Diabetes mellitus (DM) leads to several vascular and neurological complications, including diabetic retinopathy (DR). As the population ages, health problems in certain groups, including children and pregnant women, are drawing more and more attention. Pregnancy is one of the independent risk factors for the development and progression of DR. Pregnancy-induced changes may contribute to or worsen DR, which can cause a tremendous burden on public health. It is essential for pregnant women with DR and their offspring to minimize the risk of vision loss from DR in this population and adverse outcomes by understanding the development and processes behind this process. Thus, we have updated the recent situation of epidemiology, evolution characteristics, risk factors, pathophysiology, pregnancy outcomes for a better understanding of the latest status of DR, helping to improve maternal and neonatal pregnancy outcomes, and promoting health for women with DR.
TeoZLThamYCYuM, et al.Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology2021; 128: 1580–1591.
2.
LinKDHsuCCOuHY, et al.Diabetes-related kidney, eye, and foot disease in Taiwan: an analysis of nationwide data from 2005 to 2014. J Formos Med Assoc2019; 118(Suppl 2): S103–s110.
3.
SongSJHanKChoiKS, et al.Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: results from the national insurance service survey 2006–2013. J Diabetes Investig2018; 9: 173–178.
4.
WidyaputriFRogersSLKandasamyR, et al.Global estimates of diabetic retinopathy prevalence and progression in pregnant women with preexisting diabetes: a systematic review and meta-analysis. JAMA Ophthalmol2022; 140: 486–494.
5.
ClarkeKWebsterLAlthauserS, et al.The risk of development and progression of diabetic retinopathy in a group of ethnically diverse pregnant women with diabetes attending three regional Diabetic Eye Screening Programs in the UK. Eye (London, England)2023; 38: 179–184.
EganAMMcVickerLHeereyA, et al.Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes. J Diabetes Res2015; 2015: 1–7.
8.
WidyaputriFRogersSLKhongEWC, et al.Prevalence of diabetic retinopathy in women with pregestational diabetes during pregnancy and the postpartum. Clin Exp Ophthalmol2022; 50: 757–767.
9.
MakwanaTTakkarBVenkateshP, et al.Prevalence, progression, and outcomes of diabetic retinopathy during pregnancy in Indian scenario. Indian J Ophthalmol2018; 66: 541–546.
10.
RohitARoulstonTHendersonT, et al.Screening rates for diabetic retinopathy among aboriginal and torres strait islander women with hyperglycaemia in pregnancy: the PANDORA cohort study. Clin Exp Ophthalmol2021; 49: 765–767.
11.
SugimotoMSampaKTsukitomeH, et al.Trends in the prevalence and progression of diabetic retinopathy associated with hyperglycemic disorders during pregnancy in Japan. J Clin Med2021; 11: 165.
12.
WidyaputriFLimLLUtamiTP, et al.Prevalence of diabetes in pregnancy and microvascular complications in native Indonesian women: the Jogjakarta diabetic retinopathy initiatives in pregnancy (Jog-DRIP). PLoS One2022; 17: e0267663.
13.
PappotNDoNCVestgaardM, et al.Prevalence and severity of diabetic retinopathy in pregnant women with diabetes-time to individualize photo screening frequency. Diabet Med2022; 39: e14819.
14.
WidyaputriFRogersSLimL. Global estimates of diabetic retinopathy prevalence and progression in pregnant individuals with preexisting diabetes: a meta-analysis. JAMA Ophthalmol2022; 140: 1137–1138.
15.
BourryJCourtevilleHRamdaneN, et al.Progression of diabetic retinopathy and predictors of its development and progression during pregnancy in patients with type 1 diabetes: a report of 499 pregnancies. Diabetes Care2021; 44: 181–187.
16.
WidyaputriFOkadaMRogersS, et al.Diabetic retinopathy in pregnant women with type I and II diabetes in metropolitan melbourne – prevalence, adherence and barriers to the recommended eye screening guidelines. Investig Ophthalmol Vis Sci2019; 60: 60.
17.
Axer-SiegelRHodMFink-CohenS, et al.Diabetic retinopathy during pregnancy. Ophthalmology1996; 103: 1815–1819.
18.
ArunCSTaylorR. Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes. Diabetologia2008; 51: 1041–1045.
19.
FlaxelCJAdelmanRABaileyST, et al.Diabetic retinopathy preferred practice pattern®. Ophthalmology2020; 127: P66–p145.
20.
AmoakuWMGhanchiFBaileyC, et al.Diabetic retinopathy and diabetic macular oedema pathways and management: UK consensus working group. Eye (London, England)2020; 34: 1–51.
21.
