Correspondence (letter to the editor): Further Specification Required

The authors deserve high appreciation for their comprehensive approach to the subject (1). The clinical relevance demands, however, that the following items are specified to some extent:

• The authors state that during pregnancy diabetic retinopathy can deteriorate by up to 55%. This (maximum) value should be put in perspective in view of the specific treatment conditions in Germany.

• Among the risk factors for deterioration of diabetic retinopathy the authors cite the regular blood glucose monitoring required before pregnancy. 94.8% of all women with type 1 diabetes receive intensified conventional treatment (ICT) which requires regular blood glucose monitoring. This means that almost every woman with type 1 diabetes who is receiving intensified conventional treatment runs the risk of deteriorating. The parameter “regular blood glucose monitoring before pregnancy” is therefore no sufficiently predictive factor.

• The proposal to prefer bevacizumab (complete antibody) to ranibizumab (Fab fragment) is not justified, as the literature reports miscarriages during bevacizumab treatment. In the cited article, it is early pregnancy, but not the anti-VEGF antibody that causes miscarriages. Therefore, any anti-VEGF therapy should be prohibited during early pregnancy. Thus far, no VEGF inhibitor has been approved for the treatment of proliferative diabetic retinopathy.

• The recommendation to examine the retinal fundus one year after delivery in women with type 1 diabetes and diabetic retinopathy who are closely monitored is not supported by the guidelines. Since the justification for close monitoring is pre-existing retinopathy, the post partum screening intervals should be conducted according to the level of pre-existing retinopathy (mild-moderate non-proliferative diabetic retinopathy 6 months; severe non-proliferative diabetic retinopathy: 3 months).