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October 31, 2026
If you had type 1 or type 2 diabetes before pregnancy, diabetic retinopathy can get worse during pregnancy and up to a year after birth. Plan a dilated eye exam before pregnancy and again in the first trimester. If you are already pregnant and missed the first exam, contact your eye clinician. Later checks depend on your retinal findings [1,2,3,22].
Gestational diabetes, which starts during pregnancy, does not usually need these eye exams. For most women with preexisting diabetes, sight-threatening changes in pregnancy are uncommon, especially when the eyes are checked and treated early [1,4,5].
Are you pregnant and seeing spots or vision changes with a headache that will not go away, upper belly pain or trouble breathing? Call your obstetric team right away. These can be signs of preeclampsia. This article is general education and does not replace care from your obstetric, diabetes and eye teams.
Key takeaways
In this article
Vision changes in pregnancy can come from the eye or from high blood pressure problems such as preeclampsia. Both can be serious [1,6,7].
Call 911 if:
Call your obstetric team right away if you have the signs below. If you cannot reach them, go to labor and delivery or the ER:
Get emergency eye care today if you have:
Preeclampsia can also start in the weeks after childbirth, so these warning signs still apply after delivery [6]. See our guide to urgent vision changes for other symptoms.
It can, if you had diabetes before pregnancy. In the DCCT, pregnant women with type 1 diabetes were 1.6 to 2.5 times more likely than other women to have retinopathy worsen. The extra risk peaked in the second trimester and lasted up to 12 months after delivery [3].
Diabetic retinopathy is damage to the small blood vessels of the retina, the light-sensing layer at the back of the eye. It ranges from mild nonproliferative retinopathy to proliferative retinopathy, where fragile new vessels grow and can bleed. Our guide to the four stages of diabetic retinopathy explains each one.
A 2022 review pooled 18 studies of pregnant women with type 1 or type 2 diabetes. The pooled rates were about 15 per 100 pregnancies for new retinopathy and 31 per 100 for worsening nonproliferative retinopathy. About 6 per 100 progressed to the proliferative stage [4].
The worsening is often temporary. In the DCCT, women who had been pregnant had similar retinopathy levels to other women by the end of the study [3].
Newer data are reassuring. A 2025 Danish study compared 1,041 pregnant women with type 1 diabetes with matched women who were not pregnant. Both groups needed laser or injections for sight-threatening retinopathy at similar rates during and after pregnancy [5]. This was an observational study from a country with a national diabetic eye registry, so close monitoring still matters.
The biggest risk factor is how advanced retinopathy is at the start of pregnancy. Other risks include a high A1C at conception and a large drop in early pregnancy. High blood pressure, macular edema early in pregnancy and a long history of diabetes also add risk [8,9,10,11].
In one study, retinopathy progressed in about 10% of women who started with none, but in 55% of those with moderate to severe nonproliferative disease. Proliferative retinopathy developed in 29% of the moderate to severe group [8].
The same study found that a high starting A1C and a big improvement by week 14 were linked with more progression [8]. This is called early worsening, and our article on preventing diabetic vision loss explains why it happens with rapid glucose lowering. Good glucose control still matters for you and your baby, so do not let blood sugar run high.
High blood pressure, whether long-standing or starting in pregnancy, was linked with retinopathy progression [9]. In women with type 1 diabetes, sight-threatening progression was tied to macular edema, poorer vision and higher blood pressure in early pregnancy [10].
In type 2 diabetes, one study found progression in 14% of women, mostly mild. Sight-threatening change still occurred, in a woman with poor glucose control and uncontrolled blood pressure [11].
If you have type 1 or type 2 diabetes, plan a dilated eye exam before pregnancy and again in the first trimester [22]. Your eye doctor may repeat the exam each trimester and for up to a year after the baby is born, depending on what they find. More advanced disease needs more frequent visits [1,2].
