I am a 34 year old and have type 1 diabetes. I have proliferative retinopathy in both eyes and experienced retinal detachment due to scar tissue bands. I underwent a vitrectomy and reattachment of retina five years ago. My eye condition has been stable now for almost two years. I have maintained my HbA1c in the 5-7% range for several years. My eye problems started when I began this tighter control.

I am interested in becoming pregnant. I am getting mixed signals from doctors pertaining to the associated risks with my eyes. Does pregnancy itself worsen retinopathy or is the worsening of retinopathy directly related to how rapidly normal glycemia is established (which some women try to initiate with their pregnancy)? I would also be interested in hearing from anyone else who has been in a similar situation.

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The risk of retinopathy worsening during pregnancy is dependent on how severe the retinopathy is at the beginning of the pregnancy. In other words, if a women has no retinal changes it is unlikely that any will occur during the pregnancy. But if there is significant retinopathy then there is a higher risk of progression. However, some of these women may have improvement after delivery. Rapid correction of hyperglycemia may contribute to retinopathy as well. I would suggest speaking to your ophthalmologist about your condition and prognosis.

OWJ
Additional comments from Dr. Charles Garcia:

Pregnancy can accelerate retinopathy. It is not fully understood if this progression is due to the duration of diabetes or to metabolic or hormonal factors. If you have proliferative disease you most likely have had laser therapy, which you did not mention. I can not say if becoming pregnant in your situation is a good idea or not. It is generally thought that pregnancy can accelerate retinopathy but that it regresses postpartum. Even though you have been treated for your proliferative disease, by laser, you can still develop a new bleed. You would be wise to have a preliminary retinal exam prior to conception and at the least once each trimester.

CAG