Sarvepalli Swara M, Bailey Beth A, D'Alessio David, Lemaitre Madleen, Vambergue Anne, Rathinavelu Jay, Hadziahmetovic Majda
Central Michigan University, College of Medicine, Mt. Pleasant, Michigan, USA.
Department of Endocrinology, Duke University, Durham, North Carolina, USA.
Clin Exp Ophthalmol. 2023 Apr;51(3):195-204. doi: 10.1111/ceo.14168. Epub 2022 Sep 25.
Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it increases in severity during pregnancy.
Systematic review of literature from PubMed, Cochrane Library and Web of Science using keywords 'diabetic retinopathy' and 'pregnancy' and 'progression' from inception to 2021 was completed. Included studies were (1) peer-reviewed observational studies addressing progression/development of DR in pregnancy, (2) provided the number of diabetic patients that developed/progressed in DR during pregnancy, and (3) included differential data on variables between progression and non-progression groups. This was applied by two independent researchers and referred to a third researcher as necessary. Twenty-seven of the original 138 studies met this criterion. Data were pooled and analysed using fixed-effects in meta-analysis.
From 27 studies, 2537 patients were included. Pre-eclampsia [Risk Ratio (RR) 2.62 (95% CI = 1.72, 4.00)] and hypertension treatment during pregnancy [RR 2.74 (95% CI = 1.72, 4.00)] were significantly associated with the development/progression of DR. HbA1c at baseline [MD 0.82 (95% CI = 0.59, 1.06)], duration of diabetes [mean difference (MD) 5.97 (95% CI = 5.38, 6.57)], and diastolic blood pressure at baseline [MD 3.29 (95% CI = 0.46, 6.12)] were all significantly higher in the progression group while only mean birth weight [MD -0.17 (95% CI = -0.31, -0.03)] was significantly higher in the non-progression group.
This study fills a gap in the literature and provide physicians with more information on the risk factors associated with the progression of DR in pregnancy and how to counsel this vulnerable patient population appropriately.
糖尿病视网膜病变（DR）是劳动年龄人群失明的主要原因，且在孕期其严重程度会增加。
完成了对来自PubMed、Cochrane图书馆和科学网的文献的系统综述，使用关键词“糖尿病视网膜病变”、“妊娠”和“进展”，检索时间从起始到2021年。纳入的研究为：（1）针对孕期DR进展/发展的同行评审观察性研究；（2）提供了孕期发生DR/DR进展的糖尿病患者数量；（3）包括进展组和非进展组之间变量的差异数据。由两名独立研究人员进行此项工作，必要时咨询第三名研究人员。138项原始研究中有27项符合该标准。在荟萃分析中使用固定效应合并和分析数据。
纳入了27项研究中的2537名患者。子痫前期[风险比（RR）2.62（95%置信区间=1.72，4.00）]和孕期高血压治疗[RR 2.74（95%置信区间=1.72，4.00）]与DR的发生/进展显著相关。进展组的基线糖化血红蛋白[平均差（MD）0.82（95%置信区间=0.59，1.06）]、糖尿病病程[平均差（MD）5.97（95%置信区间=5.38，6.57）]和基线舒张压[MD 3.29（95%置信区间=0.46，6.12）]均显著更高，而非进展组只有平均出生体重[MD -0.17（95%置信区间=-0.31，-0.03）]显著更高。
本研究填补了文献空白，为医生提供了更多关于孕期DR进展相关危险因素的信息，以及如何对这一脆弱患者群体进行适当咨询的信息。
