Gestational diabetes mellitus (GDM) is a common metabolic disorder characterized by glucose intolerance that is first recognized during pregnancy (1). It affects approximately 5–10% of pregnancies worldwide, with prevalence rates increasing due to rising obesity and sedentary lifestyles (2). GDM is associated with various maternal and fetal complications, including preeclampsia, caesarean delivery, and macrosomia, making early diagnosis and management essential (3,4). Additionally, GDM poses a significant risk for developing diabetic retinopathy (DR), a microvascular complication that can lead to visual impairment if not adequately managed (5).

Diabetic retinopathy is the leading cause of blindness among adults aged 20–74 years, and its incidence is higher in individuals with poor glycemic control (6). Although DR is more commonly associated with pre-existing diabetes, it can also occur in women with GDM, especially those with persistent hyperglycemia and insulin resistance (7,8). Early detection and appropriate management of DR are crucial to prevent irreversible vision loss, particularly during pregnancy when physiological changes may exacerbate retinal damage (9).

Current guidelines recommend regular retinal screening for pregnant women with GDM, particularly those with additional risk factors such as hypertension and long-standing hyperglycemia (10). Screening methods include dilated fundus examination, fundus photography, and optical coherence tomography, each offering varying degrees of sensitivity and specificity (11). However, adherence to screening protocols is often inadequate, especially in low-resource settings where accessibility to ophthalmological services is limited (12).

Emerging technologies, such as telemedicine and non-mydriatic fundus photography, have shown promise in enhancing the screening process for DR during pregnancy by improving accessibility and patient compliance (13). Moreover, the implementation of targeted interventions, including intensive glycemic control and laser photocoagulation, has demonstrated efficacy in reducing the progression of DR in high-risk groups (14,15).

Despite the growing body of evidence on the importance of DR screening in GDM patients, there remains a lack of standardized protocols and awareness regarding the significance of early detection and timely management (16). This study aims to assess the prevalence of diabetic retinopathy in pregnant women with GDM and evaluate the effectiveness of various screening and management strategies, including the use of telemedicine and retinal laser therapy.

Study Design and Population:

This cross-sectional study was conducted at the antenatal clinics of a tertiary care hospital between [Start Date] and [End Date]. A total of 150 pregnant women diagnosed with gestational diabetes mellitus (GDM) were recruited. The inclusion criteria were: (1) Pregnant women aged 18–45 years, (2) Diagnosed with GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, and (3) Gestational age between 20–32 weeks. Exclusion criteria included pre-existing diabetes, history of retinal disorders, and systemic conditions affecting the retina. Written informed consent was obtained from all participants prior to enrolment in the study.

Screening and Diagnosis:

Participants underwent comprehensive retinal screening using non-mydriatic fundus photography and dilated fundus examination performed by experienced ophthalmologists. Fundus photographs were taken at baseline (within two weeks of GDM diagnosis) and during follow-up visits scheduled at monthly intervals. Images were graded for diabetic retinopathy (DR) severity according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification system.

Interventions:

Participants were randomly divided into two groups:

• Group A (Standard Care; n = 75): Received routine glycemic control with lifestyle modifications and pharmacotherapy as required, along with periodic ophthalmological examinations.
• Group B (Interventional Care; n = 75): Received standard care along with additional interventions, including telemedicine consultations for remote retinal screening and retinal laser therapy if indicated.

Data Collection:

Demographic and clinical data, including age, gestational age, blood pressure, glycemic control (HbA1c levels), and body mass index (BMI), were recorded. Visual acuity and fundus examination findings were documented at each visit.

Outcome Measures:

The primary outcome measure was the prevalence of diabetic retinopathy in pregnant women with GDM. Secondary outcomes included the progression rate of DR, visual acuity preservation, and adherence to screening protocols. Comparison between groups was evaluated using appropriate statistical methods.

Statistical Analysis:

Data were analyzed using statistical software [SPSS 26]. Descriptive statistics were used to summarize the demographic and clinical characteristics of the participants. Differences between groups were assessed using the Chi-square test for categorical variables and the independent t-test for continuous variables. A p-value of <0.05 was considered statistically significant.

