Pregnant patients with any form of diabetes should be monitored closely for DR progression.
Pregnant patients with any form of diabetes should be monitored closely for DR progression. Photo: Jay Haynie, OD. Click image to enlarge.

According to the findings of a recent study, pregnant patients with preexisting diabetes are at higher risk for diabetic retinopathy (DR) progression. Researchers analyzed global estimates of DR prevalence and progression in pregnancy to better determine the DR burden. Their systematic review and meta-analysis included 18 observational studies with 1,464 pregnant people with type one diabetes and 262 with type two diabetes.

The team reported a pooled prevalence of any DR and proliferative DR in early pregnancy as 52.3 and 6.1 per 100 pregnancies, respectively. Pooled progression rates per 100 pregnancies included:

  • New DR: 15

  • Worsened nonproliferative DR: 31

  • Nonproliferative DR to proliferative DR: 6.3

  • Worsened proliferative DR: 37

The researchers also noticed a global trend toward lower DR progression rates after the 1989 St. Vincent Declaration, which established an optimized standard of care for pregnant people with diabetes to encourage similar outcomes to pregnant people without diabetes.

The researchers concluded that DR progression rates were similar among those with types one and two diabetes, except for new DR development. “Equal attention should be given to monitoring DR during pregnancy in those already known to have DR, irrespective of diabetes type,” they wrote in their paper.

Widyaputri F, Rogers SL, Kandasamy R, et al. Global estimates of diabetic retinopathy prevalence and progression in pregnant women with preexisting diabetes: a systematic review and meta-analysis. JAMA Ophthalmol. March 31, 2022. [Epub ahead of print].