Abstract
Purpose :
To examine factors associated with eye exams during pregnancy for patients with pre-existing diabetes mellitus (DM) in the National Institutes of Health All of Us Research Program (AoU).
Methods :
The study population included all participants in AoU with diagnosis codes for DM and pregnancy, based on the International Classification of Diseases, 9th (ICD-9) and 10th (ICD-10) Revision. The outcome of interest was an eye exam occurring during the pregnancy period, which was based on Current Procedural Terminology, Fourth Edition (CPT-4) codes for general ophthalmic or retinal examinations. The pregnancy period was defined as nine months prior to an ICD-9 or ICD-10 code for a delivery. The exposures were a DM diagnosis occurring before the pregnancy period; age at delivery; race, which was categorized as White, Black/Asian/Hispanic, or Other; income, which was categorized as <$50,000, $50,000-$100,000, or >$100,000; and education, which was categorized as a high school equivalent degree or less, 1-3 years of college, or a college or advanced degree. Multivariable logistic regression was performed to examine the association between each exposure and presence of an eye exam during pregnancy, adjusting for all other exposures.
Results :
The study population included 2,072 individuals, of which 101 (4.9%) had an eye exam during pregnancy, 689 (33.3%) had a DM diagnosis prior to pregnancy, and 60/689 (8.7%) with a pre-existing DM diagnosis had an eye exam during pregnancy. Compared to individuals without pre-existing DM, a pre-existing DM diagnosis was associated with an increased likelihood of obtaining an eye exam during pregnancy (adjusted odds ratio [aOR]: 3.09, 95% confidence interval [CI]: 1.92-5.02, p < 0.001). Compared to individuals with a high school equivalent degree or less, those with a college or advanced degree were more likely to receive an eye exam during pregnancy (aOR: 2.27, 95% CI: 1.08-4.83, p = 0.031). Age, race, and income were not significantly associated with completing an eye exam during pregnancy.
Conclusions :
This study found only a small percentage of pregnant individuals with pre-existing DM received an eye exam in AoU, despite American Academy of Ophthalmology guidelines that recommend a retinal exam for these individuals. Further research should investigate individual and system-level factors contributing to this significant gap in care.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.