Jiangbo Du1,2,3, Jiong Li3, Xiaoqin Liu4, Hu Liu5, Carsten Obel6, Hongbing Shen1,2, Zhibin Hu7,8, Yongfu Yu9,10,11. 1. State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China. 2. Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China. 3. Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark. 4. NCRR-National Centre for Register-based Research, Aarhus University, Aarhus, Denmark. 5. Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China. 6. Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark. 7. State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China. zhibin_hu@njmu.edu.cn. 8. Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China. zhibin_hu@njmu.edu.cn. 9. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China. yoyu@clin.au.dk. 10. The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China. yoyu@clin.au.dk. 11. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. yoyu@clin.au.dk.
Abstract
AIMS/HYPOTHESIS: We aimed to investigate the associations between maternal diabetes before or during pregnancy and the risk of high refractive error (RE) in offspring until the age of 25 years. METHODS: This nationwide register-based cohort study comprised 2,470,580 individuals born in 1977-2016. The exposure was maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes). Cox regression was used to examine the association between maternal diabetes and the risk of high RE in offspring from birth until the age of 25 years, adjusting for multiple potential confounders. RESULTS: During up to 25 years of follow-up, 553 offspring of mothers with diabetes and 19,695 offspring of mothers without diabetes were diagnosed with high RE. Prenatal exposure to maternal diabetes was associated with a 39% increased risk of high RE: HR 1.39 (95% CI 1.28, 1.51), p < 0.001; standardised cumulative incidence in unexposed offspring at 25 years of age 1.18% (95% CI 1.16%, 1.19%); cumulative incidence difference 0.72% (95% CI 0.51%, 0.94%). The elevated risks were observed for hypermetropia (HR 1.37 [95% CI 1.24, 1.51], p < 0.001), myopia (HR 1.34 [95% CI 1.08, 1.66], p = 0.007) and astigmatism (HR 1.58 [95% CI 1.29, 1.92], p < 0.001). The increased risks were more pronounced among offspring of mothers with diabetic complications (HR 2.05 [95% CI 1.60, 2.64], p < 0.001), compared with those of mothers with diabetes but no diabetic complications (HR 1.18 [95% CI 1.02, 1.37], p = 0.030). CONCLUSIONS/ INTERPRETATION: Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring, in particular among those of mothers with diabetic complications. Early ophthalmological screening should be recommended in offspring of mothers with diabetes diagnosed before or during pregnancy.
AIMS/HYPOTHESIS: We aimed to investigate the associations between maternal diabetes before or during pregnancy and the risk of high refractive error (RE) in offspring until the age of 25 years. METHODS: This nationwide register-based cohort study comprised 2,470,580 individuals born in 1977-2016. The exposure was maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes). Cox regression was used to examine the association between maternal diabetes and the risk of high RE in offspring from birth until the age of 25 years, adjusting for multiple potential confounders. RESULTS: During up to 25 years of follow-up, 553 offspring of mothers with diabetes and 19,695 offspring of mothers without diabetes were diagnosed with high RE. Prenatal exposure to maternal diabetes was associated with a 39% increased risk of high RE: HR 1.39 (95% CI 1.28, 1.51), p < 0.001; standardised cumulative incidence in unexposed offspring at 25 years of age 1.18% (95% CI 1.16%, 1.19%); cumulative incidence difference 0.72% (95% CI 0.51%, 0.94%). The elevated risks were observed for hypermetropia (HR 1.37 [95% CI 1.24, 1.51], p < 0.001), myopia (HR 1.34 [95% CI 1.08, 1.66], p = 0.007) and astigmatism (HR 1.58 [95% CI 1.29, 1.92], p < 0.001). The increased risks were more pronounced among offspring of mothers with diabetic complications (HR 2.05 [95% CI 1.60, 2.64], p < 0.001), compared with those of mothers with diabetes but no diabetic complications (HR 1.18 [95% CI 1.02, 1.37], p = 0.030). CONCLUSIONS/ INTERPRETATION: Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring, in particular among those of mothers with diabetic complications. Early ophthalmological screening should be recommended in offspring of mothers with diabetes diagnosed before or during pregnancy.