GrauslundJAndersenNAndresenJ, et al.Evidence-based Danish guidelines for screening of diabetic retinopathy. Acta Ophthalmol2018; 96: 763–769.
22.
Fundus Disease Group of Ophthalmological Society of Chinese Medical Association FDGoOBoCMDA. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022). Chin J Ocul Fundus Dis2022; 39: 99–128. (in Chinese).
23.
GiridharSVermaLRajendranA, et al.Diabetic macular edema treatment guidelines in India: all India ophthalmological society diabetic retinopathy task force and vitreoretinal society of India consensus statement. Indian J Ophthalmol2021; 69: 3076–3086.
24.
TodorovaKMazneĭkovaVIvanovS. Can education duning pregnancy improve the perinatal outcome in diabetic pregnancies?Akush Ginekol (Sofiia)2004; 43: 21–27.
25.
BoJ. Application effect of continuous health education in nursing care of patients with gestational diabetic retinopathy. Electronic J Pract Gynecol Endocrinol2022; 9: 105–107. (in Chinese).
26.
SarvepalliSMBaileyBAD’AlessioD, et al.Risk factors for the development or progression of diabetic retinopathy in pregnancy: meta-analysis and systematic review. Clin Exp Ophthalmol2023; 51: 195–204.
27.
MyersJERelphSPatelT, et al.Adverse pregnancy outcomes in women with diabetes-related microvascular disease and risks of disease progression in pregnancy: A systematic review and meta-analysis. PLOS Med2021; 18: e1003856.
28.
JensenETRigdonJRezaeiKA, et al.Prevalence, progression, and modifiable risk factors for diabetic retinopathy in youth and young adults with youth-onset type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care2023; 46: 1252–1260.
29.
MulderEGde HaasSMohseniZ, et al.Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy – a systematic review and meta-analysis. Bjog2022; 129: 696–707.
30.
WidyaputriFLimLL. Diabetic retinopathy in pregnancy: a growing problem. Clin Exp Ophthalmol2023; 51: 192–194.
31.
LeeHYangSWKimY, et al.Risk of retinopathy in women with pregnancy-induced hypertension: a nationwide population-based cohort study of 9-year follow-up after delivery. Am J Obstet Gynecol MFM2023; 5: 100985.
32.
RudlandVLPriceSALHughesR, et al.ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol2020; 60: E18–E52.
33.
BainSCKlufasMAHoA, et al.Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: a review. Diabetes Obes Metab2019; 21: 454–466.
34.
WeiYXuQYangH, et al.Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: a population-based cohort study in China. PLOS Med2019; 16: e1002926.
35.
TilahunMGobenaTDerejeD, et al.Prevalence of diabetic retinopathy and its associated factors among diabetic patients at debre markos referral hospital, northwest Ethiopia, 2019: hospital-based cross-sectional study. Diabetes Metab Syndr Obes2020; 13: 2179–2187.
36.
ZhuWWuYMengYF, et al.Association of obesity and risk of diabetic retinopathy in diabetes patients: a meta-analysis of prospective cohort studies. Medicine (Baltimore)2018; 97: e11807.
37.
ChanJCYCheeMLTanNYQ, et al.Differential effect of body mass index on the incidence of diabetes and diabetic retinopathy in two Asian populations. Nutr Diabetes2018; 8: 16.
38.
EganAMBrassillMJBrosnanE, et al.An Irish national diabetes in pregnancy audit: aiming for best outcomes for women with diabetes. Diabet Med2020; 37: 2044–2049.
39.
LarsenMColmornLBBonnelyckeM, et al.Retinal artery and vein diameters during pregnancy in diabetic women. Invest Ophthalmol Vis Sci2005; 46: 709–713.
40.
FedotkinaOLukAJainR, et al.Perinatal famine is associated with excess risk of proliferative retinopathy in patients with type 2 diabetes. Acta Ophthalmol2022; 100: e539–e545.
41.
HainsworthDPBebuIAielloLP, et al.Risk factors for retinopathy in type 1 diabetes: the DCCT/EDIC study. Diabetes Care2019; 42: 875–882.
42.
LinKYHsihWHLinYB, et al.Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig2021; 12: 1322–1325.
43.
ShahJCheongZYTanB, et al.Dietary intake and diabetic retinopathy: a systematic review of the literature. Nutrients2022; 14: 5021.
44.
CyprykKGrycewiczJSwierzewskaP, et al.Parity does not affect diabetes complications in women with type 1 diabetes. Ann Agric Environ Med2018; 25: 114–119.
45.
AlkaKKumarJKowluruRA. Impaired mitochondrial dynamics and removal of the damaged mitochondria in diabetic retinopathy. Front Endocrinol (Lausanne)2023; 14: 1160155.
