Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study

Emily Y Chew; James L Mills; Boyd E Metzger; Nancy A Remaley; Lois Jovanovic-Peterson; Robert H Knopp; Mary Conley; Lawrence Rand; Joe L Simpson; Lewis B Holmes; Jerome H Aarons; National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study

doi:10.2337/diacare.18.5.631

Original Articles

Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study

Emily Y Chew, MD,
James L Mills, MD,
Boyd E Metzger, MD,
Nancy A Remaley, MS,
Lois Jovanovic-Peterson, MD,
Robert H Knopp, MD,
Mary Conley, MA,
Lawrence Rand, MD,
Joe L Simpson, MD,
Lewis B Holmes, MD,
Jerome H Aarons, MD and
National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study

Division of Biometry and Epidemiology, National Eye Institute, National Institutes of Health Bethesda, Maryland
Epidemiology Branch, National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland
Northwestern University Medical School Chicago, Illinois
Sansum Medical Research Foundation Santa Barbara, California
Northwest Lipid Research Clinic, University of Washington Seattle, Washington
Medical Eye Associates Norwood, Massachusetts
Baylor College of Medicine Houston, Texas
Brigham and Women's Hospital Boston, Massachusetts
Magee Women's Hospital Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Emily Y. Chew, MD, National Institutes of Health, Building 31, Room 6A52, 31 Center Dr., MSC 2510, Bethesda, MD, 20892-2510.

Diabetes Care 1995 May; 18(5): 631-637. https://doi.org/10.2337/diacare.18.5.631

Abstract

OBJECTIVE To evaluate the role of metabolic control in the progression of diabetic retinopathy during pregnancy.

RESEARCH DESIGN AND METHODS We conducted a prospective cohort study of 155 diabetic women in the Diabetes in Early Pregnancy Study followed from the periconceptional period to 1 month postpartum. Fundus photographs were obtained shortly after conception (95% within 5 weeks of conception) and within 1 month postpartum. Glycosylated hemoglobin was measured weekly during the 1st trimester and monthly thereafter.

RESULTS In the 140 patients who did not have proliferative retinopathy at baseline, progression of retinopathy was seen in 10.3, 21.1, 18.8, and 54.8% of patients with no retinopathy, microaneurysms only, mild nonproliferative retinopathy, and moderate-to-severe nonproliferative retinopathy at baseline, respectively. Proliferative retinopathy developed in 6.3% with mild and 29% with moderate-to-severe baseline retinopathy. Elevated glycosylated hemoglobin at baseline and the magnitude of improvement of glucose control through week 14 were associated with a higher risk of progression of retinopathy (adjusted odds ratio for progression in those with glycohe-moglobin ≥ 6 SD above the control mean versus those within 2 SD was 2.7; 95% confidence interval was 1.1-7.2; P = 0.039).

CONCLUSIONS The risk for progression of diabetic retinopathy was increased by initial glycosylated hemoglobin elevations as low as 6 SD above the control mean. This increased risk maybe due to suboptimal control itself or to the rapid improvement in metabolic control that occurred in early pregnancy. Excellent metabolic control before conception may be required to avoid this increase in risk. Those with moderate-to-severe retinopathy at conception need more careful ophthalmic monitoring, particularly if their diabetes was suboptimally controlled at conception.