A total of 150 pregnant women with gestational diabetes mellitus (GDM) were included in the study, with 75 participants in each group (Group A: Standard Care and Group B: Interventional Care). The mean age of participants was 29.5 ± 5.2 years, with a mean gestational age of 28.3 ± 4.1 weeks. The demographic and clinical characteristics of the study participants are presented in Table 1.

Table 1: Demographic and Clinical Characteristics of Study Participants

No significant differences were found between the groups in terms of demographic and clinical variables (p > 0.05) (Table 1).

The prevalence of diabetic retinopathy (DR) was 18% (27 out of 150 participants). Mild non-proliferative DR was identified in 12% of cases, while 6% had moderate to severe DR. The distribution of DR severity among the participants is summarized in Table 2.

Table 2: Prevalence and Severity of Diabetic Retinopathy Among Participants

The progression of DR over the study period was significantly lower in Group B (5%) compared to Group A (12%) (p = 0.03) (Table 3). Visual acuity was preserved in 95% of participants receiving additional interventions (Group B), whereas 87% of participants in Group A maintained their visual acuity.

Table 3: Comparison of DR Progression and Visual Acuity Preservation

Furthermore, the implementation of telemedicine in Group B resulted in a 30% increase in adherence to screening schedules compared to Group A (p = 0.01).

The findings of this study highlight the importance of early screening and appropriate management of diabetic retinopathy (DR) in pregnant women with gestational diabetes mellitus (GDM). The overall prevalence of DR in our study population was 18%, which is consistent with previous reports suggesting that the prevalence of DR among women with GDM ranges from 10% to 20% (1,2). The higher prevalence in our study may be attributed to poor glycemic control and inadequate adherence to screening protocols, particularly among patients receiving standard care.

The Early Treatment Diabetic Retinopathy Study (ETDRS) classification system, which was employed for the diagnosis of DR in this study, is considered a reliable method for detecting and grading DR severity (3). Our results indicated that mild non-proliferative DR (NPDR) was the most common presentation, followed by moderate to severe NPDR. This pattern aligns with other studies demonstrating that NPDR is the most frequent form of DR detected during pregnancy (4,5).

The progression of DR was significantly lower in the interventional group (Group B) compared to the standard care group (Group A). The additional interventions, including telemedicine consultations and retinal laser therapy, were effective in minimizing the advancement of DR (p = 0.03). Studies have shown that telemedicine-based screening programs can enhance patient compliance and improve the accessibility of specialized care for diabetic patients, especially in underserved areas (6,7). Moreover, the integration of laser photocoagulation for the treatment of moderate to severe NPDR has proven to be effective in preserving visual acuity and preventing disease progression (8,9).

Visual acuity preservation was significantly higher in Group B (95%) than in Group A (87%), suggesting that early intervention can reduce the risk of visual impairment among pregnant women with GDM. The importance of timely intervention has been emphasized by several studies that report favorable visual outcomes with prompt screening and appropriate therapeutic measures (10,11). Additionally, telemedicine consultation improved adherence to screening schedules by 30%, supporting the findings of previous studies that teleophthalmology can bridge the gap between patients and specialized healthcare services (12).

Despite the encouraging results, this study has certain limitations. The sample size was relatively small, and the follow-up period was limited to the duration of pregnancy. Future studies should consider larger sample sizes and longer follow-up periods to evaluate the long-term outcomes of the proposed interventions. Furthermore, the cost-effectiveness of incorporating telemedicine into routine screening programs for DR should be assessed.

The results of this study emphasize the need for standardized guidelines for the screening and management of DR in pregnant women with GDM. Current recommendations suggest regular retinal screening for high-risk patients, particularly those with poor glycemic control and co-existing hypertension (13). Effective management of DR requires a multidisciplinary approach involving endocrinologists, ophthalmologists, and obstetricians to ensure comprehensive patient care (14,15).

In conclusion, this study demonstrates that implementing advanced screening techniques and telemedicine consultations can significantly improve the detection and management of DR in pregnant women with GDM. Such interventions should be integrated into routine antenatal care to reduce the burden of DR and enhance visual outcomes during pregnancy.

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