Study: Children of Mothers With Diabetes During Pregnancy Have Increased Risk of Eye Problems

A study in Diabetologia found that mothers who have diabetes before or during their pregnancy are more likely to have children who later develop eye problems.

The research team analyzed the associations between maternal diabetes before or during pregnancy and the risk of high refractive error (RE), which are conditions in which there is a failure of the eye to properly focus images on the retina.

Previous research has shown that individuals with severe RE may have congenital eye defects before birth, which suggests that the conditions the fetus is exposed to in the uterus may play a role in the development of more serious RE later in life, according to the study. Additionally, maternal hyperglycemia during pregnancy may lead to elevated fetal blood glucose levels, which can damage the retina and optic nerve and may lead to changes in the shape of the eyes that ultimately cause RE, according to the study.

The objective of the study was to determine whether exposure to the effects of maternal diabetes while in the uterus could negatively affect the development of the fetus and whether the most distinct associations would be observed among mothers with diabetic complications because they usually represent more severe cases of the disease.

The research team used several Danish national medical registers and incorporated the details of all live births in Denmark from 1977 to 2016, with follow-up beginning at birth and continuing until the first high RE diagnosis, the death of the subject, their emigration, their 25th birthday, or the end of the study period on December 31, 2016.

The mothers were considered to have diabetes if they were diagnosed with the disease either before or during pregnancy. Those with pre-gestational diabetes who had developed issues relating to their condition were categorized according to whether they had 1 or multiple complications.

Both the occurrence of high RE in offspring and the specific type of eye problem were analyzed. Out of 2,470,580 live births included in the study, 2.3% were exposed to maternal diabetes, with 0.9% and 0.3% being type 1 and type 2 pre-gestational diabetes respectively, and 1.1% involving gestational diabetes, according to the study.

There was an increase in the proportion of births to mothers with diabetes over the study period from 0.4% in 1977 to 6.5% in 2016. Diabetes was associated with the mother being older, more educated, having had more pregnancies, and being more likely to live alone.

Further, during the follow-up period, high RE was diagnosed in 533 offspring of mothers with diabetes, and 19,695 offspring of those without the disease. Exposure to maternal diabetes was associated with a 39% greater risk of high RE compared to unexposed offspring.

The research team found a difference in RE risk between type 1 and type 2 forms of diabetes with rates of high RE compared to unexposed individuals being 32% and 68% higher, respectively. Children of mothers with complications rooted to diabetes were twice as likely to have eye problems, compared to an 18% increase in high RE risk in children of mothers who had no complications from the disease.

“It was interesting to observe that hypermetropia (long-sightedness) occurred more frequently in childhood and myopia (short-sightedness) was more frequent in adolescence and young adulthood,” the study authors said in a press release.

They noted that the difference may be due to the natural process of emmetropization, which is when the eye changes shape during early childhood to achieve normal vision by becoming less long-sighted and could correct most hyperopia in early infancy over time. The increasing number of years and intensity of school education could also increase the risk of myopia from early childhood to young adulthood, according to the study.

“In this nationwide population-based cohort study, we observed that children born to mothers with either pre-gestational or gestational diabetes were at an increased risk of developing high RE in general, as well as specific types of high RE, persisting from the neonatal period to early adulthood. Children born to mothers with diabetic complications had the highest risk of high RE,” the study authors said in the press release.

The researchers suggest that because many REs in young children are treatable, early identification and intervention are crucial to a positive impact over a lifetime.

“Although the 39% increased risk is a relatively low effect size, from a public health perspective, considering the high global prevalence of REs, any tiny improvement in this low-risk preventable factor will contribute to a huge reduction in absolute numbers of these eye conditions,” the study authors said in a press release.

Early screening for eye disorders in the children of mothers with diabetes is suggested to maintain good eyesight health, according to the study authors.

REFERENCE

New study reveals that children of mothers with diabetes during pregnancy have an increased risk of eye problems. EurekAlert! August 17, 2021. Accessed August 18, 2021.