Diabetes and Pregnancy

By Peter A. Karth MD, MBA

Vitreoretinal Physician and Surgeon

Congratulations! You or one of your loved ones is expecting! Typically, other changes in mom’s body take steps center stage, pregnancy affects the entire body, sometimes in the ways that aren’t expected.   Not only does that baby bump start to grow, but intrinsic steroids increase along with a blood pressure blood volume insulin resistance and other changes and how the blood clots.

Potential problems

Eyes are just a tiny part of mom’s body, they can be dramatically affected during pregnancy. Pregnancy, in some cases, can induce a certain retina diseases such as blood pressure related retinopathy, exudative retina detachments, and retinal vascular occlusions, not to mention dramatic worsening of pre-existing diabetes.

Moms with pre-existing diabetes are at very high risk of rapid progression of diabetic eye disease.  In the Diabetes in Early Pregnancy study, there was a significant worsening of potentially blinding retinopathy in 55% of expecting moms.   While this can happen in both type I and type II diabetics, moms-to-be with type I diabetes progress faster during pregnancy.  Diabetic retinopathy, when it reaches significant levels, requires procedures involving specialized medicine, lasers, and even surgery. Catching this complication early can dramatically improve mom’s eyesight and her ability to care for the new baby.

Retinal vascular occlusions are caused by various types of clots that prevent proper blood flow to the retina. Retinal vein occlusions, which can cause bleeding and swelling of the retina, along with vision loss, most often occur in the third trimester or during the postpartum period.

In an uncommon but potentially deadly pregnancy related complication called HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), significant pockets of fluid can develop behind the retina, causing retinal detachments.

Catching Problems Early

As is often the case with healthcare, prevention, or at least early detection, is the best option.     At this point, it’s not required for every pregnant woman to have an eye and retinal screening exam, however there are groups of women that would benefit from specific retinal screening during pregnancy.    The guidelines from the American Academy of Ophthalmology suggest maximization of glycemic control before conception for women with type I or type II diabetes. A dilated retinal examination during the first trimester is highly recommended, with follow-up as recommended by your eye doctor.  In cases with some forms of pre-existing diabetic eye disease, moms may need to be screened every month during pregnancy, due to potentially rapidly progressing disease.  It’s important to note that patients who develop gestational diabetes, without pre-existing type one or type II diabetes, do not require a retinal examination during pregnancy.

Additionally, expecting moms with existing high blood pressure, or clotting problems or other pre-existing eye disease should receive a retinal exam in the first trimester.

Pregnancy is a wonderful time for moms!   Let your eye care providers take care of your eyes, so you can take care of yourself and your bundle of joy!