46.
HussainTMurtazaGMetwallyE, et al.The role of oxidative stress and antioxidant balance in pregnancy. Mediators Inflamm2021; 2021: 9962860.
47.
SheCShangFCuiM, et al.Association between dietary antioxidants and risk for diabetic retinopathy in a Chinese population. Eye (London, England)2021; 35: 1977–1984.
48.
AntonettiDASilvaPSStittAW. Current understanding of the molecular and cellular pathology of diabetic retinopathy. Nat Rev Endocrinol2021; 17: 195–206.
49.
StittAWCurtisTMChenM, et al.The progress in understanding and treatment of diabetic retinopathy. Prog Retin Eye Res2016; 51: 156–186.
50.
Valencia-OrtegaJSaucedoRSánchez-RodríguezMA, et al.Epigenetic alterations related to gestational diabetes mellitus. Int J Mol Sci2021; 22: 9462.
51.
LiYXLongDLLiuJ, et al.Gestational diabetes mellitus in women increased the risk of neonatal infection via inflammation and autophagy in the placenta. Medicine (Baltimore)2020; 99: e22152.
52.
KaštelanSTomićMPavanJ, et al.Maternal immune system adaptation to pregnancy–a potential influence on the course of diabetic retinopathy. Reprod Biol Endocrinol2010; 8: 124.
53.
Nguyen-NgoCPerkinsAVLappasM. Selenium prevents inflammation in human placenta and adipose tissue in vitro: implications for metabolic diseases of pregnancy associated with inflammation. Nutrients2022; 14: 3286.
54.
BoBYZYQ. Correlation of serum vitamin D level with insulin resistance and inflammatory response in pregnant women. Chin Acad J Electron Publ House2023; 20: 117–120. (in Chinese).
55.
BermeaKCRodriguez-GarciaATsinA, et al.Somatolactogens and diabetic retinopathy. Growth Horm IGF Res2018; 41: 42–47.
56.
BolataiAHeYWuN. Vascular endothelial growth factor and its receptors regulation in gestational diabetes mellitus and eclampsia. J Transl Med2022; 20: 400.
57.
DavidovićSBabićNJovanovićS, et al.Serum erythropoietin concentration and its correlation with stage of diabetic retinopathy. BMC Ophthalmol2019; 19: 227.
58.
TanEKTanEL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol2013; 27: 791–802.
59.
TeramoKPiñeiro-RamosJD. Fetal chronic hypoxia and oxidative stress in diabetic pregnancy. Could fetal erythropoietin improve offspring outcomes?Free Radic Biol Med2019; 142: 32–37.
60.
RudrarajuMNarayananSPSomanathPR. Regulation of blood-retinal barrier cell-junctions in diabetic retinopathy. Pharmacol Res2020; 161: 105115.
61.
YanachkovaVStaynovaRStankovaT, et al.Placental growth factor and pregnancy-associated plasma protein-A as potential early predictors of gestational diabetes mellitus. Medicina (Kaunas, Lithuania)2023; 59: 398.
62.
RingholmLVestgaardMLaugesenCS, et al.Pregnancy-induced increase in circulating IGF-I is associated with progression of diabetic retinopathy in women with type 1 diabetes. Growth Horm IGF Res2011; 21: 25–30.
63.
LoukovaaraSImmonenIJKoistinenR, et al.The insulin-like growth factor system and Type 1 diabetic retinopathy during pregnancy. J Diabetes Complications2005; 19: 297–304.
64.
SimóRStittAWGardnerTW. Neurodegeneration in diabetic retinopathy: does it really matter?Diabetologia2018; 61: 1902–1912.
65.
HommerNKallabMSchlatterA, et al.Neuro-vascular coupling and heart rate variability in patients with type II diabetes at different stages of diabetic retinopathy. Front Med (Lausanne)2022; 9: 1025853.
66.
PomytkinaNVSorokinELPashentsevYE. Features of retinal blood flow in pregnant women with carbohydrate metabolism disorders. Vestn Oftalmol2022; 138: 16–23.
67.
LoukovaaraSHarjuMKaajaR, et al.Retinal capillary blood flow in diabetic and nondiabetic women during pregnancy and postpartum period. Investig Ophthalmol Vis Sci2003; 44: 1486–1491.
68.
ChandrasekaranPRMadanagopalanVGNarayananR. Diabetic retinopathy in pregnancy – A review. Indian J Ophthalmol2021; 69: 3015–3025.
69.
LastaMFuchsjager-MayrlGWolztM, et al.Effects of increased white blood cell count on retinal perfusion during hyperoxia-induced vasoconstriction. Microvasc Res2012; 83: 126–130.
70.
