Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes.

AIMS/HYPOTHESIS: Pregnancy in type 1 diabetic women is associated with risk of worsening of retinopathy. It has been reported that deterioration continues in the months after delivery, but direct data are lacking. It is also unclear what impact pregnancy has on the long-term progression of retinopathy.

METHODS

We studied 59 women with type 1 diabetes who had retinal photographs before pregnancy and yearly for 5 years post pregnancy. These photographs were graded using the EURODIAB retinopathy grading system.

RESULTS

The mean duration of diabetes was 14.4+/-8.2 years and mean age at pregnancy was 29.8+/-5.5 years. Mean HbA(1c) was 8.2+/-2.0% before pregnancy with tighter control during pregnancy itself. This value was high despite efforts to improve take-up of pre-conception care. Mean HbA(1c) was 8.6+/-1.5 during the follow-up period. At baseline, 43 (72.9%) women were free of retinopathy, 15 had non-proliferative retinopathy and one woman had previously had laser therapy. During pregnancy four women required laser therapy. Over the next 5 years none required laser therapy, although retinopathy worsened in 14 women. Ten-year follow-up data were available on 22 women, one of whom required laser therapy 8 years after pregnancy. Baseline retinopathy status was the only independent risk factor which predicted progression of retinopathy.

CONCLUSIONS/INTERPRETATION: Pregnancy is not associated with post-partum worsening of retinopathy.