June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Diabetic retinopathy prospective study in pregnant women with pre-existing diabetes in Metropolitan Melbourne
Author Affiliations & Notes
  • Felicia Widyaputri
    Centre for Eye Research Australia, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
    Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
  • Sophie Rogers
    Centre for Eye Research Australia, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  • Alison Nankervis
    Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
    Diabetes and Endocrine Service, Royal Women's Hospital, Parkville, Victoria, Australia
  • Jennifer Conn
    Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
    Diabetes and Endocrine Service, Royal Women's Hospital, Parkville, Victoria, Australia
  • Muhammad Bayu Sasongko
    Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
  • Alexis Shub
    Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
    Department of Obstetrics and Gynaecology, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  • Xavier Fagan
    Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
    Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia
  • Daryl Guest
    Department of Optometry and Vision Sciences, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  • Robert Charles Andrew Symons
    Centre for Eye Research Australia, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
    Department of Optometry and Vision Sciences, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  • Lyndell L Lim
    Centre for Eye Research Australia, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
    Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  • Footnotes
    Commercial Relationships   Felicia Widyaputri, Indonesian Endowment Fund for Education (R); Sophie Rogers, None; Alison Nankervis, None; Jennifer Conn, None; Muhammad Sasongko, None; Alexis Shub, None; Xavier Fagan, None; Daryl Guest, None; Robert Symons, None; Lyndell Lim, Allergen (F), Allergen (C), Bayer (F), Novartis R (R), Novotech (C)
  • Footnotes
    Support  Alfred Felton Bequest and Indonesian Endowment Fund for Education
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1169. doi:
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      Felicia Widyaputri, Sophie Rogers, Alison Nankervis, Jennifer Conn, Muhammad Bayu Sasongko, Alexis Shub, Xavier Fagan, Daryl Guest, Robert Charles Andrew Symons, Lyndell L Lim; Diabetic retinopathy prospective study in pregnant women with pre-existing diabetes in Metropolitan Melbourne. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1169.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Diabetic Retinopathy (DR) may be worsened by pregnancy. Findings from prior studies have been conflicting; many are outdated. Here, we report the prevalence, rate of DR progression and risk factors associated with progression in pregnant women with pre-existing diabetes.

Methods : Prospective longitudinal cohort study of pregnant women with type 1 (T1DM) or type 2 diabetes (T2DM) from two tertiary maternity hospitals in Melbourne, Australia (Nov 2017 - Sept 2019). Eye examinations were scheduled in each trimester and 3-months postpartum. DR severity was graded for each eye from 2-field retinal photographs. At least 2 exams (at early and late pregnancy) were required to evaluate DR change. Progression was defined as worsening by ≥1-step of the Airlie House classification, development of diabetic macular edema (DME), or the need for laser treatment during pregnancy. Sight-threatening (ST) progression was defined as development of proliferative DR (PDR) or DME.

Results : A total of 147 from 191 eligible women (77%) were recruited, with at least one eye exam performed in 130 (88.4%). Mean age was 33.7 years (range 19-47). Sixty-two women (47.7%) had T1DM while 68 had T2DM (median duration 16.5 years and 4 years). DR and STDR prevalence during the study period were 20.8 (CI 16.3-26.1) and 6.6 (CI 4.1-10.4) per 100 eyes, respectively. Among the 144 eyes (72 women) with >1 eye exam, 10/76 (13.2%) and 4/68 (5.9%) from T1DM and T2DM women had DR progression, with an overall progression rate of 9.7%. Six eyes developed new DR. Elevated systolic blood pressure (SBP) (risk ratio 5.07, CI 1.90-13.49) and presence of any DR (RR 10.36, CI 3.14-34.12) in early pregnancy significantly increased the risk of progression. ST progression was observed in 6 eyes (1 developed PDR, 3 developed DME, 2 with treated-PDR required further laser during pregnancy).

Conclusions : The prevalence of DR in pregnant women was similar to the non-pregnant diabetic population in Australia. Nearly 1 in 10 eyes had DR progression between early to late pregnancy, with almost half of these developing STDR. Risk factors for progression included higher SBP in early pregnancy and pre-existing DR at pregnancy onset. Worryingly, 1 in 5 participants failed to attend any eye exams during pregnancy, highlighting the need to address barriers to eye screening adherence given the significant risk of vision loss from DR in this population.

This is a 2021 ARVO Annual Meeting abstract.

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