Introduction:
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.
Purpose:
To examine the incidence of diabetic retinopathy progression in diabetic pregnancies in the current literature.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: diabetes • diabetic retinopathy • detection