Rasmussen Katrine Laura, Laugesen Caroline S, Datta Nigel, Damm Peter, Mathiesen Elisabeth R
Center for Gravide med Diabetes, Endokrinologisk klinik, Rigshospitalet, DK-2100 København Ø.
Ugeskr Laeger. 2008 Dec 8;170(50):4117-21.
The aim was to evaluate the prevalence and progression of diabetic retinopathy during pregnancy in women with type 1 or type 2 diabetes.
Dilated fundal photography was performed at approximately 10 and 28 gestational weeks in 58 and 18 women with type 1 and type 2 diabetes, respectively. Retinopathy was classified as five stages +/- macular oedema. Progression was defined as deterioration corresponding to at least one stage between the two examinations. Clinical parameters were obtained from the medical records.
Diabetic retinopathy was found in 36 (62%) women with type 1 and three (17%) with type 2 diabetes at the first examination. In 26 (34%) retinopathy progressed; four women developed proliferations, three macular oedema and three reduction of visual acuity >/=0.2 on Snellen's chart in at least one eye. HbA1c in early pregnancy was the only significant predictor of progression (odds ratio = 1.75, 95% confidence interval = 1.09-2.82). Progression of retinopathy also tended to be associated with type 1 diabetes and long diabetes duration.
The risk of progression of diabetic retinopathy during pregnancy was considerable, especially among women with high HbA1c values in early pregnancy. A few women developed proliferations, macular oedema and reduction of visual acuity. Development of sight-threatening alterations during pregnancy remains a clinical problem.
目的是评估1型或2型糖尿病女性在孕期糖尿病视网膜病变的患病率及进展情况。
分别对58例1型糖尿病女性和18例2型糖尿病女性在妊娠约10周和28周时进行散瞳眼底照相。视网膜病变分为五个阶段±黄斑水肿。进展定义为两次检查之间恶化至少一个阶段。临床参数从病历中获取。
首次检查时，36例（62%）1型糖尿病女性和3例（17%）2型糖尿病女性发现有糖尿病视网膜病变。26例（34%）视网膜病变出现进展；4例女性出现增殖性病变，3例出现黄斑水肿，3例至少一只眼的Snellen视力表视力下降≥0.2。孕早期糖化血红蛋白是进展的唯一显著预测因素（比值比=1.75，95%置信区间=1.09-2.82）。视网膜病变进展也往往与1型糖尿病和糖尿病病程长有关。
孕期糖尿病视网膜病变进展的风险相当大，尤其是孕早期糖化血红蛋白值高的女性。少数女性出现增殖性病变、黄斑水肿和视力下降。孕期出现威胁视力的病变仍是一个临床问题。
