Diabetic retinopathy.

This review suggests the following risk factors which accelerate the natural progression of retinopathy during pregnancy: 1. Pregnancy per se is an independent risk factor which accelerates retinopathy. 2. Hypertension potentiates this acceleration. 3. Hyperglycemia also potentiates this acceleration. 4. The duration of diabetes and state of the retina at the beginning of the pregnancy influences the rate of acceleration. 5. Rapid normalization of blood glucose accelerates the progression of retinopathy. Prudent therapy would suggest that a pregnancy be planned to be able to normalize the blood glucose slowly (over 6-8 months) before conception. In addition, although there are no clinical trials, photocoagulation treatment should be according to the recommendations of the Diabetic Retinopathy Study despite the possibility that retinopathy may regress spontaneously postpartum. Unfortunately, clinicians often are faced with a fait accompli--the diabetic woman with retinopathy presents already pregnant. In this circumstance, we would recommend acute normalization of blood glucose with intensive surveillance of the retinal status and aggressive retinal treatment as necessary.