Diabetic retinopathy in pregnancy

Pregnancy is associated with an increased risk of development and progression of diabetic retinopathy. This review examines the mechanisms underlying diabetic retinopathy progression during pregnancy, established and emerging risk factors for diabetic retinopathy progression, current screening strategies, and management options for sight-threatening disease.

The severity of retinopathy at conception, glycaemic control, duration of diabetes and hypertension are established predictors of diabetic retinopathy progression during pregnancy. Recent data suggest that patients with no retinopathy on initial screening have a very low risk of diabetic retinopathy progression, and further screening may not be indicated during pregnancy in this cohort. Pan retinal photocoagulation remains the mainstay of treatment for sight-threatening proliferative disease, while the use of intravitreal anti-VEGF therapy remains challenging because of limited safety data. Evidence regarding the postpartum course of diabetic retinopathy remains limited.

Pregnancy represents a period of increased retinal risk in women with preexisting diabetes, although this risk is not uniform. Baseline retinopathy status, duration of diabetes, extent of glycaemic control and hypertensive disease may provide a framework for future risk-stratified screening. Further prospective studies are required to determine whether surveillance can safely be individualised, and to clarify the role of anti-VEGF therapy and postpartum monitoring.