Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Adherence and Barriers to the Recommended Diabetic Retinopathy Screening Guidelines in Pregnant Women with Type 1 and Type 2 Diabetes   (#32)

Felicia Widyaputri 1 2 3 , Sophie Rogers 2 , Alison Nankervis 4 5 , Jennifer Conn 4 5 , Xavier Fagan 6 7 , Daryl Guest 8 , Alexis Shub 9 10 , Andrew Symons 8 11 12 , Lyndell Lim 1 2 7
  1. Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
  2. Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  3. Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jogjakarta, Indonesia
  4. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  5. Diabetes and Endocrine Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
  6. Department of Ophthalmology, Austin Hospital, Heidelberg, Victoria, Australia
  7. Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  8. Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
  9. Department of Obstetrics and Gynecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
  10. Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia
  11. Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  12. Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia

Aims

Diabetic Retinopathy (DR) can deteriorate during pregnancy. Current guidelines recommend at least one eye-check during pregnancy, ideally one each trimester. Here we report adherence of pregnant women with pre-existing diabetes to recommended eye-screening guidelines in a prospective cohort study.

Methods

Pregnant women with type 1 (T1DM) or type 2 diabetes (T2DM) were prospectively recruited from two tertiary maternity hospitals in Melbourne. Barriers to attending eye-screening were assessed using the Compliance with Annual Diabetic Eye Exams Survey (which primarily comprises 5-point Likert scale items).

Results

Of the 163 patients approached, 136 (83.4%) participated. Mean age was 33.8 years (range 19-47). Sixty women (44%) had T1DM (median duration 16.5 years), while 56% had T2DM (median duration 3 years). Retinal assessment was performed at least once during pregnancy in 108 women (79.4%) and 15 (11%) received assessment once in each trimester. DR was present in 34 (31.5%) women. Women who failed to attend eye-screening responded differently to women who attended. Ninety-two percent of women who were not screened each trimester felt confident controlling their blood glucose compared to 60% of women who were screened (Kendall’s tau test, p=0.002); 31% of non-attendees agreed that yearly eye exams were not a top priority compared to 7% of attendees (p=0.015). Of women who failed to attend any eye-screening during their pregnancy, 32% believe that there is treatment for diabetic eye diseases versus 58% of screening attendees (p=0.011). Overall, respondents ranked obstetrics and endocrinology appointments their highest priority during pregnancy, whilst ophthalmology review was considered a much lower priority (median rank 5th out of 7 health appointments).

Conclusions

Despite the risk of DR during pregnancy, only 15 of 136 pregnant women with diabetes adhered to recommended screening guidelines, and women ranked eye health as a low priority. More proactive efforts to educate about the importance and treatability of DR and to integrate care are needed to prevent vision loss in this growing demographic.