Diabetic retinopathy can worsen during pregnancy
Key takeaways:
- Women with chronic diabetes should undergo a retinopathy screening early in pregnancy.
- Anti-VEGF drug labels recommend against use in pregnant women.
KOLOA, Hawaii — Patients with diabetic retinopathy need special care while pregnant, according to a speaker at Retina 2025.
Irena Tsui, MD, said hormonal, metabolic and vascular changes during pregnancy can lead to worsening of diabetic retinopathy.
“Pregnant patients with either type 1 or type 2 diabetes should be screened for retinopathy early in their pregnancy,” she said.
Tsui said the rate of diabetes in pregnancy is difficult to estimate because of the number of women who do not receive adequate prenatal care, but it is probably around the same as the general population.
If possible, before getting pregnant, patients with diabetes should make sure their disease is well managed and undergo an eye exam to determine baseline retinopathy, while in the first trimester, those with chronic, not gestational, diabetes should be screened with an eye exam, Tsui said. Depending on these results, screening should continue in the second and third trimesters and then every 3 to 6 months postpartum for the first year.
Tsui said available diabetic retinopathy therapies are not well studied in pregnant women. Specifically, anti-VEGF drug labels recommend against use in pregnant women, she said. A decrease in VEGF can cause placental insufficiency, possibly leading to preeclampsia, fetal growth restriction or preterm birth.
A case series and systematic literature review published in 2023 included 42 pregnant women who underwent treatment with anti-VEGF during their pregnancy. Tsui said 40% of women did not know they were pregnant at the time of the injection. Overall, 12% experienced first trimester miscarriages and 7% experienced stillbirths, mostly in those with high risk. However, there were no complications reported when the injection occurred in the third trimester, Tsui said.
“We should think about anti-VEGF use carefully before using it in pregnant women,” Tsui said.
Reference:
- Ong AY, et al. Eye (Lond). 2024;doi:10.1038/s41433-023-02811-6.
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Tsui I. Diabetic retinopathy in pregnancy. Presented at: Retina 2025; Jan. 18-24, 2025; Koloa, Hawaii.
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