Pregnancy and Diabetic Retinopathy

  • J. V. Forrester
  • H. M. A. Towler
  • D. W. M. Pearson


In 1950 Beetham reported on the occurrence of retinopathy in a group of 200 pregnant diabetics. He found that diabetic retinopathy deteriorated during pregnancy, and his results were supported by data from further studies (Oakley 1953; Stephens et al. 1963). In 12 patients with proliferative retinopathy, Beetham observed that all experienced visual deterioration and four progressed to blindness. Later studies by White (1965) confirmed that both haemorrhagic and proliferative retinopathy worsened during pregnancy and that there was a tendency towards regression of the retinopathy (i.e. improvement) after delivery, an observation made anecdotally in two cases of longstanding diabetes by Lawrence in 1948. Beetham (1950) advocated that patients with proliferative retinopathy should avoid pregnancy, and terminations should be offered to pregnant diabetics on the basis that more than 50% of patients with any degree of retinopathy had a reduced chance of a successful pregnancy and all patients with proliferative retinopathy at the onset of pregnancy experienced perinatal mortality plus visual loss.


Growth Hormone Diabetic Retinopathy Proliferative Diabetic Retinopathy Proliferative Retinopathy Pregnant Diabetic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Almer L-O, Pandolfi M, Milsson IM (1975) Diabetic retinopathy and the fibrinolytic system. Diabetes 24:529–541PubMedCrossRefGoogle Scholar
  2. Amiel SAJ, Sherwin RS, Hintz RL, Gertner JM, Press CM, Tamborline WV (1984) Effect of diabetes and its control on insulin-like growth factors in the young subject with Type I diabetes. Diabetes 33:1175–1179PubMedCrossRefGoogle Scholar
  3. Ashton N (1983) Pathogenesis of diabetic retinopathy. In: Little HL, Jack RL, Patz A, Forsham PH (eds) Diabetic retinopathy. Thieme-Stratton, New York, pp 85–97Google Scholar
  4. Baird A, Esch F, Gospodarowicz D, Guillemin R (1985) Retina- and eye-derived endothelial growth factors: partial molecular characterisation and identity with acidic and basic fibroblast growth factors. Biochemistry 24:7855–7860PubMedCrossRefGoogle Scholar
  5. Bala RM, Lopatka J, Leung A et al. (1981) Serum immunoreactive somatomedin levels in normal adults, pregnant women at term, children at various ages and children with constitutionally delayed growth. J Clin Endocrinol Metab 52:508–512PubMedCrossRefGoogle Scholar
  6. Beetham WP (1950) Diabetic retinopathy in10pregnancy. Trans Am Ophthalmol Soc 48:205–211PubMedGoogle Scholar
  7. Borsey DQ, Dawes J, Fraser DM, Prowse CV, Elton RA, Clarke BF (1980) Plasma betathromboglobulin in diabetes mellitus. Diabetologia 18:353–357PubMedGoogle Scholar
  8. Brownlee M, Cerami A (1981) The biochemistry of the complications of diabetes mellitus. Annu Rev Biochem 50:385–432PubMedCrossRefGoogle Scholar
  9. Burger W, Hovener G, Dusterhus R, Hartmann R, Weber B (1986) Prevalence and development of retinopathy in children and adolescents with Type I (insulin dependent) diabetes mellitus. A longitudinal study. Diabetologia 29:17–22PubMedCrossRefGoogle Scholar
  10. Cassar J, Kohner EM, Hamilton AM, Gordon H, Joplin GF (1978) Diabetic retinopathy and pregnancy. Diabetologia 15:105–111PubMedCrossRefGoogle Scholar
  11. Cogan DG, Toussaint D, Kuwabara T (1961) Retinal vascular patterns. IV. Diabetic retinopathy. Arch Ophthalmol 66:366–378PubMedCrossRefGoogle Scholar
  12. Cohen MP, Jasti K, Rye DL (1977) Somatomedin in insulin dependent diabetes mellitus. J Clin Endocrinol Metab 60:648–657Google Scholar
  13. Cugini P, Letizia C, Murano G (1987) Increased serum aldosterone in diabetic pregnancy. Diabetologia 30:166–168PubMedCrossRefGoogle Scholar
  14. Dahl-Jorgensen K, Brinchmann-Hansen O, Hanssen KF, Sandvik L, Aagenaes O (1985) Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo Study. Br Med J 290:811–815CrossRefGoogle Scholar
