Diabetes Care, Vol 23, Issue 8 1084-1091, Copyright © 2000 by American Diabetes Association

ARTICLES

Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group

OBJECTIVE: To assess the effect of pregnancy on the development and progression of retinopathy and microalbuminuria in type 1 diabetes. RESEARCH DESIGN AND METHODS: We conducted longitudinal analyses of the Diabetes Control and Complications Trial (DCCT), a multicenter controlled clinical trial that compared intensive treatment with conventional diabetes therapy and studied 180 women who had 270 pregnancies and 500 women who did not become pregnant during an average of 6.5 years of follow-up. Women assigned to the conventional treatment group were changed to intensive therapy if they were planning pregnancy or as soon as possible after conception. Fundus photography was performed every 6 months, and the urinary albumin excretion rate (AER) was measured annually. RESULTS: Compared with nonpregnant women, pregnant women had a 1.63-fold greater risk of any worsening of retinopathy from before to during pregnancy (P < 0.05) in the intensive treatment group; the risk was 2.48-fold greater for pregnant vs. not pregnant women in the conventional group (P < 0.001). In the conventional group, the odds of > or =3-step progression from the baseline retinopathy level was >2.9-fold among pregnant vs. not pregnant women (P = 0.003). The odds ratio (OR) peaked during the second trimester (OR = 4.26, P = 0.001) and persisted as long as 12 months postpregnancy (OR = 2.87, P = 0.005). The level of AER during pregnancy in the intensive group, but not in the conventional group, was significantly elevated from the level at baseline, albeit in the normal range. Although individual patients had transient worsening of retinopathy during pregnancy, even to the proliferative level, at the end of the DCCT, mean levels of retinopathy and albuminuria in subjects who had become pregnant were similar to those in subjects who had not become pregnant within each treatment group. CONCLUSIONS: Pregnancy in type 1 diabetes induces a transient increase in the risk of retinopathy; increased ophthalmologic surveillance is needed during pregnancy and the first year postpartum. The long-term risk of progression of early retinopathy and albumin excretion, however, does not appear to be increased by pregnancy.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				E. S. Kilpatrick, A. S. Rigby, and S. L. Atkin A1C Variability and the Risk of Microvascular Complications in Type 1 Diabetes: Data from the Diabetes Control and Complications Trial Diabetes Care, November 1, 2008; 31(11): 2198 - 2202. [Abstract] [Full Text] [PDF]

				J. L. Kitzmiller, J. M. Block, F. M. Brown, P. M. Catalano, D. L. Conway, D. R. Coustan, E. P. Gunderson, W. H. Herman, L. D. Hoffman, M. Inturrisi, et al. Managing Preexisting Diabetes for Pregnancy: Summary of evidence and consensus recommendations for care Diabetes Care, May 1, 2008; 31(5): 1060 - 1079. [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes--2008 Diabetes Care, January 1, 2008; 31(Supplement_1): S12 - S54. [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes--2007 Diabetes Care, January 1, 2007; 30(suppl_1): S4 - S41. [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes-2006 Diabetes Care, January 1, 2006; 29(suppl_1): S4 - S42. [Full Text] [PDF]

				G. T. Lueder, J. Silverstein, and and Section on Ophthalmology and Section on Endocr Screening for Retinopathy in the Pediatric Patient With Type 1 Diabetes Mellitus Pediatrics, July 1, 2005; 116(1): 270 - 273. [Abstract] [Full Text] [PDF]

				P. Suryanarayana, M. Saraswat, T. Mrudula, T. P. Krishna, K. Krishnaswamy, and G. B. Reddy Curcumin and Turmeric Delay Streptozotocin-Induced Diabetic Cataract in Rats Invest. Ophthalmol. Vis. Sci., June 1, 2005; 46(6): 2092 - 2099. [Abstract] [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes Diabetes Care, January 1, 2005; 28(suppl_1): S4 - S36. [Full Text] [PDF]

				S. Rowe, C. H. MacLean, and P. G. Shekelle Preventing Visual Loss From Chronic Eye Disease in Primary Care: Scientific Review JAMA, March 24, 2004; 291(12): 1487 - 1495. [Abstract] [Full Text] [PDF]

				Standards of Medical Care in Diabetes Diabetes Care, January 1, 2004; 27(90001): s15 - 35. [Full Text] [PDF]

				Standards of Medical Care for Patients With Diabetes Mellitus Diabetes Care, January 1, 2003; 26(2007): S33 - S50. [Full Text] [PDF]

				D. M. Nathan The Impact of Clinical Trials on the Treatment of Diabetes Mellitus J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 1929 - 1937. [Abstract] [Full Text] [PDF]

				Standards of Medical Care for Patients With Diabetes Mellitus Diabetes Care, January 1, 2002; 25(1): 213 - 229. [Full Text] [PDF]

				S. S. MCELVY, S. DEMARINI, M. MIODOVNIK, J. C. KHOURY, B. ROSENN, and R. C. TSANG Fetal Weight and Progression of Diabetic Retinopathy Obstet. Gynecol., April 1, 2001; 97(4): 587 - 592. [Abstract] [Full Text] [PDF]

				D. M. Nathan, M. Davis, P. Cleary, and J. Lachin Response to Cundy Diabetes Care, April 1, 2001; 24(4): 795 - 796. [Full Text]

				T. Cundy Do All Women Require Intensive Retinal Surveillance During Pregnancy? Diabetes Care, April 1, 2001; 24(4): 794-a - 795. [Full Text]