New study reveals that children of mothers with diabetes during
pregnancy have an increased risk of eye problems

Date:
August 17, 2021
Source:
Diabetologia
Summary:
A new study finds that mothers who have diabetes before or during
their pregnancy are more likely to have children who go on to
develop eye problems.



FULL STORY ==========================================================================
A new study published in Diabetologia (the journal of the European
Association for the Study of Diabetes [EASD]) finds that mothers who
have diabetes before or during their pregnancy are more likely to have
children who go on to develop eye problems.


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The research is by Dr Jiangbo Du, State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China, and Dr Jiong Li,
Aarhus University, Aarhus, Denmark, and colleagues. It analysed the associations between maternal diabetes before or during pregnancy and
the risk of high refractive error (RE): conditions in which there is a
failure of the eye to properly focus images on the retina.

RE is one of the most common forms of visual impairment and includes
both long and short-sightedness as well as astigmatism. Collectively
these conditions are the second most common form of disability globally,
and while low-degree REs can be corrected optically using spectacles or
contact lenses, more serious high-degree REs can develop into severe and irreversible visual impairment that can reduce an individual's quality
of life.

In recent decades there has been a rapid increase in the prevalence of
RE, indicating that non-genetic factors may play an important role in its development. An increased tendency to perform close-up work such as using computers for long periods, as well as a lack of outdoor activity has
been established as the main acquired risk factors for low and moderate
RE development in school-age children and young adults. The causes of
high RE defects, however, are still not fully understood.

Earlier research has shown that individuals with severe RE may have
congenital eye defects before birth, suggesting that the conditions
to which the fetus is exposed in the uterus may play a role in the
development of more serious RE in later life. Maternal hyperglycaemia
(high blood sugar) 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.

The authors believed that exposure to the effects of maternal diabetes
while in the uterus could negatively affect the development of the
fetus and lead to high RE in later life. They also anticipated that
the most pronounced associations would be observed among mothers with
diabetic complications since they usually represent more severe cases
of the disease.



==========================================================================
The team conducted a population-based cohort study using several Danish national medical registers and incorporated the details of all live births
in Denmark from 1977 to 2016. Follow-up began at birth and continued
until the first high RE diagnosis (where applicable), the death of the
subject, their emigration, their 25th birthday, or the end of the study
period on 31 December 2016, whichever came first. Mothers were considered
to have diabetes if they were diagnosed with the disease either before
or during pregnancy, and those with pre-gestational diabetes who had
developed problems relating to their condition were grouped according
to whether they had one or multiple complications.

The authors analysed both the occurrence of high RE in offspring and
the specific type of eye problem. Out of 2,470,580 live births included
in the study, 56,419 (2.3%) were exposed to maternal diabetes with 0.9%
and 0.3% being type 1 and type 2 pre-gestational diabetes respectively
(meaning diabetes already present before pregnancy), and 1.1% involving gestational diabetes.

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

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 researchers observed 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. In addition, children of mothers
with complications arising from 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.



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The authors say: "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."
They suggest that the difference might be due to the natural process of emmetropisation in which the eye changes shape during early childhood
to achieve normal vision by becoming less long-sighted, and which could
correct most hyperopia in early infancy over time. In addition, they point
out that the increasing number of years and intensity of school education
could increase the risk of myopia from early childhood to young adulthood.

The strengths of this study are that it used high-quality data covering
the whole Danish population over a long follow-up period, thus minimising
the possibility of selection bias and recall bias. Availability of sociodemographic and medical information enabled the team to adjust for a
wide range of factors which could influence the studied medical outcomes,
and the large sample size allowed them to investigate details such as
the specific types of RE involved.

The authors say: "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 researchers suggest:
"As many REs in young children are treatable, early identification
and intervention can have a lifelong positive impact. 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." They advise
that early screening for eye disorders in the children of mothers with
diabetes may play an important role in maintaining good eyesight health.

========================================================================== Story Source: Materials provided by Diabetologia. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Jiangbo Du, Jiong Li, Xiaoqin Liu, Hu Liu, Carsten Obel, Hongbing
Shen,
Zhibin Hu, Yongfu Yu. Association of maternal diabetes during
pregnancy with high refractive error in offspring: a nationwide
population-based cohort study. Diabetologia, 2021; DOI:
10.1007/s00125-021-05526-z ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210817193001.htm

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