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The aim of this study was to determine the prevalence and progression of diabetic retinopathy (DR) with hyperglycemic disorders during pregnancy (HDPs) in Japan between 2013 and 2018 using two cohorts. The patients with HDPs were classified as those with pre-existing DM (pexD), gestational DM (GDM), and overt DM (ODM). Cohort 1 was obtained from the health claims database whose diseases were classified by the International Classification of Diseases-10. Cohort 2 was derived from a retrospective, multicenter analysis of the medical records of 225 patients from 10 ophthalmological institutions. In Cohort 1, there were 5268 patients with an HDP prevalence of 8.4%. Among them, 73 of 1139 patients had pexD (6.4%) and 61 of 4129 patients with GDM (1.5%) had DR; the overall prevalence of DR was 2.5%. In Cohort 2, 36 of 225 patients (16.0%) had DR, and 149 patients were followed at the early and late stages of pregnancy. Moreover, 10 of the 102 patients with pexD (9.8%) and two of five patients with ODM (40.0%) had a progression of DR. In conclusion, the prevalence and progression of DR in patients with pexD is lower than previously reported. More attention should be given to pexD and ODM.

Background: The presence of maternal diabetes mellitus (DM) during pregnancy has complications for both mother and child. Pre-existing DM can result in higher risk of maternal and child mortality and morbidity. In Ethiopia, the magnitude of pre-existing DM among pregnant women is not well studied. The aim of this study was to assess the magnitude of pre-existing DM among pregnant women in Wolaita Zone, Southern Ethiopia., Methods: A retrospective document review was carried out to determine the magnitude of pre-existing DM in three hospitals and four health centers in Wolaita Zone, Southern Ethiopia. A total of 600 pregnant mothers who attended maternity services at the study health facilities in one year period from January 1, to December 31, 2017 were included in the study. Data were collected from medical records of mothers. Chi-square and logistic regression analysis model were used to check the relationship between pre-existing DM and independent variables., Results: A total of 600 mothers were included in the analysis. The magnitude of pre-existing DM among mothers receiving maternity care within a one year period was 2.8% (95% CI: 1.5, 4.2). The magnitudes among urban and rural residents were 3.4% and 1.4%, respectively. Pre-existing DM is significantly associated with family history of diabetes (Chi square 24.8, P-value, 0.001). Previous history of spontaneous abortion (aOR: 5.3; 95% CI: 1.6-17.4) and fetal macrosomia (aOR: 3.9; 95% CI: 1.2-13.1), was identified to be significantly associated with pre-existing DM. The magnitude of pre-existing DM is comparable with International Diabetes Federation Estimate to Ethiopia in the study area. Family history of DM was found to be associated with pre-existing DM. Pre-existing DM is associated with increased risk of abortion and fetal macrosomia., Conclusion: The magnitude of pre-existing DM is comparable with previous estimates to the country. A nationwide, large-scale study is important to estimate the burden of pre-existing DM and associated risk factors among pregnant mothers at national level., Competing Interests: The authors declare that there is no conflict of interests., (© 2021 Wolka et al.)

Women with type 1 (T1DM) or type 2 diabetes (T2DM) diagnosed prior to pregnancy are classified as having pre-existing diabetes mellitus (DM). The prevalence of hyperglycemia in pregnancy has been estimated at 17% globally and 5.4% in Europe, differences existing among racial and ethnic groups, following the prevalence of type 2 diabetes. Only a minority (approximately 15%) of the cases of diabetes during pregnancy represent women with pre-existing diabetes. Because of the rising prevalence of obesity and limited screening for diabetes in young women, there has been, globally, an increase in the diagnosis of previously unknown overt diabetes early in pregnancy; these women should be treated as women with pre-existing diabetes, as they may already have unrecognized complications (e.g., nephropathy and retinopathy). The Hellenic Endocrine Society and the Hellenic Society of Maternal-Fetal Medicine commissioned an expert group to construct national guidelines on "Diabetes mellitus and pregnancy: Pre-existing type 1 and 2 diabetes mellitus". Following a search for the best available evidence and critical appraisal of the search results, the writing group generated a series of consensus recommendations regarding preconception counseling and care, care during pregnancy, and care after the pregnancy in cases of pre-existing T1DM and T2DM.

Objective: To examine the association of elevated early pregnancy hemoglobin A1c (HbA1c) levels with adverse pregnancy outcomes in women with preexisting diabetes mellitus., Study Design: Retrospective cohort study of 330 women with preexisting diabetes enrolled in a Diabetes in Pregnancy Program at an academic institution between 2003 and 2011 who had an early HbA1c determination. The frequencies of composite maternal adverse pregnancy outcomes (birth at<37 weeks, preeclampsia, and medically indicated birth <39 weeks), and composite fetal adverse pregnancy outcomes [shoulder dystocia, Apgar scores<7 at 5 minutes, small for gestational age (SGA), large for gestational age (LGA), and stillbirth] were compared between HbA1c categories (<6.5, 6.5-7.4, 7.5-8.4 and ≥ 8.5%)., Results: There was no statistically significant difference between composite adverse maternal pregnancy outcomes and composite adverse fetal pregnancy outcomes as well as other individual outcomes between different HbA1c categories. Of the vaginally delivered women in our cohort, the 37 patients with HbA1c levels of ≥ 8.5% had a significantly higher frequency of fetal shoulder dystocia than the 62 with HbA1c levels of < 8.5% (24.2 vs. 1.6%, P = 0.002). Neonates of patients with HbA1c ≥ 8.5% were more likely to have low five minute Apgar scores than neonates of patients with HbA1c < 8.5%, but this was of borderline statistical significance (7.4% vs. 0.5%, P = 0.05)., Conclusion: In patients with preexisting diabetes mellitus, HbA1c levels of ≥ 8.5% during early pregnancy are not useful in predicting most adverse outcomes, although there may be an increased risk for shoulder dystocia., (© 2014 Elsevier Inc. All rights reserved.)