The table below sums up advice from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It also draws on a 2017 American Diabetes Association position statement and published reviews. Your eye doctor will set your own schedule.
| Stage | Preexisting type 1 or type 2 diabetes | Gestational diabetes only |
|---|---|---|
| Planning pregnancy | Dilated eye exam; treat sight-threatening disease before conceiving if possible | Not applicable |
| First trimester | Dilated eye exam again, even if you had one before pregnancy [22] | No routine retinal exam usually needed |
| Second and third trimesters | Repeat exams, often each trimester, based on retinopathy level | See an eye doctor for any new vision symptom |
| After delivery | Follow-up for up to 1 year, based on findings | Ask about your future risk of diabetes |
Tell the eye clinic you are pregnant when you book, and bring your due date, diabetes type and any past laser or injection dates. Our guide to how often you need a diabetic eye exam covers routine screening outside pregnancy.
A planned pregnancy gives time to find and treat retinopathy first. A review advises stabilizing proliferative retinopathy with laser before pregnancy when possible [12]. The American Diabetes Association also advises counseling about retinopathy risk before pregnancy [2].
Review your medicines too. The Ozempic label says to stop it at least 2 months before a planned pregnancy [13]. The Eylea label advises effective birth control during treatment and for at least 3 months after the last injection [14]. Ask your prescribers before changing anything.
Usually not. Diabetes that starts during pregnancy does not usually cause diabetic eye disease. The NIDDK and the American Diabetes Association say routine retinal exams are not usually needed. The National Eye Institute still lists gestational diabetes as a risk, so ask your doctor what applies to you [1,2,15].
Sometimes diabetes found early in pregnancy was actually present before. Doctors may call this diabetes in pregnancy rather than gestational diabetes [16]. If that applies to you, ask whether you need the same eye exams as someone with preexisting diabetes.
Gestational diabetes also raises the risk of diabetes later in life [16]. If you are later diagnosed with type 2 diabetes, regular diabetic eye exams start from that point.
Yes, routine diabetic eye tests are part of pregnancy care. The NIDDK says you may have frequent dilated eye exams during pregnancy. Retinal photos and OCT scans are also used. Fluorescein angiography, which uses an injected dye, is done less often, so tell the clinic you are pregnant before any test [10,17,18,19].
OCT, or optical coherence tomography, takes cross-section scans of the retina. It can show macular edema, which is swelling in the center of the retina. Our guide to dilation, OCT and angiography explains each test.
A 1990 survey found that 77% of retina specialists had never done fluorescein angiography on a pregnant woman. In the cases they reported, there was no high rate of birth defects or complications [19]. Because data are limited, ask whether the result would change your treatment before agreeing to it.
Laser treatment is the main option for severe or proliferative retinopathy during pregnancy. Anti-VEGF injections, the usual treatment for macular edema, are generally avoided, especially early in pregnancy. Macular edema may be watched closely or treated with laser or a steroid implant. Surgery is delayed until after delivery when possible [12,16,20].
Sight-threatening retinopathy should not simply be left until after the baby is born. Your retina specialist and obstetric team can weigh the risks to your sight against the risks of each treatment. See our guide to diabetic retinopathy injections, laser and surgery for how these treatments work in general.
Panretinal photocoagulation, or PRP, treats the outer retina with laser to shrink abnormal new vessels. A review advised that PRP can be given for severe nonproliferative and proliferative retinopathy during pregnancy [12]. PRP can reduce side vision [2].
A case series of women with sight-threatening retinopathy in pregnancy recommended considering laser for severe disease. It also found that proliferative disease may not go away after delivery [20].
Anti-VEGF drugs block VEGF, a growth signal that drives leaky and abnormal vessels. VEGF also matters for fetal development. The Eylea label says the drug may pose a risk to the developing baby. It should be used in pregnancy only if the benefit justifies the risk [14].
A 2024 review collected reports of 41 pregnant women treated with these injections. Most pregnancies, 81%, ended in live births. Miscarriages and stillbirths occurred mostly in women with other major risk factors, and the numbers are too small to judge safety [21].
Another review noted several reports of pregnancy loss after injections, mostly early in pregnancy, and advised against them in pregnant women with diabetes [12]. About 40% of women in the 2024 review did not know they were pregnant when treated [21].
If you had an injection before you knew you were pregnant, tell both your eye and obstetric teams the drug name and date. Do not panic or make decisions alone. Your doctors can review what is known with you.
