Progression of diabetic retinopathy in women with pregestational diabetes during pregnancy and postpartum

IF 4.9 2区医学 Q1 OPHTHALMOLOGY

Clinical and Experimental Ophthalmology Pub Date : 2024-06-19 DOI:10.1111/ceo.14410

Felicia Widyaputri MD, PhD, Edmund W. C. Khong MD, Sophie L. Rogers MEpi, Alison J. Nankervis MD, FRACP, Jennifer J. Conn MClinEd, FRACO, Muhammad B. Sasongko MD, PhD, Alexis Shub PhD, FRANZCOG, Xavier J. Fagan FRANZCO, Daryl Guest MScOptom, Robert C. A. Symons PhD, FRANZCO, Lyndell L. Lim DMedSci, FRANZCO

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引用次数: 0

Abstract

Background

Diabetic retinopathy (DR) may worsen during pregnancy, but its course in the postpartum remains poorly understood. Understanding the natural history of DR during and after pregnancy can help determine when sight-threatening DR treatment should be administered.

Methods

A prospective longitudinal cohort study recruited pregnant women with pre-existing type 1 (T1D) or type 2 diabetes from two tertiary Diabetes Antenatal Clinics in Melbourne, Australia. Eye examination results in early pregnancy, late pregnancy, and up to 12-months postpartum were compared to determine DR changes. Two-field fundus photographs and optical coherence tomography scans were used to assess DR severity.

Results

Overall, 105 (61.4%) women had at least two eye examinations during the observation period. Mean age was 33.5 years (range 19–51); 54 women (51.4%) had T1D; 63% had HbA1c <7% in early pregnancy. DR progression rate was 23.8% (95% CI 16.4–32.6). Having T1D (RR 4.96, 95% CI 1.83–13.46), pre-existing DR in either eye (RR 4.54, 95% CI 2.39–8.61), and elevated systolic blood pressure (adjusted RR 2.49, 95% CI 1.10–5.66) were associated with increased risk of progression. Sight-threatening progression was observed in 9.5% of women. Among the 19 eyes with progression during pregnancy, 15 eyes remained stable, three eyes progressed, and only one eye regressed in the postpartum.

Conclusions

Nearly 1 in 4 women had DR progression from conception through to 12-months postpartum; almost half of these developing sight-threatening disease. DR progression occurring during pregnancy was found to predominantly remain unchanged, or worsen, after delivery, with very few eyes spontaneously improving postpartum.

查看原文本刊更多论文

妊娠期和产后糖尿病妇女糖尿病视网膜病变的进展。

背景：妊娠期糖尿病视网膜病变（DR）可能会恶化，但人们对其在产后的病程仍然知之甚少。了解妊娠期间和妊娠后糖尿病视网膜病变的自然病史有助于确定何时应该对危及视力的糖尿病视网膜病变进行治疗：方法：一项前瞻性纵向队列研究从澳大利亚墨尔本的两家三级糖尿病产前检查诊所招募了患有 1 型糖尿病（T1D）或 2 型糖尿病的孕妇。比较孕早期、孕晚期和产后 12 个月的眼部检查结果，以确定 DR 的变化。双视野眼底照片和光学相干断层扫描用于评估 DR 的严重程度：总体而言，105 名（61.4%）妇女在观察期间至少进行了两次眼科检查。平均年龄为 33.5 岁（19-51 岁不等）；54 名女性（51.4%）患有 T1D；63% 的女性得出 HbA1c 结论：从受孕到产后 12 个月期间，每 4 名妇女中就有近 1 人患有 DR，其中近一半会发展成危及视力的疾病。研究发现，妊娠期间出现的DR进展在分娩后主要保持不变或恶化，只有极少数眼睛在产后自发好转。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Ophthalmology 医学-眼科学

CiteScore

7.60

自引率

12.50%

发文量

150

审稿时长

4-8 weeks

期刊介绍： Clinical & Experimental Ophthalmology is the official journal of The Royal Australian and New Zealand College of Ophthalmologists. The journal publishes peer-reviewed original research and reviews dealing with all aspects of clinical practice and research which are international in scope and application. CEO recognises the importance of collaborative research and welcomes papers that have a direct influence on ophthalmic practice but are not unique to ophthalmology.