ForresterJVKuffovaLDelibegovicM. The role of inflammation in diabetic retinopathy. Front Immunol2020; 11: 583687.
71.
YeeKHTanKHArisIM, et al.History of gestational diabetes mellitus and postpartum maternal retinal microvascular structure and function. Diabet Med2019; 36: 784–786.
72.
KhalooPQahremaniRRabizadehS, et al.Nitric oxide and TNF-α are correlates of diabetic retinopathy independent of hs-CRP and HbA1c. Endocrine2020; 69: 536–541.
73.
De VrieseASVerbeurenTJVan de VoordeJ, et al.Endothelial dysfunction in diabetes. Br J Pharmacol2000; 130: 963–974.
74.
WongTYCheungCMLarsenM, et al.Diabetic retinopathy. Nat Rev Dis Primers2016; 2: 16012.
75.
AkpolatCKurtMMEvliyaogluF, et al.Analysis of retinal neurodegeneration in gestational and type 2 diabetes using swept-source optical coherence tomography. Can J Ophthalmol2021; 56: 184–190.
76.
JoDHYunJHChoCS, et al.Interaction between microglia and retinal pigment epithelial cells determines the integrity of outer blood-retinal barrier in diabetic retinopathy. Glia2019; 67: 321–331.
77.
FletcherELDixonMAMillsSA, et al.Anomalies in neurovascular coupling during early diabetes: a review. Clin Exp Ophthalmol2023; 51: 81–91.
78.
TriebelJMacotelaYde la EscaleraGM, et al.Prolactin and vasoinhibins: endogenous players in diabetic retinopathy. IUBMB Life2011; 63: 806–810.
79.
Adán-CastroESiqueiros-MárquezLRamírez-HernándezG, et al.Sulpiride-induced hyperprolactinaemia increases retinal vasoinhibin and protects against diabetic retinopathy in rats. J Neuroendocrinol2022; 34: e13091.
80.
AlexABhandaryEMcGuireKP. Anatomy and physiology of the breast during pregnancy and lactation. Adv Exp Med Biol2020; 1252: 3–7.
81.
RassieKGiriRJohamAE, et al.Prolactin in relation to gestational diabetes and metabolic risk in pregnancy and postpartum: a systematic review and meta-analysis. Front Endocrinol (Lausanne)2022; 13: 1069625.
82.
Pérez-IbaveDCGarza-RodríguezMLPérez-MayaAA, et al.Expression of growth hormone and growth hormone receptor genes in human eye tissues. Exp Eye Res2019; 181: 61–71.
83.
HarveySMartinez-MorenoCG. Growth hormone and ocular dysfunction: endocrine, paracrine or autocrine etiologies?Growth Horm IGF Res2016; 29: 28–32.
84.
DongXSuLPattiME. Growth hormone and counterregulation in the pathogenesis of diabetes. Curr Diab Rep2022; 22: 511–524.
85.
LiaoSVickersMHStanleyJL, et al.Human placental growth hormone variant in pathological pregnancies. Endocrinology2018; 159: 2186–2198.
86.
McIntyreHDSerekRCraneDI, et al.Placental growth hormone (GH), GH-binding protein, and insulin-like growth factor axis in normal, growth-retarded, and diabetic pregnancies: correlations with fetal growth. J Clin Endocrinol Metab2000; 85: 1143–1150.
87.
Wilkinson-BerkaJLSuphapimolVJeromeJR, et al.Angiotensin II and aldosterone in retinal vasculopathy and inflammation. Exp Eye Res2019; 187: 107766.
88.
Velazquez-RomanJAVillafañaSLopez SanchezP, et al.Effect of pregnancy and diabetes on vascular receptors for angiotensin II. Clin Exp Hypertens2011; 33: 167–173.
89.
GajeraDTrivediVThakerP, et al.Detailed review on gestational diabetes Mellitus with emphasis on pathophysiology, epidemiology, related risk factors, and its subsequent conversion to type 2 diabetes Mellitus. Horm Metab Res2023; 55: 295–303.
90.
AlnomanAPeevaMBadeghieshAM, et al.Pregnancy, delivery and neonatal outcomes among women with diabetic retinopathy. J Matern Fetal Neonatal Med2022; 35: 10621–10628.
91.
XiangLJWangYLuGY, et al.Association of the presence of microangiopathy with adverse pregnancy outcome in type 1 diabetes: a meta-analysis. Taiwan J Obstet Gynecol2018; 57: 659–664.
92.
TrottMSmithLVeroneseN, et al.Eye disease and mortality, cognition, disease, and modifiable risk factors: an umbrella review of meta-analyses of observational studies. Eye (London, England)2022; 36: 369–378.
