Diabetic retinopathy in pregnancy during tight metabolic control

Background. The relation between retinopathy and the parameters: 24-h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studi ed before, during, and after pregnancy in women with insulin-dependent diab etes mellitus on tight metabolic control during pregnancy. Methods. Prospective study of 112 pregnant women with insulin-dependent dia betes mellitus followed with fundus photography at the Department of Ophtha lmology, Arhus University Hospital. Changes in retinopathy were related to 24-h blood pressure, blood glucose, albuminuria, and adverse perinatal outc ome. Results. There was an association between grade of retinopathy and HbAlc be fore (Spearman's rho=0.49, p<0.04) and after pregnancy (Spearman's rho=O.42 , p<0.02), but no such correlation was found at any examination during preg nancy where glycemia was kept tight. Those women who had progression of ret inopathy during or after pregnancy had significantly earlier onset of diabe tes mellitus (14+/-8 years, range 1-27) than those women with improvement o r no progression of retinopathy (19+/-8 years, range 1-36, p<0.04). No asso ciation was found between progression of retinopathy and HbAlc, blood press ure, adverse perinatal outcome or any of the other variables studied. Conclusions. Tight glycemic control during pregnancy is recommendable to av oid progression of retinopathy. Attention should be given to the period aft er delivery where the tight regulation may be difficult to achieve. IDDM wo men should be encouraged to plan pregnancies early in life.