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Fetal weight and progression of diabetic retinopathy
S S McElvy1, S Demarini, M Miodovnik
1Department of Obstetrics and Gynecology, University of California-Davis, Davis, California, USA. ssmcelvy@gte.net
Insights
Diabetic retinopathy progression during pregnancy is linked to smaller babies. This study found that women with worsening retinopathy were more likely to have infants who were small for gestational age or had low birth weights.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Neonatology
Background:
- Diabetic retinopathy is a common complication of diabetes.
- Pregnancy can exacerbate diabetic retinopathy.
- Fetal growth and neonatal outcomes in diabetic pregnancies require careful monitoring.
Purpose of the Study:
- To investigate the association between diabetic retinopathy progression during pregnancy and fetal growth.
- To determine if retinopathy progression impacts neonatal morbidity.
Main Methods:
- Prospective study of 205 women with type 1 diabetes before 14 weeks' gestation.
- Intensive insulin therapy and serial ophthalmologic evaluations.
- Group comparison based on retinopathy progression versus no progression.
Main Results:
- Diabetic retinopathy progressed in 29% of women, associated with advanced White classification.
- Retinopathy progression correlated with reduced fetal growth, including more small-for-gestational-age and low-birth-weight infants.
- Small for gestational age was significantly associated with chronic hypertension and retinopathy progression.
Conclusions:
- Diabetic retinopathy development and progression in pregnancy are linked to reduced fetal growth.
- Increased rates of small-for-gestational-age and low-birth-weight infants are associated with retinopathy progression.
- These findings highlight the importance of monitoring retinopathy in pregnant individuals with diabetes.
Objective:
To test the hypothesis that progression of diabetic retinopathy in pregnancy is associated with reduced fetal growth and related neonatal morbidity.
Methods:
Women with type 1 diabetes (n = 205) were enrolled before 14 weeks' gestation in a prospective study of diabetes in pregnancy and treated with intensive insulin therapy. They had serial ophthalmologic evaluations before 20 weeks' gestation and in late gestation or postpartum. Subjects were divided into two groups based on whether retinopathy progressed (progression group) or remained unchanged (no progression group).
Results:
Retinopathy progressed in 59 of 205 women (29%) and was associated with advanced White classification (P =.001): three (5%) were class B, 14 (23%) class C, 24 (41%) class D, and 18 (30%) class F-RF. Reduced fetal growth was associated with progression of retinopathy. Mean birth weight was lower (P =.02), and more infants were small for gestational age (P =.02) and had low birth weights (P =.02) in the progression group. More large-for-gestational-age infants were noted in the no-progression group (P =.04). Birth weight percentile distributions showed a shift of the curve to the left in the progression group (P =.03). There were no differences in gestational age at delivery, macrosomia, preterm delivery, respiratory distress syndrome, neonatal hypoglycemia, or neonatal death. Small for gestational age was associated with chronic hypertension (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.5, 27.9) and retinopathy progression (OR 4.7; 95% CI 1.2, 23.8).
Conclusion:
Development and progression of diabetic retinopathy during pregnancy were associated with reduced fetal growth manifested as increased rate of small-for-gestational-age and low-birth-weight infants.