Author: Narendra Dhingra (United Kingdom)
Co-authors: Reema Gupta, Katherine Barton, Chitra Rajagopalan, Nosheen Aslam, Tolulope Shonibare
Purpose
The aim of this retrospective study was to evaluate the screening frequency and progression of diabetic retinopathy in pregnant women with pre-gestational diabetes attending a single Screening Programme in England.
Setting/Venue
Wakefield Diabetic Retinopathy Screening Services
Methods
The diabetic retinopathy screening services record of all the pregnant women who had screening photographs, between 2013-2016, were retrieved. The information recorded included age, type of diabetes mellitus (type 1 or 2 DM), gravida, blood pressure (BP), glycosylated haemoglobin (HbA1c), the number of screening visits, any referral to the eye clinic and any investigation or treatment carried out, within one year post-partum. The National Standard was to screen pregnant women once in each trimester followed by one post-natal visit. For this study, adequate frequency of screening was defined as at least two or more retinal evaluations in separate trimesters. The diabetic retinopathy (DR) definitions used in screening programme were background (BDR), pre-proliferative (PPDR) and proliferative retinopathy (PDR). A one-step progression was defined as at least one stage of deterioration of DR and/or development of diabetic maculopathy in at least one eye. A two-step progression was defined as development of PDR in an eye with BDR or development of PPDR in an eye with no DR at baseline. Binary logistic regression was utilised to assess the association of multiple covariates (systolic BP, diastolic BP, HbA1c and gravida) with the progression of DR.
Results
Of the 200 pregnant women identified, 33 had to be excluded for various reasons (19 had gestational diabetes, 13 suffered a miscarriage before 24 weeks of gestation and 1 moved out of the area). Of the 167 women, the mean age was 31.2±4.7 years, mean gravida was 2 (range 1-8), and 71 women had Type DM. The mean systolic and diastolic BP recorded were 126±15.5 mm Hg (range 98-178) and 78.7±10.3 mm Hg (range 56-99) respectively The mean HbA1c was 55.2±15.4 mmol/mol (range 30-110). No DR was seen in 54.1%, BDR in 35%, PPDR in 7.7%, PDR in 1.1% and 2.3% of eyes had panretinal photocoagulation (PRP) at baseline. Baseline maculopathy was seen in 3.6% of eyes. Three-quarters of these women had two or more screening photography visit. New DR developed in 3.5% of eyes with one-step and two-step worsening seen in 11.9% and 0.5% of eyes respectively. New maculopathy developed in 5.9% of eyes. Logistic regression analysis revealed that HbA1c more than 50 mmol/mol was associated with maculopathy development (P=0.01), while other variables had no effect on DR progression. Of the 49 patients referred from diabetic screening to the eye clinic, 2 underwent macular laser and 5 needed PRP.
Conlusions
Nearly a quarter of pregnant women did not have the three mandated diabetic screening visits as per the standard set by the National Programme. The development of new retinopathy or progression of retinopathy was low as compared to previously published studies. Raised blood sugar at booking (HbA1c) was associated with new maculopathy development
Financial Disclosure
received study, research and travel grant from Novartis and Bayer None for this study
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