Association of vaginal delivery efforts with retinal disease in women with type I diabetes

Abstract

Objective: To determine whether the second stage of labor affects the progression of retinopathy in women with type I diabetes mellitus (DM). Research and Design: The study is a secondary analysis of 192 pregnant women with type I DM who participated in an interdisciplinary diabetes in pregnancy intervention program between 1978 and 1993. Evaluation for diabetic retinopathy (DR) was performed each trimester and 6–12 weeks postpartum by the same two ophthalmologists. Women were divided into three groups: (i) elective cesarean delivery (n = 60), (ii) cesarean delivery prior to the second stage of labor (n = 69) and (iii) vaginal or cesarean delivery in the second stage (n = 63). Progression of DR during pregnancy and between pregnancy and postpartum was compared among the groups. Results: Maternal demographics, glycemic control and pregnancy complications were similar among groups. Progression of retinopathy from early and late pregnancy to postpartum did not differ between the three groups. Conclusion: With close follow-up and good glycemic control, expulsive efforts in the second stage of labor do not affect the progression of retinopathy in women with type I DM. Our data support the premise that pregnant women with type I DM and stable retinopathy should not be denied vaginal delivery, if otherwise not contraindicated.

Keywords::

• Pregnancy
• progression of diabetic retinopathy
• Valsalva

Declaration of interest: Supported in part by National Institutes of Health (NIH) Grant HD 11725, Diabetes in Pregnancy (Program Project Grant), United States Public Health Service Training in Perinatal Care and Research Grant MCH MCT 000174, NIH Clinical Research Center Grant RR00068, and NIH Perinatal Emphasis Research Center Grant HD 10748.