High rate of diabetic retinopathy seen in pregnant women with diabetes
New findings suggest that the prevalence and progression of diabetic retinopathy (DR) in pregnant women with diabetes has remained higher than in non-pregnant women with diabetes, despite improvements in diabetes management during pregnancy .
Additionally, data show that women with type 1 diabetes (T1D) and type 2 diabetes (T2D) had a similar risk of DR progression during pregnancy.
“Therefore, equal attention should be given to monitoring DR during pregnancy in people already known to have DR, regardless of diabetes type,” wrote study author Lyndell L. Lim, MBBS, DMedSci, Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital.
Previously, the St. Vincent Declaration (SVD) provided an optimized standard of care for pregnant women with diabetes, including reducing the rate of maternal complications and reducing the rate of adverse fetal and neonatal complications.
However, the wide range of reported prevalences of dibaetic retinopathy, as well as its progression, have made it difficult to determine the disease burden and led to a lack of consensus on guidelines for its management.
A systematic review and meta-analysis was conducted from November 2018 to June 29, 2021 in the MEDLINE/Ovid, Embase/Ovid and Scopus databases. The dual objectives of the review were to determine the prevalence of DR in pregnancy and to determine the rate of progression of diabetic retinopathy in pregnancy.
For an analysis of progression, studies were included if DR was assessed at least twice (≤ 22 weeks gestation and up to 12 weeks postpartum) and if they described the change in interval in the participants’ retinopathy status (stable, progressing or regressing).
For the prevalence analysis, the outcomes measured were the number of pregnancies with any DR and proliferative DR (PDR). The review also focused on the prevalence of DR in early pregnancy (≤ 22 weeks gestation) and around delivery (23 weeks gestation to 12 weeks postpartum).
The review included a total of 18 observational studies, involving 1464 pregnant women with T1D and 262 pregnant women with T2D. The overall prevalence of any DR and ROP in early pregnancy was 52.3 (95% CI, 41.9, 62.6; P P <.001 respectively.>
Additionally, the data show that the pooled progression rate per 100 pregnancies for development of new DR was 15.0 (95% CI, 9.9 – 20.8), worsened non-proliferative DR was 31, 0 (95% CI, 23.2, 39.2), progression from NPDR to PDR was 6.3 (95% CI, 3.3, 10.0), and worsened ROP was 37.0 (95% CI, 21.2 – 54.0).
Investigators observed that DR progression rates per 100 pregnancies were similar between T1D and T2D groups (T1D groups: 15.8; 95% CI, 10.5 – 21.9; T2D groups: 9.0 95% CI, 4.9 – 14.8). However, the rate of development of new DR was significantly higher in women with T1DM than in women with T2DM.
“Taken together, these results suggest that women with T1D have a higher risk of developing a new DR during pregnancy, but that once a woman has a DR, her risk of DR progression is similar during pregnancy, regardless of her type of diabetes,” the investigators wrote.
The study, “Global estimates of the prevalence and progression of diabetic retinopathy in pregnant women with pre-existing diabetes,” was published in JAMA Ophthalmology.