High Rate of Diabetic Retinopathy Observed in Pregnant Women with Diabetes

Lyndell L. Lim, MBBS

New findings suggest the prevalence and progression of diabetic retinopathy (DR) in pregnant women with diabetes has remained higher than nonpregnant women with diabetes, despite improvements made in diabetes management during pregnancy.

Moreover, data show 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 those already known to have DR, irrespective of diabetes type,” wrote study author Lyndell L. Lim, MBBS, DMedSci, Centre 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 prevalence of dibaetic retinopathy, as well as its progression, had made it difficult to determine the disease burden and led to a lack of consensus for guidelines regarding its management.

A systematic review and meta-analysis was conducted from November 2018 - June 29 2021 in MEDLINE/Ovid, Embase/Ovid, and Scopus databases. The dual objectives of the review were to determine the prevalence of DR in pregnancy and determine the progression rate of diabteic retinopathy during pregnancy.

For a progression analysis, studies were included if DR was assessed at least twice (≤22 week’s gestation and up to 12 weeks postpartum) and if they described the interval change in participants' retinopathy status (stable, progressed, or regressed).

For the prevalence analysis, the outcomes measured were the number of pregnancies with any DR and proliferative DR (PDR). The review additionally focused on the prevalence of DR at early pregnancy (≤22 weeks’ gestation) and around delivery (from 23 weeks’ gestation to 12 weeks postpartum).

The analysis included a total of 18 observational studies, consisting of 1464 pregnant women with T1D and 262 pregnant women with T2D. The overall prevalence of any DR and PDR in early pregnancy was 52.3 (95% CI, 41.9 - 62.6; P <.001) and 6.1 (95% CI, 3.1 - 9.8; P <.001), respectively.

Further, data show the pooled progression rate per 100 pregnancies for new DR development was 15.0 (95% CI, 9.9 - 20.8), worsened nonproliferative 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 PDR was 37.0 (95% CI, 21.2 - 54.0).

Investigators observed DR progression rates per 100 pregnancies to be similar between the 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 for the development of new DR was substantially higher in women with T1D than T2D.

“Taken together, these findings suggest that women with T1D have a higher risk of developing new DR during pregnancy, but that once a woman has DR, her risk of DR progression is similar in pregnancy irrespective of her diabetes type,” investigators wrote.

The study, “Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Women With Preexisting Diabetes,” was published in JAMA Ophthalmology.