Exposure to Type 1 and Type 2 Maternal Diabetes is Associated with Stage 3-5 Retinopathy of Prematurity.
Pathologic similarities between retinopathy of prematurity (ROP) and diabetic retinopathy, leading causes of blindness, suggest that in utero exposure to maternal hyperglycemia may influence an infant's risk of ROP progression to vision-threatening stages. Prior studies exploring this association yielded conflicting results and did not explore maternal diabetes mellitus (DM) subtypes. We aim to clarify these associations while adjusting for significant comorbidities.
Retrospective cohort study.
Preterm infants born at <31 weeks gestational age (GA) or <1500 g birth weight (BW) receiving care at Vanderbilt University Medical Center's Neonatal Intensive Care Unit between 2004 and 2021 with documented ROP staging and maternal diabetes status.
Review of data from the Vanderbilt Neonatal Clinical Repository supplemented by chart review. Data analyzed by descriptive statistics of prevalence, BW, and GA for the cohorts as well as through multivariate logistic regression analyses with ROP stage and maternal diabetes as dependent and independent variables while adjusting for GA, BW, sex, race, year of birth, birth center location, necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia. Infants with ROP stage 3-5 were considered cases, and those with ROP stage 0 were used as controls.
The association between exposure to maternal diabetes and the presence of stage 3-5 versus stage 0 ROP.
Two thousand one hundred twenty-one (68%) infants had stage 0 ROP, and 311 (10%) had stage 3-5 ROP. Maternal DM prevalence was 9% and resulted in higher BW and GA in premature infants. Lower BW and GA were associated with more severe ROP. Stage 3-5 ROP was significantly associated with maternal DM (odds ratio [OR] 3.04, 95% confidence interval [CI]: 1.67-5.45, P = 0.000218), including type 1 DM (T1DM) (OR 6.36, 95% CI 1.29-28.29, P = 0.0174) and type 2 DM (T2DM) (OR 5.82, 95% CI 2.06-15.71, P = 0.00066).
Our results suggest that maternal diabetes, including T1DM and T2DM, increase an infant's risk of developing vision-threatening ROP. The BW and GA profiles of infants with maternal diabetes may provide false reassurance regarding their risk of progression. Considering maternal DM exposure in screening decisions (inclusion and intervals) may help to preserve vision in at-risk infants.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Retrospective cohort study.
Preterm infants born at <31 weeks gestational age (GA) or <1500 g birth weight (BW) receiving care at Vanderbilt University Medical Center's Neonatal Intensive Care Unit between 2004 and 2021 with documented ROP staging and maternal diabetes status.
Review of data from the Vanderbilt Neonatal Clinical Repository supplemented by chart review. Data analyzed by descriptive statistics of prevalence, BW, and GA for the cohorts as well as through multivariate logistic regression analyses with ROP stage and maternal diabetes as dependent and independent variables while adjusting for GA, BW, sex, race, year of birth, birth center location, necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia. Infants with ROP stage 3-5 were considered cases, and those with ROP stage 0 were used as controls.
The association between exposure to maternal diabetes and the presence of stage 3-5 versus stage 0 ROP.
Two thousand one hundred twenty-one (68%) infants had stage 0 ROP, and 311 (10%) had stage 3-5 ROP. Maternal DM prevalence was 9% and resulted in higher BW and GA in premature infants. Lower BW and GA were associated with more severe ROP. Stage 3-5 ROP was significantly associated with maternal DM (odds ratio [OR] 3.04, 95% confidence interval [CI]: 1.67-5.45, P = 0.000218), including type 1 DM (T1DM) (OR 6.36, 95% CI 1.29-28.29, P = 0.0174) and type 2 DM (T2DM) (OR 5.82, 95% CI 2.06-15.71, P = 0.00066).
Our results suggest that maternal diabetes, including T1DM and T2DM, increase an infant's risk of developing vision-threatening ROP. The BW and GA profiles of infants with maternal diabetes may provide false reassurance regarding their risk of progression. Considering maternal DM exposure in screening decisions (inclusion and intervals) may help to preserve vision in at-risk infants.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Authors
Lewis Lewis, Bakis Bakis, Love Love, Sucre Sucre, Van Driest Van Driest, Bastarache Bastarache, Padovani-Claudio Padovani-Claudio
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