A new study published in ‘Diabetologia’, the journal of the European Association for the Study of Diabetes (EASD), concludes that mothers who have diabetes before or during their pregnancy are more likely to have children who develop eye problems.
The research looked at associations between maternal diabetes before or during pregnancy and the risk of high refractive error (ER): conditions in which there is a failure of the eye to correctly focus images on the retina.
ER is one of the most common forms of visual impairment and includes both nearsightedness and farsightedness, as well as astigmatism. Collectively, these conditions are the second most common form of disability worldwide, and while low-grade RDs can be optically corrected by glasses or contact lenses, more severe high-grade RDs can develop into severe and irreversible visual impairment. which can reduce a person’s quality of life.
In recent decades, there has been a rapid increase in the prevalence of RDs, indicating that non-genetic factors may play an important role in their development. It has been established that a greater tendency to perform close work, such as the use of computers for long periods, as well as a lack of outdoor activity, are the main acquired risk factors for the development of low and moderate RD in children in school age and young adults. However, the causes of elevated ER defects are still not fully understood.
Previous research has shown that individuals with severe RD may have congenital eye defects before birth, suggesting that conditions to which the fetus is exposed in the womb may play a role in the development of more severe RD later in life. life.
Maternal hyperglycemia (high blood sugar) during pregnancy can lead to high blood glucose levels in the fetus, which can damage the retina and optic nerve and lead to changes in the shape of the eyes that, ultimately cause ER.
The research was conducted by Dr. Jiangbo Du, from the State Laboratory for Reproductive Medicine, Nanjing Medical University, China, and Dr. Jiong Li, from Aarhus University, Denmark, and their colleagues. He and his colleagues believed that exposure to the effects of maternal diabetes while in the womb could negatively affect fetal development and lead to elevated RD in later life. They also anticipated that the most pronounced associations would be seen among mothers with diabetic complications, as these tend to represent more severe cases of the disease.
The team conducted a population-based cohort study using several Danish national medical records and incorporated details of all live births in Denmark from 1977 to 2016. Follow-up started at birth and continued until the first diagnosis of RD. discharge (if applicable), subject’s death, emigration, 25th birthday, or the end of the study period on December 31, 2016, whichever came first.
Mothers were considered to have diabetes if they were diagnosed with the disease before or during pregnancy, and those with pregestational diabetes who had developed problems related to their disease were grouped according to having one or more complications.
The authors analyzed both the occurrence of elevated ERs in the offspring and the specific type of eye problem. Of the 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 2 pregestational diabetes, respectively (which meaning that the diabetes was already present before the pregnancy), and 1.1% involved gestational diabetes.
The proportion of births to mothers with diabetes increased throughout the study period, from 0.4% in 1977 to 6.5% in 2016, and diabetes was associated with the mother being older, having more education, having had more pregnancies and was more likely to live alone.
During the follow-up period, high RD was diagnosed in 533 children of mothers with diabetes and in 19,695 children of mothers without the disease. Maternal diabetes exposure was associated with a 39% increased risk of high RD compared with unexposed offspring.
The researchers observed a difference in RD risk between type 1 and type 2 forms of diabetes, with elevated RD rates compared to unexposed individuals being 32% and 68% higher, respectively.
In addition, children of mothers with complications from diabetes were twice as likely to have eye problems, compared to an 18% increased risk of high RD in children of mothers who had no complications from the disease.
The authors note that “it was interesting to observe that hyperopia (long vision) occurred more frequently in childhood and myopia (short vision) was more frequent in adolescence and youth.”
They suggest that the difference could be due to the natural process of emmetropia in which the eye changes shape during early childhood to achieve normal vision by being less farsighted, and that it could correct most early childhood farsightedness over time. .
In addition, they point out that the increase in the number of years and the intensity of school education could increase the risk of myopia from early childhood to youth.
The strengths of this study are that it used high-quality data covering the entire Danish population over a long follow-up period, which minimizes the possibility of selection and recall bias. The availability of sociodemographic and medical information allowed the team to adjust for a wide range of factors that could influence the medical outcomes studied, and the large sample size allowed them to investigate details such as the specific types of RD involved.
“In this national population-based cohort study, we found that infants born to mothers with pregestational or gestational diabetes were at increased risk of developing elevated RDs in general, as well as specific types of elevated RDs, persisting from the neonatal period to early adulthood, they point out. Children born to mothers with diabetic complications had the highest risk of elevated RD.”
The researchers suggest that, “since many RDs in young children are treatable, early identification and intervention can have a lifelong positive impact. Although the 39% increased risk is a relatively small effect size, from a public health perspective, given the high global prevalence of RD, any small improvement in this low-risk preventable factor will contribute to a huge reduction. of the absolute numbers of these eye conditions.
For this reason, they advise that the early detection of eye disorders in the children of diabetic mothers can play an important role in maintaining good visual health.
With information from Europe Press.
Source: GEM Digital