Emerging evidence suggests that in-utero exposure to maternal diabetes may increase the likelihood of severe retinopathy of prematurity (ROP) in premature infants – an association that could have implications for screening strategies and risk stratification.
In a retrospective cohort study published in Ophthalmology Science, Vanderbilt University researchers analyzed more than 3,100 premature infants treated at a tertiary neonatal intensive care unit between 2004 and 2021. The team examined whether maternal diabetes – specifically Type 1, Type 2, or gestational diabetes – was associated with progression to advanced ROP stages.
ROP remains a leading cause of childhood blindness worldwide. Although screening protocols rely primarily on gestational age (GA) and birth weight (BW), identifying additional risk factors could improve early detection and management. The study was motivated in part by biological parallels between ROP and diabetic retinopathy: both conditions involve ischemia-driven retinal neovascularization.
The investigators evaluated infants born at less than 31 weeks’ gestation or with birth weight under 1,500 g who underwent ROP screening. Of the 3,139 infants included in the analysis, 311 (10%) developed Stage 3–5 ROP – considered to be a vision-threatening disease requiring treatment – while 2,121 had no detectable ROP.
Maternal diabetes was present in approximately 9% of pregnancies. After adjusting for key confounders – including GA, BW, sex, race, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular hemorrhage, and year of birth – maternal diabetes exposure was significantly associated with severe ROP. Infants exposed to maternal diabetes had nearly three times the odds of developing Stage 3–5 disease compared with unexposed infants.
The association was particularly strong for pre-gestational diabetes. Maternal Type 1 diabetes increased the odds of severe ROP more than sixfold, while Type 2 diabetes increased the odds nearly sixfold as well. In contrast, gestational diabetes showed a weaker and non-significant association in this cohort.
Interestingly, infants born to mothers with diabetes tended to have higher gestational age and birth weight – characteristics usually associated with lower ROP risk. This finding raises the possibility that clinicians may underestimate the risk in these infants if screening decisions rely solely on traditional parameters.
The authors propose that maternal hyperglycemia during pregnancy could influence fetal retinal vascular development, potentially predisposing the premature retina to pathological angiogenesis after birth.
While the study does not establish causality, it highlights maternal diabetes as a potentially under-recognized contributor to ROP progression. The researchers suggest that incorporating maternal metabolic history into screening decisions – particularly for infants at the margins of current BW and GA criteria – may help identify at-risk patients earlier.
With survival rates for extremely premature infants continuing to improve, refining ROP risk assessment remains a priority. Considering maternal diabetes exposure in screening decisions, the authors conclude, could represent an important piece of that puzzle.
In a retrospective cohort study published in Ophthalmology Science, Vanderbilt University researchers analyzed more than 3,100 premature infants treated at a tertiary neonatal intensive care unit between 2004 and 2021. The team examined whether maternal diabetes – specifically Type 1, Type 2, or gestational diabetes – was associated with progression to advanced ROP stages.
ROP remains a leading cause of childhood blindness worldwide. Although screening protocols rely primarily on gestational age (GA) and birth weight (BW), identifying additional risk factors could improve early detection and management. The study was motivated in part by biological parallels between ROP and diabetic retinopathy: both conditions involve ischemia-driven retinal neovascularization.
The investigators evaluated infants born at less than 31 weeks’ gestation or with birth weight under 1,500 g who underwent ROP screening. Of the 3,139 infants included in the analysis, 311 (10%) developed Stage 3–5 ROP – considered to be a vision-threatening disease requiring treatment – while 2,121 had no detectable ROP.
Maternal diabetes was present in approximately 9% of pregnancies. After adjusting for key confounders – including GA, BW, sex, race, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular hemorrhage, and year of birth – maternal diabetes exposure was significantly associated with severe ROP. Infants exposed to maternal diabetes had nearly three times the odds of developing Stage 3–5 disease compared with unexposed infants.
The association was particularly strong for pre-gestational diabetes. Maternal Type 1 diabetes increased the odds of severe ROP more than sixfold, while Type 2 diabetes increased the odds nearly sixfold as well. In contrast, gestational diabetes showed a weaker and non-significant association in this cohort.
Interestingly, infants born to mothers with diabetes tended to have higher gestational age and birth weight – characteristics usually associated with lower ROP risk. This finding raises the possibility that clinicians may underestimate the risk in these infants if screening decisions rely solely on traditional parameters.
The authors propose that maternal hyperglycemia during pregnancy could influence fetal retinal vascular development, potentially predisposing the premature retina to pathological angiogenesis after birth.
While the study does not establish causality, it highlights maternal diabetes as a potentially under-recognized contributor to ROP progression. The researchers suggest that incorporating maternal metabolic history into screening decisions – particularly for infants at the margins of current BW and GA criteria – may help identify at-risk patients earlier.
With survival rates for extremely premature infants continuing to improve, refining ROP risk assessment remains a priority. Considering maternal diabetes exposure in screening decisions, the authors conclude, could represent an important piece of that puzzle.
