The highest risk of DR progression happens between the second and third trimester of pregnancy. Photo: Getty Images.

It’s been shown that pregnancy can accelerate the onset or progression of diabetic retinopathy (DR), but the relationship between trimesters and the manifestation of the different stages of DR is unknown. In a study presented last Monday at ARVO in New Orleans, researchers investigated pregnant patients and tracked the trimester in which DR initially presented, as well as the progression of the disease throughout the pregnancy. They found that the highest risk of DR progression is between the second and third trimesters. Additionally, the risk of developing DR during pregnancy during these trimesters is higher than the first.

A total of 220 pregnant patients seen at the Cole Eye Institute in Cleveland, Ohio—65% were Caucasian—diagnosed with diabetes from January 2012 to June 2021 were evaluated. The start date of the first trimester was based on the last menstrual period in the patient’s prenatal chart, and trimester durations ranged from week one through 13, 14 through 27 and weeks 27 on. Severity of DR, as noted by proliferative or mild, moderate and severe nonproliferative DR, as well as time of onset and progression were recorded.

The study was broken into three timepoints between pre-pregnancy and three subsequent trimesters (PP-T1, T1-T2 and T2-T3). Progression was noted if a patient increased in grading of the severity of their DR between timepoints, and manifestation of DR was noted if there was no DR in pre-pregnancy but in a subsequent trimester.

In adjacent trimester visits, the most likely progression in DR occurred between the second and third trimester at 32% compared with PP-T1 (6.67%) and T1-T2 (4.74%). The most likely time to manifest DR was similar between T2 and T3 at 10.53% and 10%, respectively, while T1 was lower at 4.64%. These results indicate that DR is more likely to progress to a more severe stage and also manifest from no prior DR history during later trimesters in pregnancy.

Original abstract content © Association for Research in Vision and Ophthalmology 2023.

Singer JM, Seth K, Rana NK, et al. Characterization and progression of diabetic retinopathy during pregnancy. ARVO 2023 annual meeting.