Diabetic retinopathy in pregnancy: A review (original) (raw)

1990, International Journal of Gynecology & Obstetrics

Introduction: Pregnancy represents a serious challenge to all body systems. The progressive physiological changes that occur are essential to support and protect the developing fetus in addition to prepare the mother for parturition. These physiologic changes involve cardiovascular, renal, pulmonary, hormonal, metabolic, hematologic, immunologic, and visual systems. 1 In the presence of clinical or sub-clinical pathology, the normal physiologic changes of pregnancy can place significant strain on already compromised systems .1,2 Ocular complications are common during pregnancy. 3 The number of women with diabetes in pregnancy is increasing, partly as a reflection of increasing obesity in women of child-bearing age. 4 Diabetic retinopathy (DR) is the most common ocular condition modified by pregnancy and pregnancy is associated with an increased risk of development and progression of DR. 4-7 However, there are currently no widely accepted, precise clinical guidelines regarding its management during pregnancy. At present it is not possible to predict who will regress and who will progress without treatment. Some of the variation in progression of DR in pregnancy may be a result of well-known risk factors such as hypertension or inadequate glycemic control prior to pregnancy. 8 DR developing during pregnancy may show a highrate of spontaneous regression after delivery. In a study patients with no DR at onset developed mild nonproliferative DR (NPDR) during pregnancy and 50% of them had complete regression, and 30% had partial regression after delivery. 9 Factors that have been shown to influence the progression of DR in pregnancy include, the pregnant state itself, duration of diabetes, degree of retinopathy at the time of conception, metabolic control of diabetes and the presence of co-existing hypertension. 10 The American Academy of Ophthalmology recommends