Diabetic retinopaty and pregnancy

Pregnancy may adversely affect the natural course of diabetic retinopathy ( DR). Reported rates of new cases or progression of DR during pregnancy rang e from 10% to 70%. Regression of some of the nonproliferative vascular chan ges have been reported after delivery. Several risk factors contribute to t he aggravation of DR, such as pregnancy itself, duration of the diabetes, e levated glycohemoglobin level, degree of retinopathy at the beginning of th e pregnancy, rapid normalization of blood glucose level. The mechanisms by which pregnancy may alter the course of DR is not elucidated: worsening of DR may be due to modifications of retinal blood flow, or to increase in cir culating growth factors levels. Careful ophthalmologic monitoring during pregnancy is required. Fundus exam ination should be performed before pregnancy or at the beginning of it. In patients with no retinopathy, fundus examination should be performed every three months. In those with diabetic retinopathy, fundus examination should be repeated every month. In eyes with proliferative DR or severe nonprolif erative DR before pregnancy or at its beginning, laser photocoagulation sho uld be performed promptly.