Eye problems more common among children exposed to diabetes in utero
Mothers who develop diabetes before or during pregnancy are more likely to have children who develop refractive errors, according to findings published in Diabetologia.
Refractive error is one of the most common forms of visual impairment and includes nearsightedness and farsightedness as well as astigmatism, Jiangbo Du, PhD, a lecturer in the department of social medicine and health education at Nanjing Medical University in Jiangsu province, China, and colleagues wrote in the study background. Low-degree refractive errors can be corrected with eyeglasses or contact lenses; however, more serious high-degree refractive errors can develop into severe and irreversible visual impairment.
“Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high refractive error in offspring, in particular among those of mothers with diabetic complications,” Yongfu Yu, PhD, a researcher in the department of biostatistics at Fudan University School of Public Health and the department of clinical epidemiology at Aarhus University Department in Denmark, told Healio. “Early ophthalmological screening should be recommended in offspring of mothers with diabetes diagnosed before or during pregnancy.”
In a population-based cohort study, Du and colleagues analyzed data from several Danish national medical registers and details from 2,470,580 live births in Denmark from 1977 to 2016. Follow-up began at birth and continued until the first high refractive error diagnosis, age 25 years or death. Mothers were considered to have diabetes if they were diagnosed with the disease either before or during pregnancy. Researchers assessed the occurrence of high refractive errors in offspring and the specific type of eye problem.
Within the cohort, 56,419 (2.3%) were exposed to maternal diabetes, with 0.9% and 0.3% diagnosed as type 1 and type 2 pregestational diabetes, respectively, and 1.1% were diagnosed as gestational diabetes. The proportion of births to mothers with diabetes increased during the study period from 0.4% in 1977 to 6.5% in 2016.
During follow-up, high refractive error was diagnosed in 553 offspring of mothers with diabetes and in 19,695 offspring of those without diabetes. Exposure to maternal diabetes was associated with a 39% greater risk of high refractive error compared with unexposed offspring.
The researchers observed a difference in refractive error risk between type 1 and type 2 diabetes; compared with unexposed offspring, rates of high refractive error were 32% and 68% higher, respectively.
Additionally, children of mothers with diabetes complications were twice as likely to have eye problems, compared with an 18% increase in high refractive error risk in children of mothers without diabetes complications.
“As many refractive errors in young children are treatable, early identification and intervention can have a lifelong positive impact,” the researchers wrote. “Therefore, although the 39% increased risk is a relatively low effect size, from a public health perspective, considering the high global prevalence of refractive errors, any tiny improvement in this low-risk preventable factor will contribute to a huge reduction in absolute incidence of refractive errors. Thus, the value of early ophthalmological screening should be evaluated in offspring of mothers with diabetes, especially those with diabetic complications, before or during pregnancy for their eyesight health in the future.”
Yu said the findings support early screening for eye disorders in the children of mothers with diabetes.
“Positive glucose control in mothers with gestational diabetes or pregestational diabetes is crucial for reducing high refractive error risk in offspring,” Yu told Healio. “However, we still lack sufficient information on the evaluation of the severity of maternal diabetes and the effects of glucose control. Thus, a validation study with comprehensive exposure assessment is warranted.”