Progression of diabetic retinopathy during pregnancy: Retrospective study from birmingham and solihull

IF 2.8 3区医学 Q1 OPHTHALMOLOGY Acta Ophthalmologica Pub Date : 2025-01-19 DOI:10.1111/aos.17423

Ahmad Khalifa, Joseph Sobha

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Abstract

Aims/Purpose: To assess the progression of diabetic retinopathy (DR) in pregnant women with pre-existing diabetes in the Birmingham and Solihull area and to evaluate adherence to recommended screening guidelines.

Methods: A retrospective review was conducted over 12 months (01/09/2022-31/08/2023) using data from the Diabetic Eye Screening Program (DESP) and hospital records (Medisoft, OCT, and retina images). The study included pregnant women with pre-existing diabetes who received maternity services at University Hospitals Birmingham (UHB) and were referred to DESP. Patients with gestational diabetes were excluded. Data collected included demographics, DR screening attendance, progression rates, and clinical outcomes.

Results: Out of 149 pregnant women with pre-existing diabetes, 54 (36.2%) were not referred for initial screening by 12 weeks due to late presentation and delayed diabetes status confirmation. Of the total, 88 (59%) missed the 12-week screening, 57 (40%) missed the 16-20 week screening, and 67 (48%) missed the 28-week screening. At 12 weeks, 27% were R0M0, 9% R1M0, 3% R1M1, and 1% R2M0/R2M1, with 8 referred to HES. At 16-20 weeks, 43% were R0M0, 16% R1M0, 1% R3SM0, and 1% were unable to assess, with 2 referred to HES. By 28 weeks, 37% were R0M0, 12% R1M0, 1% R3SM1, and 2% were still being graded, with 1 referred to HES. The study highlighted significant cases, including one patient who progressed to severe NPDR and required bilateral PRP and Ozurdex treatment, and another who developed DMO treated with Ozurdex.

Conclusions: Diabetic retinopathy progression during pregnancy remains a significant concern, with many patients missing critical screening appointments, leading to advanced DR stages and severe visual impairment. Despite adherence to screening guidelines, patient non-compliance and late referrals hinder effective management. Improved patient education and follow-up strategies are essential to enhance screening attendance and outcomes, thereby preventing severe DR progression during pregnancy. Further research is necessary to develop targeted interventions for better compliance and timely treatment.

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妊娠期间糖尿病视网膜病变的进展：来自伯明翰和索利赫尔的回顾性研究

目的：评估伯明翰和索利赫尔地区已有糖尿病的孕妇糖尿病视网膜病变（DR）的进展情况，并评估对推荐筛查指南的依从性。方法：对糖尿病眼筛查项目（DESP）的数据和医院记录（Medisoft、OCT和视网膜图像）进行了为期12个月（2022年9月1日至2023年8月31日）的回顾性研究。该研究包括在伯明翰大学医院（UHB）接受产科服务并转介到DESP的已有糖尿病的孕妇。排除妊娠期糖尿病患者。收集的数据包括人口统计、DR筛查出勤、进展率和临床结果。结果：在149名既往患有糖尿病的孕妇中，54名（36.2%）由于出现较晚和糖尿病状态确认延迟而未在12周前进行初始筛查。其中88例（59%）错过了12周的筛查，57例（40%）错过了16-20周的筛查，67例（48%）错过了28周的筛查。12周时，27%为R0M0, 9%为R1M0, 3%为R1M1, 1%为R2M0/R2M1, 8例为HES。16-20周时，43%为R0M0, 16%为R1M0, 1%为R3SM0, 1%无法评估，2例为HES。28周时，37%为R0M0, 12%为R1M0, 1%为R3SM1, 2%仍在分级，其中1例为HES。该研究强调了一些重要病例，包括一名进展为严重NPDR并需要双侧PRP和Ozurdex治疗的患者，以及另一名接受Ozurdex治疗的DMO患者。结论：妊娠期间糖尿病视网膜病变的进展仍然值得关注，许多患者错过了关键的筛查预约，导致晚期DR阶段和严重的视力损害。尽管遵守筛查指南，患者不遵守和延迟转诊阻碍了有效的管理。改善患者教育和随访策略对于提高筛查出勤率和结果至关重要，从而防止妊娠期间严重的DR进展。有必要进一步研究制定有针对性的干预措施，以提高依从性和及时治疗。

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来源期刊

Acta Ophthalmologica 医学-眼科学

CiteScore

7.60

自引率

5.90%

发文量

433

审稿时长

6 months

期刊介绍： Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER). Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.