Progression of diabetic retinopathy during pregnancy: Retrospective study from birmingham and solihull

Abstract

Aims/Purpose: To assess the progression of diabetic retinopathy (DR) in pregnant women with pre-existing diabetes in the Birmingham and Solihull area and to evaluate adherence to recommended screening guidelines.

Methods: A retrospective review was conducted over 12 months (01/09/2022-31/08/2023) using data from the Diabetic Eye Screening Program (DESP) and hospital records (Medisoft, OCT, and retina images). The study included pregnant women with pre-existing diabetes who received maternity services at University Hospitals Birmingham (UHB) and were referred to DESP. Patients with gestational diabetes were excluded. Data collected included demographics, DR screening attendance, progression rates, and clinical outcomes.

Results: Out of 149 pregnant women with pre-existing diabetes, 54 (36.2%) were not referred for initial screening by 12 weeks due to late presentation and delayed diabetes status confirmation. Of the total, 88 (59%) missed the 12-week screening, 57 (40%) missed the 16-20 week screening, and 67 (48%) missed the 28-week screening. At 12 weeks, 27% were R0M0, 9% R1M0, 3% R1M1, and 1% R2M0/R2M1, with 8 referred to HES. At 16-20 weeks, 43% were R0M0, 16% R1M0, 1% R3SM0, and 1% were unable to assess, with 2 referred to HES. By 28 weeks, 37% were R0M0, 12% R1M0, 1% R3SM1, and 2% were still being graded, with 1 referred to HES. The study highlighted significant cases, including one patient who progressed to severe NPDR and required bilateral PRP and Ozurdex treatment, and another who developed DMO treated with Ozurdex.

Conclusions: Diabetic retinopathy progression during pregnancy remains a significant concern, with many patients missing critical screening appointments, leading to advanced DR stages and severe visual impairment. Despite adherence to screening guidelines, patient non-compliance and late referrals hinder effective management. Improved patient education and follow-up strategies are essential to enhance screening attendance and outcomes, thereby preventing severe DR progression during pregnancy. Further research is necessary to develop targeted interventions for better compliance and timely treatment.