Wpływ ciąży na progresję retinopatii cukrzycowej

Purpose
Pregnancy is considered an important risk factor of the development and progression of diabetic retinopathy (DR). The aim of the study was to assess whether retinal changes tend to progress during pregnancy in women with type 1 diabetes.

Material and methods
136 women with type 1 diabetes were enrolled to this 3 years prospective study. The patients were divided according to White’s scale into the following classes: B (n=76), C (n=34), D (n=24), R (n=2). Before conception and during pregnancy the patients were treated with intensive insulin therapy to achieve optimal metabolic control. Ophthalmic examination was performed before planned conception, in each trimester of the pregnancy and after delivery

Results
No pathologies were discovered with fundoscopy in all the women belonging to class B, in 22 women from class C and in 4 women from class D. No progression of diabetic retinopathy was observed during the entire period of observation in 12 women from class C and in 20 from class D with nonproliferative DR in the first examination. In 3 women from class C progression of DR were observed in the second trimester with partial improvement after delivery. Visual acuity in these patients also deteriorated. Proliferative DR diagnosed in 2 patients from class R at the beginning of the observation, progressed during the pregnancy to diminish after delivery.

Conclusions
Pregnancy does not influence significantly the progression of pre–existing diabetic retinopathy, provided that proper metabolic control is achieved and patients are subject to systematic ophthalmological control.