Gestational diabetes mellitus as an independent risk factor for long-term pediatric ophthalmic morbidity of the offspring

Objective
The impact of gestational diabetes mellitus (GDM) on the health of the offspring is yet to be established. We sought to determine whether children born to mothers with GDM are at increased risk for pediatric ophthalmic morbidity.

Study Design
A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations involving ophthalmic morbidity of children born to mothers with diet controlled GDM (GDMA1), medically treated GDM (GDMA2) and no GDM. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Congenital malformations, multiple gestations and patients lacking prenatal care were excluded from the analysis. A Kaplan-Meier curve was constructed to compare cumulative morbidity in both groups, and a Cox proportional hazard model was used to control for confounders.

Results
During the study period, 238,622 deliveries met the inclusion criteria; 5.0% of mothers were diagnosed with GDM (n=11,999), of which 4.0% were classified as GDMA1 (n=9,601) and 1.0% as GDMA2 (n=2,398). Although the crude ophthalmic complications were comparable between the groups (table), while using Kaplan-Meier survival curve, a higher cumulative incidence of ophthalmic complications was noted in the GDMA2 group (Kaplan-Meier log rank test p<0.05, Figure). In a Cox proportional hazard model, controlling for preterm delivery, birth weight, maternal age and hypertension, GDMA2 was found to be an independent risk factor for long-term pediatric ophthalmic morbidity of the offspring (adjusted OR =1.5, 95% CI 1.05-2.1; p=0.025).

Conclusion
Gestational diabetes mellitus unbalanced by diet (GDMA2) is an independent risk factor for long-term pediatric ophthalmic morbidity of the offspring.