Axer-Siegel R, Hod M, Fink-Cohen S, Kramer M, Weinberger D, Schindel B, Yassur Y
Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, Israel.
Ophthalmology. 1996 Nov;103(11):1815-9. doi: 10.1016/s0161-6420(96)30421-1.
The purpose of the study is to evaluate the incidence, prevalence, progression, and risk factors of diabetic retinopathy during pregnancy.
Sixty-five patients who were pregnant and had insulin-dependent diabetes mellitus were evaluated before pregnancy, in every trimester during the pregnancy, and 12 months postpartum. The medical data included age, diabetes duration, glycohemoglobin, fructosamine, hemoglobin, creatinine, uric acid, and systolic and diastolic blood pressure.
Progression of the retinopathy occurred in 77.5% of the patients who presented with diabetic retinopathy at conception; proliferative diabetic retinopathy occurred in 22.5%. Only 26% of the patients who started the pregnancy without diabetic retinopathy had some progression of the retinopathy. Duration of the diabetes was longer in the progressive group compared with the nonprogressive group (P = 0.007). The glycohemoglobin was higher in the progressive group than in the nonprogressive group at each time point, but only in the third trimester was the difference statistically significant (P = 0.04). The hemoglobin level was lower in the progressive group than in the nonprogressive group (P < 0.01). The systolic blood pressure was higher in the progressive group (P < 0.005).
Understanding the risk factors contributing to the aggravation of diabetic retinopathy during pregnancy is helpful in designing criteria for the team management of pregnant patients with diabetes.
本研究旨在评估妊娠期糖尿病视网膜病变的发病率、患病率、进展情况及危险因素。
对65例妊娠合并胰岛素依赖型糖尿病的患者在妊娠前、妊娠各期及产后12个月进行评估。医学数据包括年龄、糖尿病病程、糖化血红蛋白、果糖胺、血红蛋白、肌酐、尿酸以及收缩压和舒张压。
妊娠时已患有糖尿病视网膜病变的患者中，77.5%出现视网膜病变进展；22.5%发生增殖性糖尿病视网膜病变。妊娠开始时无糖尿病视网膜病变的患者中，仅26%出现视网膜病变进展。进展组糖尿病病程长于非进展组（P = 0.007）。进展组各时间点糖化血红蛋白均高于非进展组，但仅在孕晚期差异有统计学意义（P = 0.04）。进展组血红蛋白水平低于非进展组（P < 0.01）。进展组收缩压较高（P < 0.005）。
了解妊娠期糖尿病视网膜病变加重的危险因素有助于制定糖尿病孕妇团队管理的标准。