For mild to moderate macular edema in pregnancy, a 2024 review suggests close monitoring first, then laser if it does not improve. Evidence on steroid injections in pregnancy is limited [16]. In a small series of 5 pregnant women, a dexamethasone implant reduced swelling in most eyes and improved vision in 6 of 8. Three eyes had a mild, temporary rise in eye pressure [18].
Our guide to diabetic macular edema treatment covers these options outside pregnancy.
Bleeding that does not clear or a retinal detachment may need vitrectomy surgery. A review advised delaying such surgery until after delivery when possible. If it cannot wait, local anesthesia is preferred [12].
Usually not. A 2024 review stated that diabetic retinopathy should not be seen as a reason to avoid vaginal birth. With active, untreated proliferative retinopathy, there is concern that hard pushing could cause bleeding in the eye. Teams may then discuss an epidural or an assisted delivery to shorten pushing [16].
The final birth plan is an obstetric decision. Ask your retina specialist to send your obstetric team a clear note about your eye findings and any concerns.
Keep your eye visits after the baby is born. In the DCCT, the higher risk lasted up to a year after delivery. Proliferative retinopathy may not settle after birth. One review suggests a dilated exam 1 to 2 months after delivery for women who had retinopathy or macular edema in pregnancy [3,16,20].
Book your postpartum eye visit before you deliver. Plan for transport and childcare, since a dilated exam can blur vision for a few hours [1].
Tell your eye doctor if you are breastfeeding. The Eylea label says it is not known whether aflibercept passes into breast milk, and the drug is not recommended during breastfeeding [14]. Your eye and baby's doctors can weigh treatment needs with breastfeeding.
Netra Restoration Therapy (NRT) is an adjunctive program based on acupuncture and Oriental medicine principles. It is offered alongside care from your obstetric, diabetes and eye teams, never instead of it. You can read what NRT involves on our site.
NRT has not been tested in controlled trials for diabetic retinopathy in pregnancy. It does not replace eye exams, laser or any other treatment, and it should never delay them. If you are pregnant or breastfeeding, check with your obstetric team before starting any complementary care, herb or supplement. Our page on how NRT effectiveness is assessed explains how we discuss evidence.
It can be, if you had type 1 or type 2 diabetes before pregnancy. The risk is highest when retinopathy is already moderate or worse, or when A1C was high at conception. Most worsening is temporary, but some cases need laser treatment, so regular eye exams matter.
Mild changes often settle after delivery. Proliferative retinopathy may not improve on its own and can keep progressing. That is why eye follow-up usually continues for up to a year after the baby is born.
Retinopathy does not automatically rule out pregnancy. The usual advice is an eye exam and treatment of sight-threatening disease before conceiving, then close monitoring. Your diabetes, eye and obstetric teams can discuss your own risks.
Yes. Dilated eye exams are a routine part of diabetic eye care in pregnancy, and many women have several. Tell the clinic you are pregnant when you book so they can plan your visit.
Anti-VEGF injections are usually avoided during pregnancy, especially early on, because safety data are limited and VEGF matters for fetal development. Laser or a steroid implant may be used instead. In rare cases where sight is at serious risk, specialists may discuss injections with your obstetric team.
Usually not. Gestational diabetes does not usually cause diabetic eye disease, so routine retinal exams are not usually needed. See an eye doctor for any new vision symptoms, and ask whether your diabetes might have started before pregnancy.
Plan one before pregnancy and another in the first trimester [22]. After that, your eye doctor may check you each trimester and for up to a year after delivery, depending on your retinopathy level. More advanced disease needs more frequent visits.
Laser (panretinal photocoagulation) is the main treatment for sight-threatening proliferative retinopathy during pregnancy. Reviews suggest it is usually preferred over anti-VEGF injections, whose safety in pregnancy is less certain. Your retina specialist will explain the number of sessions and possible effects on side vision.
Sources checked October 31, 2026.
This article provides general education and does not replace an individual eye examination, diagnosis or treatment plan. During pregnancy or after delivery, vision changes with a severe headache or upper belly pain need urgent obstetric care, and sudden vision loss, new floaters or a curtain over your vision needs emergency eye care today.
