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TOPLINE:

Among women with diabetes, a history of gestational diabetes was associated with a nearly threefold higher risk for diabetic retinopathy; the risk increased with increasing gestational diabetes severity and development of hypertension after pregnancy.

METHODOLOGY:

• Women with gestational diabetes have a 10-fold increased risk of developing diabetes later in life — primarily type 2 diabetes — and are at higher risk for other pregnancy complications. Although prior studies link gestational diabetes to diabetic retinopathy , the effects of its severity and subsequent hypertension remain unclear.
• Researchers conducted a nationwide, register-based cohort study of 708,250 women giving birth in Denmark from 1997 to 2018, of whom, 24,139 had gestational diabetes in one or more pregnancies while 684,111 did not (median age in both groups, 28 years); women with preexisting diabetes or diabetic retinopathy were excluded.
• The severity of gestational diabetes was assessed using insulin treatment during pregnancy as a proxy measure; subsequent diabetes and hypertension were identified using standard diagnostic codes and/or medication records after pregnancy.
• The outcome was newly developed diabetic retinopathy in either eye among women who subsequently developed diabetes after pregnancy.
• The women were followed for a median of 12 years, beginning 6 weeks after delivery of the first pregnancy.

TAKEAWAY:

• Overall, 18,556 women developed diabetes during follow-up — 20.1% with prior gestational diabetes vs 2.0% without. Of these, 655 (3.5%) developed diabetic retinopathy, and 38.1% developed hypertension after pregnancy but before their diabetic retinopathy diagnosis.
• Among women who developed subsequent diabetes, the risk for diabetic retinopathy was threefold higher among those with gestational diabetes than those without (adjusted hazard ratio [aHR], 3.04; 95% CI, 2.59-3.57).
• The risk for diabetic retinopathy increased with gestational diabetes severity — more than twofold for non-insulin-treated gestational diabetes (aHR, 2.37; 95% CI, 1.97-2.85) and more than fivefold for those requiring insulin (aHR, 5.57; 95% CI, 4.47-6.94) — compared with women without gestational diabetes.
• Among women who developed post-pregnancy hypertension, gestational diabetes was associated with a 2.72-fold higher risk for diabetic retinopathy compared with those without the condition; in women who did not develop hypertension, prior gestational diabetes still conferred a 2.02-fold higher diabetic retinopathy risk.

IN PRACTICE:

“The clinical implication of our findings is that awareness of [gestational diabetes ] history should be included in the individual planning of [diabetic retinopathy] screening in women with diabetes,” the authors wrote.

SOURCE:

This study was led by Maria Hornstrup Christensen, Odense University Hospital, Odense, Denmark. It was published online in Diabetes Care.

LIMITATIONS:

Denmark used selective screening for gestational diabetes, potentially leading to some women being missed and some being misclassified as unexposed. The use of insulin as a proxy for severity of gestational diabetes may have understated the true extent of the condition. Data on diabetic retinopathy outcomes were not captured from private practicing ophthalmologists, possibly underestimating the rate of the outcome.

DISCLOSURES:

This study was supported the Danish Diabetes Academy and from the University of Southern Denmark and Region of Southern Denmark. The authors disclosed having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.