Diabetic Retinopathy Progression Risk Is Low in Pregnancy With Diabetes

Clinically-referable diabetic retinopathy progression risk during late pregnancy is low among women with diabetes who do not have diabetic retinopathy during early pregnancy, according to a UK-based study published in Eye. These findings suggest that reducing the number of diabetic eye screenings appointments in these individuals may be warranted.

“[Screening guidelines in the US and Denmark] now advise that retinopathy screening beyond early pregnancy may be safely omitted in women without retinopathy and with good glycemic control in early pregnancy,” the researchers explain. “However, the UK’s National [Diabetic Eye Screening Program] has yet to adjust.”

Investigators performed a retrospective cohort study that included women of various ethnicities with diabetes (n=4718; median age at conception, 34 years; 27% White; 21% Black; 6% Indian) who were pregnant and attended a diabetic eye screening program between 2011 and 2019. The team included eye screening grades at 13 and 28 weeks gestation and assessed the incidence of diabetic retinopathy progression between the 2 time points. A total of 23% of study participants had type 1 diabetes and 69% had type 2 diabetes.

Among 3085 women with diabetic eye screening grades recorded for both time points, 65.39% had no retinopathy at 13-weeks gestation, and most of them (74.7%) did not develop retinopathy by the 28-week gestation visit. Women without retinopathy at the initial visit who developed referable retinopathy comprised 0.45% of the cohort, and none of them required treatment. 

An ordered logistic regression analysis revealed that diabetic retinopathy at 13-weeks gestation remained a significant predictor of diabetic retinopathy progression at 28-weeks gestation after controlling for age, ethnicity, and diabetes type (P<.001). Older age and type 1 diabetes also predicted diabetic eye screening grade worsening at 28-weeks gestation compared with 13-weeks gestation (P <.001 for both). Although ethnicity did not predict retinopathy grade at 28-weeks gestation, 10 of the 14 individuals who progressed to a referable grade were of minority ethnicity.

“[T]his study has demonstrated that the burden of managing diabetes for pregnant mothers may be safely reduced by limiting the number of diabetic eye screening appointments in women who have no retinal changes (R0M0) in early pregnancy,” according to the study authors.

Study limitations include the strict enrollment of individuals from 1 city and an inability to collect data pertaining to diabetic retinopathy progression risk factors, such as blood sugar levels and blood pressure.