Functional tests in detecting early changes of diabetic retinopathy during pregnancy

Purpose:It is well known that diabetes during pregnancy causes many epiphenomena, especially alterations of maternal glucose metabolism, which can threaten proper fetal growth and life. Many studies have been performed using functional tests as a major parameter for the study of retinopathy, together with ophthalmoscopy and fluorescein angiography. The use of fluorescein angiography during pregnancy is controversial, although neither toxic nor teratogenic effects have been clearly demonstrated. Methods:We analyzed 22 women during pregnancy at time 3 months - 6 months - Birth and 3 months after delivery. 16 of these women presented IDDM, 2 Gestational Diabetes and 4 NIDDM. In present study Static contrast-sensitivity, Electro-physiologic and Colour vision tests were used to detect early changes of visual function to prevent maternofetal complications. Blood glucose HbA1c, and Systemic Blood Pressure were main methabolic parameters Adapto-electroretinography was used as the main monitoring parameter and particularly the relationship between the cone-mediated (b1) and rod-mediated (b2). Results:The results indicate that the b2/b1 ratio can detect alterations in visual function before the onset of ophthalmoscopically detectable retinopathy. Moreover this test is significantly correlated to incidence of foetal complications (abortion, perinatal sufference, Macrosomia, and maternal more severe retinal alterations. Alterations in colour vision tests was also found, but the significance for these test were not able to allow definitive considerations. Conclusion: Functional monitoring of diabetic retinopathy particularly b2/b1 ratio in pregnancy can be dramatically useful to predict in diabetic pregnancy the future development of retinopathy and pervent maternofoetal complications.