Abstract
Purpose :
Diabetic Retinopathy (DR) is a major cause of preventable blindness during childbearing age. While the interaction of DR and pregnancy has been studied, the temporal relationship between trimester of pregnancy and progression of this disease is not well elucidated. This study follows the evolution of the stages of DR and its manifestation with respects to trimester of pregnancy.
Methods :
A retrospective analysis was performed of pregnant patients diagnosed with diabetes mellitus (DM) from January 2012 to June 2021 at the Cole Eye Institute in Cleveland, Ohio. The start date of the first trimester was based on the last menstrual period (LMP) in the patient’s prenatal chart. Trimester durations ranged from week 1-13, 14-27, and weeks 27+. Severity of DR, as noted by proliferative or mild, moderate, and severe non-proliferative DR, time of onset, and progression were recorded. The primary outcome of this study explored the progression and manifestation of DR between each trimester of pregnancy. This study was broken into 3 time points between pre-pregnancy (PP) and 3 subsequent trimesters (PP-T1, T1-T2, and T2-T3). A progression was noted if a patient increased in grading of the severity of their DR between time points. An ANOVA was run to determine statistical significance. A manifestation of DR was noted if there was no DR in PP, but developed in a subsequent trimester.
Results :
220 patients were found to have DM at LMP with a mean age of 30.4 +/- 5.3 years. 65% and 6.4% identified as white and current everyday smokers, respectively (Table 1). 75 patients experienced adjacent visits between PP and T1, with 6.67% increasing their severity. 4.76% of 21 and 32% of 26 patients progressed in T1-T2 and T2-T3, respectively. 10.99% of 91 patients who had non-adjacent trimester visits experienced progression (Table 2). 4.62%, 10.53%, and 10% of patients developed DR during T1, T2, and T3, respectively (Table 3).
Conclusions :
In adjacent trimester visits, the most likely progression in DR occurred between the second and third trimester at 32% compared to between PP-T1 (6.67%) and T1-T2 (4.74%). The most likely time to manifest DR was similar between T2 and T3 at 10.53% and 10%, respectively while T1 was lower at 4.64%. Taken these results together, this indicates that DR is more likely to progress to a more severe stage and also manifest from no prior DR hisotry during later trimesters in pregnancy.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.