  15. D’Amore P (1987) Mechanisms of angiogenesis. Annu Rev Physiol 49:453–464PubMedCrossRefGoogle Scholar
  16. D’Amore PA, Klagsburn M (1984) Endothelial cell mitogens derived from retina and hypothalamus: biochemical and biological similarities. J Cell Biol 99:1545–1549PubMedCrossRefGoogle Scholar
  17. Dintenfass L (1977) Blood viscosity factors in severe non diabetic and diabetic retinopathy. Biorheology 14:151–157PubMedGoogle Scholar
  18. Elstow SF, Schor AM, Weiss JB (1985) Bovine retinal angiogenesis factor is a small molecule (molecular mass <600). Invest Ophthalmol Vis Sci 26:74–79PubMedGoogle Scholar
  19. Engerman RL, Kern TS (1987) Progression of incipient diabetic retinopathy during good glycemic control. Diabetes 36:808–812PubMedCrossRefGoogle Scholar
  20. Folkman J (1982) Angiogenesis: initiation and control. Ann NY Acad Sci 401:212–227PubMedCrossRefGoogle Scholar
  21. Forrester JV (1987) Mechanisms in the formation of new vessels in the retina. Diab Med 4:423–431CrossRefGoogle Scholar
  22. Grant M, Russel B, Fitzgerald C, Merimee TJ (1986) Insulin-like growth factors in the vitreous. Studies in control and diabetic subjects with neovascularisation. Diabetes 35:416–420PubMedCrossRefGoogle Scholar
  23. Grant M, Jordan J, Merimee TJ (1987) Insulin-like growth factor 1 modulates endothelial cell Chemotaxis. J Clin Endocrinol Metab 65:370–371PubMedCrossRefGoogle Scholar
  24. Helve E, Laatikainen L, Merennines L, Koivisto VA (1987) Continuous insulin infusion therapy in patients with Type 1 diabetes. Acta Endocrinol 115:313–319PubMedGoogle Scholar
  25. Hercules B, Wozencroft M, Gayel IJ, Jeacock J (1980) Peripheral retinal ablation in the treatment of proliferative diabetic retinopathy during pregnancy. Br J Ophthalmol 64:87–93PubMedCrossRefGoogle Scholar
  26. Horvat M, MacLean H, Goldberg L, Crock GW (1980) Diabetic retinopathy in pregnancy: a 12 year prospective survey. Br J Ophthalmol 64:398–403PubMedCrossRefGoogle Scholar
  27. Jansen M, van Schaik FMA, Ricker AT et al. (1983) Sequence of cDNA encoding human insulin-like growth factor I precursor. Nature 306:609–611PubMedCrossRefGoogle Scholar
  28. Kalkhoff RK (1975) Effects of oral contraceptive agents on carbohydrate metabolism. J Steroid Biochem 6:949–956PubMedCrossRefGoogle Scholar
  29. Kalkhoff RK, Jacobson M, Lemper D (1970) Progesterone, pregnancy and the augmented plasma insulin response. J Clin Endocrinol Metab 31:24–28PubMedCrossRefGoogle Scholar
  30. Kastrup J, Rorsgaard S, Parving HH, Lassen MA (1986) Impaired regulation of cerebral blood flow in long-term Type 1 (insulin-dependent) diabetic patients with nephropathy and retinopathy. Clin Physiol 6:549–559PubMedCrossRefGoogle Scholar
  31. Kennedy A, Frank RN, Varma SD (1983) Aldose reductase activity in retinal and cerebral microvessels and cultured microvascular cells. Invest Ophthalmol Vis Sci 24:1250–1258PubMedGoogle Scholar
  32. Klein R, Klein BEK, Moss SE, Davis MD, De Mets DL (1984) The Wisconsin Epidemiological Study of Diabetic Retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526PubMedCrossRefGoogle Scholar
  33. Kohner EM, Oakley NW (1975) Diabetic retinopathy. Metabolism 24:1085–1102PubMedCrossRefGoogle Scholar
  34. Kroc Collaborative Study (1984) Blood glucose control and the evolution of diabetic retinopathy and albuminuria. N Engl J Med 311:365–372CrossRefGoogle Scholar
  35. Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR (1986) Risk of proliferative diabetic retinopathy in juvenile-onset Type I diabetes: a 40 year follow-up study. Diabetes Care 9:443–452PubMedCrossRefGoogle Scholar
  36. Kuniman MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ (1986) Multiple factors in the prediction of risk of proliferative diabetic retinopathy. N Engl J Med 313:1433–1438Google Scholar
