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Fetal Weight and Progression of Diabetic Retinopathy

From the Department of Obstetrics and Gynecology, University of California-Davis, Davis, California; Stabilimento Ospedaliero Thiene, Thiene, Italy; Department of Obstetrics and Gynecology, St. Luke’s- Roosevelt Hospital Center, New York, New York, Division of Biostatistics, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Address reprint requests to: Sherrie Smith McElvy, MD Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of California, Davis 4860 Y Street, Suite 2500 Sacramento, CA 95817 E-mail: ssmcelvy{at}gte.net

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.

This article has been cited by other articles:

				S. Loukovaara, I. Immonen, K. A. Teramo, and R. Kaaja Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women Treated With Insulin Lispro Diabetes Care, April 1, 2003; 26(4): 1193 - 1198. [Abstract] [Full Text] [PDF]