Changes in diabetic retinopathy during pregnancy. Correlations with regulation of hyperglycemia
R. L. Phelps, P. Sakol, B. E. Metzger, L. M. Jampol and N. Freinkel
Thirty-eight pregnancies in 35 women with insulin-dependent diabetes
mellitus were monitored for changes in diabetic retinopathy during the
institution of "tight" metabolic control by intensive medical management.
Eye findings were scored on paired sets of retinal photographs obtained
when enrolled in this study and shortly after delivery. These findings were
then correlated with measurements of diabetic regulation. Intensive therapy
for the diabetes mellitus resulted in improved glucose control by the time
of delivery. However, retinal abnormalities worsened as gestation proceeded
in 55% of the pregnancies. Deterioration of background retinopathy
correlated significantly with the levels of plasma glucose at entry and
with the magnitude of improvement in glycemia achieved during the first six
to 14 weeks after entry (ie, "early changes") and by the final week before
delivery (ie, "overall changes"). Our findings indicate that the changing
retinopathy during pregnancy cannot be interpreted without assessment of
concurrent changes in the regulation of maternal diabetes and that the
abrupt institution of improved diabetic control during pregnancy may be one
factor in the deterioration of background retinopathy sometimes seen during
pregnancy.
