{
  "abstract": "Objective Diabetic retinopathy (DR) in pregnancy can cause blindness. National guidelines recommend at least one eye examination in early pregnancy, then ideally 3-monthly, through to the postpartum for pregnant women with pregestational diabetes. Here we examined adherence rates, barriers and enablers to recommended DR screening guidelines.Design Cross-sectional survey study, as part of a larger prospective cohort study.Setting Participants were recruited from two tertiary maternity hospitals in Melbourne, Australia.Participants Of the 173 pregnant women with type 1 (T1D) or type 2 diabetes (T2D) in the main cohort study, with an additional four who participated solely in this survey study, 130 (74.3%) completed the survey.Primary and secondary outcome measures This study calculated rates of adherence to guideline-recommended DR screening schedules and collected data on the enablers and barriers to attendance using a modified Compliance with Annual Diabetic Eye Exams Survey. Each of the 5-point Likert-scale survey items was compared between adherent and non-adherent participants using the Wilcoxon rank-sum test and logistic regression models were constructed to quantify associations as ORs.Results A retinal assessment was undertaken at least once during pregnancy in 86.3% of participants, but only 40.9% attended during their first trimester and only 21.2% attended the recommended number of examinations. Competing priorities were the main barriers to adherence, with eye examinations ranked as the fourth priority (IQR 4th–5th) among other health appointments during pregnancy. Meanwhile, knowledge of the benefits of eye screening examinations, eye-check reminders and support from relatives was identified as enablers.Conclusions Despite the risk of worsening DR during pregnancy, less than half of the participants adhered to recommended screening guidelines, suggesting that eye health is not a priority. Proactive measures to integrate care are needed to prevent visual loss in this growing population.",
  "authors": [
    {
      "affiliations": [
        "Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia",
        "Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia",
        "Ophthalmology, Department of Surgery, University of Melbourne, Parkville, Victoria, Australia"
      ],
      "name": "Felicia Widyaputri"
    },
    {
      "affiliations": [
        "Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia"
      ],
      "name": "Sophie L. Rogers"
    },
    {
      "affiliations": [
        "Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "Diabetes and Endocrine Service, Royal Women’s Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Alison J. Nankervis"
    },
    {
      "affiliations": [
        "Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "Diabetes and Endocrine Service, Royal Women’s Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Jennifer J. Conn"
    },
    {
      "affiliations": [
        "Perinatal Department, Mercy Hospital for Women, Heidelberg, Victoria, Australia",
        "Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Alexis Shub"
    },
    {
      "affiliations": [
        "Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia",
        "Ophthalmology, Department of Surgery, University of Melbourne, Parkville, Victoria, Australia",
        "Department of Ophthalmology, Royal Children’s Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Sandra E. Staffieri"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia"
      ],
      "name": "Muhammad B. Sasongko"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Austin Hospital, Heidelberg, Victoria, Australia",
        "Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia"
      ],
      "name": "Xavier J. Fagan"
    },
    {
      "affiliations": [
        "Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia",
        "Ophthalmology, Department of Surgery, University of Melbourne, Parkville, Victoria, Australia",
        "Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Surgery, Alfred Hospital, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Robert C. A. Symons"
    },
    {
      "affiliations": [
        "Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia",
        "Ophthalmology, Department of Surgery, University of Melbourne, Parkville, Victoria, Australia",
        "Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia"
      ],
      "name": "Lyndell L. Lim"
    }
  ],
  "title": "Adherence to the recommended diabetic retinopathy screening guidelines in pregnant women with pregestational diabetes: a cross-sectional survey study",
  "uid": "a2d3076a-107a-59fd-af6b-beff6be3fc1f"
}