Pregnant diabetic patients need extra evaluation and monitoring

BUENOS AIRES — When treating a pregnant patient with diabetes, ophthalmologists must monitor their ocular complications closely by assisting them during their pregnancy and following them in the postpartum period.

Gustavo Piantoni

"More and more type 1 and type 2 diabetic patients become pregnant," Gustavo Piantoni, MD, said at the opening conference of the Argentinean Society of Ophthalmology Annual Course. "Until not such a long time ago ... pregnancies would be terminated by abortion. Now they can become pregnant, but these pregnancies have also become a complication for the eye patient."

Dr. Piantoni explained that pregnancy induces physiologic changes in a woman's eye, such as decreased corneal sensitivity, changes in accommodation and decreased IOP. Although these changes are common, he said a physician cannot make a diagnosis of physiological change and must examine further when monitoring a pregnant diabetic patient.

"If they have pre-existing diseases, [these changes] may influence the pregnancy or the pregnancy in the development of the disease," Dr. Piantoni said. "Do not stick to the diagnosis of physiological change. It demands studying in case the woman has something else. A concomitant pathology ... is relatively frequent."

He said ophthalmologists must take a second look and consider pathologies such as choroiditis, amniotic fluid embolism, tumor, neuritis or endophthalmitis. Pre-existing conditions can include Graves' disease, high myopia, retinitis, choroidal hemangioma and diabetic retinopathy.

In a study of 123 patients in his hospital, Dr. Piantoni showed that 21% had a worsening of their diabetic retinopathy through the course of their pregnancy, with more type 1 diabetics affected.

"What are the factors that may have an impact? Those factors that may determine any diabetes," Dr. Piantoni said. "The evolution of diabetic retinopathy [also] depends on what degree of retinopathy is expressed at the beginning of pregnancy."

He said physicians must closely monitor postpartum diabetic patients to catch any worsening early. He said that 7.6% of patients under strict control had progression of their disease, while 19.1% under standard control worsened.