Maternal diabetes mellitus during pregnancy as a risk factor for strabismus and refractive errors in the offspring—A large-scale national study

Objective: To investigate whether maternal diabetes during pregnancy is associated with increased risk of strabismus and refractive errors (RE) in their offspring. Methods: This retrospective cohort study utilized electronic medical records from Clalit Health Services (CHS) in Israel, 2001–2023. Births were categorized by maternal diabetes type (type 1, type 2, or gestational) or no diabetes. Mixed models compared demographics and ocular conditions, including RE and strabismus, while generalized estimating equations calculated odds ratios adjusting for confounders. Results: A total of 505 928 maternal and offspring records were analyzed. Strabismus prevalence was 496 (2.0%) in children of diabetic mothers versus 7346 (1.5%) in those of non-diabetic mothers (odds ratio [OR] 1.29, 95% confidence interval [CI]: 1.18–1.42), and remained significant after adjustment (OR 1.40, 95% CI: 1.27–1.55). In children of mothers with HbA1c >6.5%, strabismus prevalence was 49 (2.9%) compared to 7793 (1.5%) with HbA1c ≤6.5% (adjusted OR 1.78, 95% CI: 1.30–2.43). RE prevalence was 753 (3%) among offspring of diabetic mothers versus 10 785 (2.2%) among non-diabetic mothers (OR 1.34, 95% CI: 1.24–1.44), with maternal diabetes remaining significantly associated with RE after adjustment (OR 1.61, 95% CI: 1.48–1.74). In the HbA1c >6.5% group, RE prevalence was 71 (4.2%) versus 11 467 (2.3%) with normal HbA1c (adjusted OR 1.97, 95% CI: 1.54–2.53). Conclusion: Maternal diabetes during pregnancy is associated with strabismus and RE in the offspring, with higher risk with high HbA1c levels.