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B. Ha, J. Trang, J. Song, G. Wu; Pregnancy and Diabetic Retinopathy: A Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3540.
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Diabetic retinopathy is a complication of diabetic pregnancies. Approximately 1 in 100 women of childbearing age has diabetes before pregnancy. An additional 4 out of 100 develop diabetes during pregnancy (gestational diabetes) or 14,000 pregnancies each year in the US.
To examine the incidence of diabetic retinopathy progression in diabetic pregnancies in the current literature.
A meta-analysis of all Medline articles about pregnancy and diabetic retinopathy was performed, using search strategy of "diabetic retinopathy AND pregnancy," for the years of 1991-2009. The investigators reviewed these abstracts and reviewed articles that met the inclusion criteria of data available about diabetic retinopathy classification and type of diabetes in pregnancy.
16 articles revealed 1656 diabetic pregnant patients: 1290 IDDM, 164 NIDDM, 202 type DM unknown. Avg age=28.5yrs±4.9. Avg HbA1c prepartum=7.6±2.6. A subgroup of 455 IDDM patients had defined levels of retinopathy. Prepartum: 263 without retinopathy(NDR), 174 Non Proliferative Diabetic Retinopathy(NPDR), and 18 Proliferative Diabetic Retinopathy(PDR). During the pregnancy, 47 patients (10.3%) developed NPDR, 43 patients (9.5%) developed PDR postpartum. Total of 90 patients of the 455 patients (19.8%) had worsening diabetic retinopathy.
This meta-analysis shows that approximately 20% percent of patients have worsening retinopathy. Most of the study patients are Type 1 DM and the classification of the progression of diabetic retinopathy has not been standardized in the non-ophthalmic literature. Thus, in the future, more work is needed to document the progression of diabetic retinopathy in pregnant diabetics, using modern imaging techniques and standardized diabetic retinopathy classification.
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