Diabetic retinopathy and termination of pregnancy. For discussion

Purpose. Assessment of the influence of the clinical course of diabetic retinopathy (DR) in pregnant women with diabetes mellitus (DM) on obstetric tactics of pregnancy management and the formation of indications for its premature termination. Material and methods. 49 pregnant women with type 1 of DM and progression of DR: 34 with proliferative diabetic retinopathy (PDR) and 15 with preproliferative diabetic retinopathy (PPDR). Macular edema was detected in 5 patients. Standard ophthalmological examination, optical coherence tomography (OCT) and OCT angiography were performed in all trimesters of pregnancy and 3 months after birth. The pregnancy outcomes of the patients were analyzed according to medical records. All patients underwent retinal laser coagulation (RLC) during gestation. Results. Performing RLC during pregnancy stabilized the course of DR before delivery in 78% of patients (38 women, 76 eyes). The progression of DR continued in the postpartum period in 11 patients (22 eyes), and they underwent additional RLC or the introduction of anti-VEGF drugs. Delivery occurred by cesarean section at 36–37 weeks of pregnancy due to the development of preeclampsia, progression of diabetic nephropathy or fetal hypoxia in the majority of pregnant women (82%, 40 patients). 9 pregnant women (18%) gave birth naturally at 38–39 weeks of gestation. Despite the progressive course of DR, there was no case when it became necessary to terminate pregnancy for ophthalmological reasons. Our patients also had no ophthalmological indications for the management of labor with the exception of the pushing period. In our opinion, with active management of a pregnant woman with DR and timely treatment measures, the main indications for cesarean section should be only somatic and obstetric-gynecological. Conclusion. Panretinal laser coagulation, performed during gestation with the progression of DR, can stabilize the course of retinopathy in the majority of pregnant women with DM. Active management of pregnant women with DM and timely RLC make it possible to exclude the PDR progression from the indications for premature abortion. Carrying out RLC in the progression of DR during gestation allows to minimize ophthalmological indications for cesarean section in pregnant women with DM. Key words: diabetic retinopathy, pregnancy, termination of pregnancy, cesarean section, retinal laser coagulation