Aims: To summarize current evidence on lifestyle interventions, metabolic stabilization and screening strategies relevant to diabetic retinopathy during pregnancy. Material and methods: A narrative review of clinical studies, systematic reviews, meta-analyses and guideline documents was performed using PubMed/MEDLINE, Scopus and Google Scholar. Results: Baseline retinal status in early pregnancy is the strongest predictor of progression. Additional risk is associated with longer diabetes duration, elevated glycated hemoglobin, glycemic variability, nephropathy and hypertensive disorders, including preeclampsia. Women without retinopathy in early pregnancy generally have a low risk of sight-threatening disease during the same gestation, whereas women with pre-existing retinopathy require close surveillance. Lifestyle interventions do not directly treat retinal lesions, but they improve glycemic control, support appropriate gestational weight gain and reduce vascular burden. Evidence also suggests that continuous glucose monitoring and automated insulin delivery may indirectly support retinal protection by improving metabolic stability. Conclusions: In pregnant women with diabetes, ophthalmic screening remains the main clinical priority. However, lifestyle-based metabolic support is a meaningful complementary strategy and should be integrated into antenatal care alongside risk-stratified retinal follow-up.