  37. Labat-Robert J, Leutenegger M, Llopis G, Ricard Y, Derouette J-C (1984) Plasma and tissue fibronectin in diabetes. Clin Physiol Biochem 2:39–48PubMedGoogle Scholar
  38. Larinkari J, Laatikainen L, Ranta T, Moronen P, Pesonen K, Laatikainen T (1982) Metabolic control and serum hormone levels in relation to retinopathy in diabetic pregnancy. Diabetologia 22:327–332PubMedCrossRefGoogle Scholar
  39. Lauritzen T, Frost-Larsen K, Larsen H-W, Decker T (1983) Steno Study Group. Effect of one year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics. Lancet 1:200–204PubMedCrossRefGoogle Scholar
  40. Lawrence RD (1948) Acute retinopathy without hyperpiesis in diabetic pregnancy. Br J Ophthalmol 32:461–465CrossRefGoogle Scholar
  41. Lostroh AJ Krahl ME (1974) A hyperglycemic peptide from pituitary growth hormone: preparation with pepsin and assay in ob/ob mice. Proc Natl Acad Sci USA 71:1244–1246PubMedCrossRefGoogle Scholar
  42. Lostroh AJ, Krahl ME (1976) Diabetogenic peptide from human growth hormone: partial purification from peptic digest and long-term action in ob/ob mice. Proc Natl Acad Sci USA 73:4706–4710PubMedCrossRefGoogle Scholar
  43. Lundbaeck K, Christiansen MJ, Jensen VA et al. (1970) Diabetes, diabetic angiopathy and growth hormone. Lancet 11:131–133CrossRefGoogle Scholar
  44. Maes M, Underwood LE, Ketelslegers J-M (1986) Low serum somatomedin-C in insulin-dependent diabetes: evidence for a post-receptor mechanism. Endocrinology 118:377–382PubMedCrossRefGoogle Scholar
  45. Mathews LS, Morstedt G, Palmitter RD (1986) Regulation of insulin-like growth factor I gene expression by growth hormone. Proc Natl Acad Sci USA 83:9343–9347PubMedCrossRefGoogle Scholar
  46. McIntosh L, Muckersie L, Forrester JV (1988) Retinal capillary endothelial cells prefer different substrates for growth and migration. Tissue Cell 20 (in press)Google Scholar
  47. Merimee TJ, Fineberg SE, McKusick VA et al. (1970) Diabetes mellitus and ateliotic dwarfism; a comparative study. J Clin Invest 49:1096–1102PubMedCrossRefGoogle Scholar
  48. Merimee TJ, Zapf J, Froesch ER (1983) Insulin-like growth factors: studies in diabetics with and without retinopathy. N Engl J Med 309:527–530PubMedCrossRefGoogle Scholar
  49. Michaelson IC (1948) The mode of development of retinal vessels. Trans Ophthalmol Soc UK 68:137–180Google Scholar
  50. Mills NC, Gyves MT, Dan J (1985) Mol Cell Endocrinol 39:61–69PubMedCrossRefGoogle Scholar
  51. Moloney JBM, Drury MI (1982) The effect of pregnancy on the natural course of diabetic retinopathy. Am J Ophthalmol 93:745–756PubMedGoogle Scholar
  52. Nash H (1979) Growth failure, somatomedin and growth hormone levels in juvenile diabetes mellitus: a pilot study. Aust NZ J Med 45:236–239Google Scholar
  53. Neilsen JH (1984) Direct effect of gonadal and contraceptive steroids on insulin release from mouse pancreatic islets in organ culture. Acta Endocrinol 105:245–250Google Scholar
  54. Oakley W (1953) Prognosis in diabetic pregnancy. Br Med J 1:1413–1415PubMedCrossRefGoogle Scholar
  55. Orlidge A, D’Amore PA (1987) Inhibition of capillary endothelial cell growth by pericytes and smooth muscle cells. J Cell Biol 105:1455–1462PubMedCrossRefGoogle Scholar
  56. Palmberg P, Smith M, Waltman S et al. (1981) The natural history of retinopathy in insulin dependent juvenile onset diabetes. Ophthalmology 88:613–618PubMedGoogle Scholar
  57. Parving HH, Viberti GC, Keen H, Christiansen JS, Lassen NA (1983) Haemodynamic factors in the genesis of diabetic macroangiopathy. Metabolism 32:943–949PubMedCrossRefGoogle Scholar
  58. Passa P, Ganville C, Canivet J (1974) Influence of muscular exercise on plasma level of growth hormone in diabetics with and without retinopathy. Lancet 11:72–74CrossRefGoogle Scholar
  59. Paton RC, Guillot R, Passa P, Canivet J (1982) Prostacyclin production by human endothelial cells cultured in diabetic serum. Diabete Metab 8:323–328PubMedGoogle Scholar
