Management of diabetic retinopathy in pregnancy

Abstract

Introduction. The onset and development of diabetic retinopathy are more common during pregnancy. Pregnancy has no long-term effect on diabetic retinopathy; however, in 50-70% of cases, changes in retinopathy continues. The probability of worsening is highest in the second trimester and up to one year postpartum. Additional factors that have been associated with disease progression include duration of diabetes, the degree of retinopathy at the time of conception, management of hyperglycemia, anemia, and development of associated hypertension. In cases of severe non-proliferative retinopathy, it is recommended to promptly initiate laser photocoagulation rather than wait for early proliferative changes. Maintaining good diabetic control before and during pregnancy can help prevent disease progression and serious vision loss. Material and methods. Diabetic retinopathy management in pregnancy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: „Diabetic retinopathy”; „pregnancy”; „laser photocoagulation”; „intravitreal steroids”; „anti-vascular endothelial growth factor”. Results. It is suggested that women with diabetes receive pre-conception and post-pregnancy counselling from a multidisciplinary team including an ophthalmologist, endocrinologist, and perinatologist, as diabetic retinopathy may worsen during pregnancy. The risk of progression of the disease and the importance of appropriate metabolic control before and during pregnancy should be clearly explained to the patient. Careful monitoring is required in patients with advanced gestation, significant retinopathy, concomitant hypertension, and nephropathy. Conclusion. The risk of retinopathy development may increase during pregnancy. Serious effects can arise for both the mother and the fetus, even though retinopathy is not common during pregnancy. It is possible to avoid significant retinopathy by carefully planning a young diabetic woman’s pregnancy and proceeding promptly to laser photocoagulate in cases of severe non-proliferative retinopathy. A tendency for regress is frequently seen in diabetic retinopathy during the post-natal period. Subsequent pregnancies do not significantly increase the risk of progression if the retinopathy is stable before pregnancy.