A 28-year-old woman with type 1 diabetes since age 14 is seen at 10 weeks gestation. Fundoscopy shows proliferative diabetic retinopathy with new vessels. She asks whether pregnancy must be terminated. What is the correct management of her retinopathy?
- A Scatter laser photocoagulation, which is safe and indicated during pregnancy ✓
- B Defer any treatment until 6 weeks after delivery
- C Pregnancy termination, because retinopathy always progresses irreversibly in pregnancy
- D Intravitreal anti-VEGF injection every month until delivery
Correct answer: A. Scatter laser photocoagulation, which is safe and indicated during pregnancy
Explanation
Pregnancy is not a contraindication to laser treatment. Proliferative retinopathy requires scatter (panretinal) photocoagulation, which can be performed safely in pregnancy and prevents vitreous haemorrhage and neovascular glaucoma. Retinopathy may worsen during pregnancy, particularly with high baseline HbA1c and rapid tightening of control, but progression usually regresses postpartum, so termination is not advised. Anti-VEGF agents are avoided in pregnancy because of unknown fetal safety, which kills the most tempting alternative.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.