Study: Pregnancy Not Independently Associated with DR or DME in the US

Findings using a nationwide cohort’s data suggest that pregnancy may not independently increase the risk of DR or progression. Photo: Jay M. Haynie, OD. Click image to enlarge. Diabetic retinopathy (DR) prevalence and progression rates during pregnancy vary widely, highlighting the challenges in establishing definitive conclusions regarding disease progression and management. Addressing these knowledge gaps requires large-scale investigations, which are especially critical in the US, where maternal health outcomes remain a significant public health concern. Researchers based in Little Rock, AR, recently used the data from the official portal of the All of Us research program to determine that pregnancy was not associated with higher nonproliferative (NPDR) or proliferative DR (PDR) prevalence. Their findings were published in Ophthalmology Retina.This cross-sectional analysis included 935 participants: 148 individuals with at least one pregnancy episode (303 total episodes) and 787 non-pregnant controls. The pregnancy group had a lower median age (56.8 years vs. 70.0 years), which is expected given that pregnancy occurred in earlier adulthood, and this study assessed participants at a single, later point in time.Type 2 diabetes was the most common subtype, though less prevalent in the pregnancy group (40% vs. 51%). Essential hypertension was also lower among pregnant participants (77.7% vs. 85.5%). No significant differences were observed for diabetic nephropathy, diabetic chronic kidney disease or hypertriglyceridemia. The pregnancy group also had a lower diabetes complications severity index score.NPDR was present in 8.6% of the cohort, with no significant difference between the groups. PDR was observed in 9% of participants, and DME rates were similar. Among the 303 pregnancy episodes, progression of NPDR, development of DME or progression to PDR occurred in fewer than 20 episodes (<6.7%).  Triamcinolone intravitreal injections were more common in the pregnancy group (17.6% vs. 10.7%), while no significant differences were seen for anti-VEGF therapy or other intravitreal injections.“Although our study does not negate a possible association between pregnancy and DR progression, it points to the positive impact of improved prenatal and postpartum care protocols—including tighter glycemic control and routine retinal examinations in the study population,” the study authors wrote in their paper.They also noted that their study was adequately powered to detect differences greater than 7%. Therefore, if any true difference exists in the NPDR, PDR or DME rates, it would be below this threshold and therefore of limited clinical relevance.Click here for the journal source. Hallaj S, Chauhan MZ, Shakarchi AF, et al. Pregnancy and diabetic retinopathy: a report from the All of Us Research Program. Ophthalmol Retina. May 19, 2025. [Epub ahead of print].