etiology
chemical_list: D001786:Blood Glucose