Diabetic Retinopathy During Pregnancy

Abstract

Before the development of a clinically useful form of insulin, the prognosis for insulin-dependent diabetes patients was grim. When a young woman with the condition became pregnant, she and her offspring rarely survived the pregnancy. With the development of insulin, short-term survival was more likely to occur. We then had the dubious privilege of observing the long-term complications and disabilities that accompany diabetes of long duration (1). The large number of diabetic individuals followed at the Joslin Clinic has been a source of much of the information concerning the problems encountered in pregnancy by these patients. White reported that 50% of all pregnant women followed at that institution between January 1936 and January 1965 had vascular lesions, and 10% of them had “malignant angiopathy.” The rate of spontaneous abortions in these women was high, and the mothers often experienced severe hypoglycemic episodes during the pregnancy. Specifically, in 2,000 cases of obstetrical diabetes White found proliferative retinopathic changes in 87 cases. Of the 20 eyes that had sustained a hemorrhage, 11 progressed to blindness. Viable infants resulted from 74% of these cases (2). Cassar and colleagues reported that in 20% of 67 pregnant women with retinopathy, the lesions progressed during pregnancy (3). Similarly, Jervell et al reported a progression of retinopathy in 68 of 234 women who were followed through pregnancy at the Rikshospitalet in Oslo (4).