Exposure to Type 1 and Type 2 Maternal Diabetes is Associated with Stage 3-5 Retinopathy of Prematurity

AbstractPurpose 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 (DM) subtypes. We aim to clarify these associations while adjusting for significant comorbidities. Design Retrospective cohort study. Participants Preterm infants born at GA) or BW) receiving care at Vanderbilt University Medical Center's Neonatal Intensive Care Unit between 2004-2021 with documented ROP staging and maternal diabetes status. Methods 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. Main Outcome Measures The association between exposure to maternal diabetes and the presence of Stage 3-5 vs Stage 0 ROP. Results 2,121 (68%) infants had Stage 0 ROP and 311 (10%) had Stage 3-5 ROP. Lower BW and GA were associated with more severe ROP. Maternal DM prevalence was 9% and resulted in higher BW and GA in premature infants; however, Stage 3-5 ROP was significantly associated with maternal DM (OR 2.87, 95% CI: 1.56-5.19, p=0.00056), including Type 1(T1DM; OR 6.43, 95% CI 1.31-28.19, p=0.02) and Type 2 (T2DM; OR 5.77, 95% CI 2.02-15.59, p=0.0007). Conclusions Our results suggest that maternal diabetes, including Type 1 and Type 2 DM, 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.