The Impact of Pregnancy on Diabetic Retinopathy: A Single-Site Study of Clinical Risk Factors

Jay Rathinavelu; Swara M Sarvepalli; Beth Bailey; David D'Alessio; Majda Hadziahmetovic

doi:10.1159/000533416

The Impact of Pregnancy on Diabetic Retinopathy: A Single-Site Study of Clinical Risk Factors

Ophthalmic Res. 2023;66(1):1169-1180. doi: 10.1159/000533416. Epub 2023 Aug 11.

Authors

Jay Rathinavelu¹, Swara M Sarvepalli², Beth Bailey³, David D'Alessio⁴, Majda Hadziahmetovic⁵

Affiliations

¹ Duke University School of Medicine, Durham, North Carolina, USA.
² Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA, sarve1sm@cmich.edu.
³ Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA.
⁴ Department of Endocrinology, Duke University, Durham, North Carolina, USA.
⁵ Department of Ophthalmology, Duke University, Durham, North Carolina, USA.

Abstract

Introduction: This study aimed to provide information on modifiable and non-modifiable risk factors for the progression and development of diabetic retinopathy (DR) and diabetic macular edema (DME). This retrospective chart review case-control study was designed to provide perspective on clinical variables.

Methods: Single-center study analysis was completed with chart review, identifying 50 patients (100 eyes) ultimately included in the final analysis. Included patients were women with type 1 or 2 diabetes that entered prenatal care and had a delivery from January 2010 to December 2022. The primary outcome measure was clinical variables between progression and no progression groups. Data were analyzed via χ2 analysis and independent samples t test when appropriate. Significantly different variables were further analyzed by binary logistic regression.

Results: The DR progression group had significantly higher prepregnancy HbA1c levels (9.9) when compared to the no progression group (8.5, p value 0.028). DR progression group also had higher rates (51.9%) of full-term births. The DME progression group had significantly higher rates of type 2 diabetics (100%) compared to the no progression group (30.9%, p value 0.029). Hypertension treatment before (81.8%; p value 0.008) pregnancy was also more common in the DME progression group. Intravitreal injections were more common in patients with visual acuity deterioration (26.7%, p value 0.046). The average number of fetal complications was significantly higher in the visual acuity non-worsening group (1.1) compared to the progression group (0.5, p value 0.04). These variables were not statistically significant after entry into multivariate analysis.

Discussion: Severity and treatment of retinopathy before pregnancy, type of diabetes, and blood pressure control are all significant factors affecting the progression and development of severe ocular complications in pregnancy.

Keywords: Diabetic retinopathy; Pregnancy; Retina; Visual acuity.

MeSH terms

Case-Control Studies
Diabetes Mellitus*
Diabetic Retinopathy* / complications
Diabetic Retinopathy* / diagnosis
Diabetic Retinopathy* / epidemiology
Female
Humans
Macular Edema* / diagnosis
Macular Edema* / epidemiology
Macular Edema* / etiology
Male
Pregnancy
Retrospective Studies
Risk Factors

Grants and funding

There was no funding of any research relevant to this study or any sponsors. There were no sponsors involved in the preparation of data or the manuscript.