  60. Phelps RL, Sakol P, Metzger BE, Jampol LM, Freinkel N (1986) Changes in diabetic retinopathy during pregnancy. Correlations with regulation of hyperglycemia. Arch Ophthalmol 104:1806–1810PubMedCrossRefGoogle Scholar
  61. Price JH, Hadden DR, Archer DB, Harley J (1984) Diabetic retinopathy in pregnancy. Br J Obstet Gynecol 91:11–17CrossRefGoogle Scholar
  62. Rand LI, Krolewski AS, Aiello LM, Warram JH, Baker RS, Maki T (1985) Multiple factors in the prediction of risk of proliferative diabetic retinopathy. N Engl J Med 313:1433–1438PubMedCrossRefGoogle Scholar
  63. Rhie FH, Christheb AR, Sandor T et al. (1982) Retinal vascular reactivity to norepinephrine and angiotensin II in normals and diabetics. Diabetes 31:1056–1060PubMedCrossRefGoogle Scholar
  64. Sacchi S, Curci L, Piccinini L et al. (1985) Platelet granule release in diabetes mellitus. Scand J Clin Lab Invest 45:165–168PubMedCrossRefGoogle Scholar
  65. Serup L (1986) Influence of pregnancy on diabetic retinopathy. Acta Endocrinol (Suppl) 277:122–124Google Scholar
  66. Shen S-J, Wang C-Y, Nebson KK, Jansen M, Ilan J (1986) Expression of insulin-like growth factor II in human placentas from normal and diabetic pregnancies. Proc Natl Acad Sci USA 83:9179–9182PubMedCrossRefGoogle Scholar
  67. Sinclair SH, Nesler C, Foxman B, Nichols CW, Grabbe S (1984) Macular oedema and pregnancy in insulin-dependent diabetes. Am J Ophthalmol 97:154–167PubMedGoogle Scholar
  68. Stephens JW, Page OC, Hare RL (1963) Diabetes and pregnancy. A report of experience in 119 pregnancies over a period of ten years. Diabetes 12:213–219PubMedGoogle Scholar
  69. Strain A, Hill DJ, Swenne I, Milner RDG (1987) Regulation of DNA synthesis in human fetal hepatocytes by placental lactogen, growth hormone and insulin-like growth factor 1/somatomedin C. J Cell Physiol 132:33–40PubMedCrossRefGoogle Scholar
  70. Sundkvist G, Aimer L-O, Lilja B, Pandolfi M (1984) Growth hormone and endothelial function during exercise in diabetics with and without retinopathy. Acta Med Scand 215:55–61PubMedCrossRefGoogle Scholar
  71. Takahashi M, Trempe CL, Maguire K, McMeel JW (1981) Vitreoretinal relationship in diabetic retinopathy. A biomicroscopic evaluation. Arch Ophthalmol 99:241–245PubMedCrossRefGoogle Scholar
  72. Taylor CM, Weiss JB (1985) Partial purification of a 5.7 K glycoprotein from bovine vitreous which inhibits both angiogenesis and collagenase activity. Biochem Biophys Res Commun 133:911–916PubMedCrossRefGoogle Scholar
  73. Teale JD, Marks V (1986) The measurement of insulin-like growth factor 1: clinical applications and significance. Ann Clin Biochem 23:413–424PubMedGoogle Scholar
  74. Van Ohrt (1984) The influence of pregnancy on diabetic retinopathy with special regard to the reversible changes shown in 100 pregnancies. Acta Ophthalmol 62:603–616Google Scholar
  75. West KM (1978) Epidemiology of diabetes and its vascular lesions. Elsevier, New York p. 425Google Scholar
  76. White P (1965) Pregnancy and diabetes: medical aspects. Med Clin North Am 49:1015–1024PubMedGoogle Scholar
  77. Winter RJ, Phillips LS, Klein MN, Traismain HS, Green OC (1979) Somatomedin activity and diabetic control in children with insulin-dependent diabetes. Diabetes 28:952–954PubMedCrossRefGoogle Scholar
  78. Yoshida A, Feke GT, Morales-Stoppello J, Collas GD, Gioger DG, McMeal JW (1983) Retinal blood flow alterations during progression of diabetic retinopathy. Arch Ophthalmol 101:225–227PubMedCrossRefGoogle Scholar
  79. Zatz R, Meyer TW, Rennke HG, Brenner BM (1985) Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sci 82:5963–5967PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • J. V. Forrester
  • H. M. A. Towler
  • D. W. M. Pearson

There are no affiliations available

Personalised recommendations