BACKGROUND AND PURPOSE:

• Diabetic retinopathy (DR) may worsen during pregnancy among women with preexisting diabetes, but prevalence and risk of progression is unclear
• Widyaputri et al. (JAMA Ophthalmology, 2022) estimate the prevalence of DR and its progression rate in pregnant women with preexisting type 1 (T1D) or type 2 diabetes (T2D) diagnosed before pregnancy

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • Observational studies
  • Studies that reported on DR and its changes in pregnant women with preexisting T1D and T2D
• Study design
  • Data were pooled using a random-effects model
  • The study followed MOOSE reporting guidelines
• Primary outcome
  • Prevalence of any DR
  • Proliferative DR
  • DR progression rates

RESULTS:

• 18 studies | 1464 pregnant women with T1D; 262 with T2D
• Pooled prevalence of DR in pregnancy
  • Any DR: 52.3 (95% CI, 41.9 to 62.6) per 100 pregnancies
  • Proliferative DR: 6.1 (95% CI, 3.1 to 9.8) per 100 pregnancies
• Pooled progression rates
  • New DR development: 15.0 (95% CI, 9.9 to 20.8) per 100 pregnancies
  • Worsened nonproliferative DR: 31.0 (95% CI, 23.2 to 39.2) per 100 pregnancies
  • Progression from nonproliferative DR to proliferative DR: 37.0 (95% CI, 21.2 to 54.0) per 100 pregnancies
• DR progression rates were similar between the T1D and T2D groups, except for the development of new DR
  • T1D groups: 15.8 (95% CI, 10.5 to 21.9) per 100 pregnancies
  • T2D groups: 9.0 (95% CI, 4.9 to 14.8) per 100 pregnancies
• A global trend toward a lower DR progression rate was observed after the 1989 St. Vincent Declaration (Goals and standards for diabetes care developed by the European community under the auspices of WHO and International Diabetes Federation)

CONCLUSION:

• Women with T1D and T2D face similar rates of DR progression during pregnancy and both groups should be monitored appropriately
• However, rates of DR prevalence and progression remain higher in pregnant women with diabetes compared to nonpregnant women with diabetes
• The authors conclude

Results of this systematic review and meta-analysis suggest that the risk of DR progression in pregnant women with preexisting DR was similar between women with T1D and T2D

Therefore, equal attention should be given to monitoring DR during pregnancy in those already known to have DR, irrespective of diabetes type

Learn More – Primary Sources:

Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Women With Preexisting Diabetes: A Systematic Review and Meta-analysis

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