Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes
Version of Record online: 7 APR 2010
© 2010 The Authors. Journal compilation © 2010 Diabetes UK
Volume 27, Issue 4, pages 431–435, April 2010
How to Cite
Vestgaard, M., Ringholm, L., Laugesen, C. S., Rasmussen, K. L., Damm, P. and Mathiesen, E. R. (2010), Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes. Diabetic Medicine, 27: 431–435. doi: 10.1111/j.1464-5491.2010.02958.x
- Issue online: 7 APR 2010
- Version of Record online: 7 APR 2010
- Accepted 23 December 2009
- diabetic macular oedema;
- diabetic retinopathy;
- Type 1 diabetes and pregnancy
Diabet. Med. 27, 431–435 (2010)
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 16 years (range 1–36) and HbA1c 6.7% (4.9–10.8) in early pregnancy. Fundus photography was performed at 8 and 27 weeks. 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.