The Impact of Pregnancy on Diabetic Retinopathy: a Single-Center Study of Clinical Risk Factors

This study aimed to provide information on modifiable and non-modifiable risk factors for the progression and development of diabetic retinopathy (DR) and diabetic macular edema (DME). This retrospective chart review case-control study was designed to provide perspective on clinical variables.Single-center study analysis was completed with chart review, identifying 50 patients (100 eyes) ultimately included in the final analysis. Included patients were women with type 1 or 2 diabetes that entered prenatal care and had a delivery from January 2010-December 2022. The primary outcome measure was clinical variables between progression and no progression groups. Data was analyzed via chi-square analysis and independent samples t-test when appropriate. Significantly different variables were further analyzed by binary logistic regression.The DR progression group had significantly higher pre-pregnancy HbA1c levels (9.9) when compared to the no progression group (8.5, p-val 0.028). DR progression group also had higher rates (51.9%) of full-term births. The DME progression group had significantly higher rates of Type 2 diabetics (100%) compared to the no progression group (30.9%, p-val 0.029). Hypertension treatment before (81.8%; p-val 0.008) pregnancy was also more common in the DME progression group. Intravitreal injections were more common in patients with visual acuity deterioration (26.7%, p-val 0.046). The average number of fetal complications was significantly higher in the VA non-worsening group (1.1) compared to the progression group (0.5, p-val 0.04). These variables were not statistically significant after entry into multivariate analysis.Severity and treatment of retinopathy before pregnancy, type of diabetes, and blood pressure control are all significant factors affecting the progression and development of severe ocular complications in pregnancy.