Abstract
Background
Gestational diabetes (GD) occurs in 5.8% to 25.1% of pregnant women. This disorder has been linked with intrauterine growth delays, congenital anomalies, and neurobehavioral disorders following birth. As to ophthalmological effects, changes in macular thickness and hypoplasia of the upper quadrant of the papilla have been described.
Objective
To investigate whether GD has an effect on ophthalmological development in the children born of mothers with this condition.
Methods
Observational study carried out in children seen in the ophthalmological outpatient clinic of a pediatric hospital in Barcelona (Spain) between January 2011 and December 2015. Participants were ultimately divided into two groups, a study group whose mothers had GD managed either by insulin or diet (GD group) and a control group of children with non-diabetic mothers. Pregestational diabetes cases, were excluded. Complete information was collected on the children’s refraction status, ophthalmological disease, and congenital malformations.
Results
Data were compiled on 350 children (229 children born of mothers with GD-186 managed with diet vs 43, with insulin- and 121 controls). The prevalence of amblyopia and strabismus was similar between the groups, but children of mothers with GD had a three-fold greater probability of having refractive errors than children born to mothers without GD. Hyperopia (14.8% vs. 7.4%) and myopia (3.5% vs 0%) were found to be significantly more prevalent in children born of mothers with GD than in the controls (p = 0.027 in both groups).The prevalence of astigmatism was similar in both groups (1.7% vs 0.8%).
Conclusions for Practice
Refractive errors are more common in children born of mothers with GD. These conditions are easily managed, but if they are not detected, they can lead to amblyopia or accommodative strabismus, interfere with acquisition of fine motor skills, and lead to learning problems. Regular ocular examinations would be recommended in these patients.
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References
Allen, V. M., Armson, B. A., Wilson, R. D., et al. (2007). Teratogenicity associated with pre-existing and gestational diabetes. Journal of Obstetrics and Gynaecology Canada,29, 927–944.
Banhidy, F., Acs, N., Puhó, E. H., et al. (2010). Congenital abnormalities in the offspring of pregnant women with type 1, type 2 and gestational diabetes mellitus: A population-based case-control study. Congenital Anomalies,50(2), 115–121.
Buscicchio, G., Gentilucci, L., & Tranquilli, A. L. (2010). Computerized analysis of fetal heart rate in pregnancies complicated by gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction and premature rupture of membranes. Journal of Maternal-Fetal and Neonatal Medicine,23(4), 335–337.
CDC. (2010). MMWR racial differences by gestational age in neonatal deaths attributable to congenital heart defects—United States, 2003–2006. Morbidity and Mortality Weekly Report,59(37), 1208–1211.
Clive, J. (2010). Gestational diabetes: risk factors and recent advances in its genetics and treatment. British Journal of Nutrition,104, 775–787.
Damm, P. (1998). Gestational diabetes mellitus and subsequent development of overt diabetes mellitus. Danish Medical Bulletin,45(5), 495–509.
Davis, E. M., Peck, J. D., Thompson, D., et al. (2010). Maternal diabetes and renal agenesis/dysgenesis. Birth Defects Research A,88(9), 722–727.
Dawid, G., Wegrzynowski, J., Kwiatek, M., et al. (2010). A fetal dilated and hypertrophic cardiomyopathy associated with maternal gestational diabetes: a case report. Pediatric Endocrinology Diabetes Metabolism,16(2), 123–125.
DeSisto, C. L., Kim, S. Y., & Sharma, A. J. (2014). Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (PRAMS), 2007–2010. Preventing Chronic Disease,11, E104.
García-Flores, J., Jañez, M., Gonzalez, M. C., et al. (2011). Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes. European Journal of Obstetrics, Gynecology, and Reproductive Biology,154(1), 24–26.
Horvath, K. (2010). ACP Journals Club: Treatment for gestational diabetes reduces risk for shoulder dystocia. Annals of Internal Medicine,153(6), JC3–JC6.
Huidobro, A., Prentice, A., Fulford, T., et al. (2010). Gestational diabetes, comparison of women diagnosed in second and third trimester of pregnancy with non GDM women: Analysis of a cohort study. Revista Medica de Chile,138(3), 316–321.
Landau, K., Bajka, J. D., & Kirchschläger, B. M. (1998). Topless optic disks in children of mothers with type I diabetes mellitus. American Journal of Ophthalmology,125(5), 605–611.
Lempert, P. (1998). Optic nerve hypoplasia diagnosis should be confirmed by accurate measurements. Archives of Ophthalmology,116(6), 831–832.
Main, K. M., Skakkebaek, N. E., Virtanen, H. E., et al. (2010). Genital anomalies in boys and the environment. Best Practice & Research Clinical Endocrinology & Metabolism,24(2), 279–289.
Miki, A., Shirakashi, M., Yaoeda, K., et al. (2010). Optic nerve head analysis of superior segmental optic hypoplasia using Heidelberg retina tomography. Clinical Ophthalmology,4, 1193–1199.
Nazer Herrera, J., García Huidobro, M., & Cifuentes, O. L. (2005). Congenital malformations among offspring of diabetic women. Revista Médica de Chile,133(5), 547–554.
Oddsberg, J., Lu, Y., & Lagergren, J. (2010). Maternal diabetes and risk of esophageal atresia. Journal of Pediatric Surgery,45(10), 2004–2008.
Ornoy, A. (2005). Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes. Pediatric Endocrinology Reviews,3(2), 104–113.
Reece, E. A. (2010). The fetal and maternal consequences of gestational diabetes mellitus. Journal of Maternal-Fetal and Neonatal Medicine,23(3), 199–203.
Ricci, B., Scullica, M. G., Ricci, F., et al. (1998). Iris vascular changes in newborns of diabetic mothers. Ophthalmologica,212(3), 175–177.
Tan, R. R., Zhang, S. J., Li, Y. F., et al. (2015). Proanthocyanidins prevent high glucose-induced eye malformation by restoring Pax6 expression in chick embryo. Nutrients,7(8), 6567–6581.
Tariq, Y. M., Samarawickrama, C., Li, H., et al. (2010). Retinal thickness in the offspring of diabetic pregnancies. American Journal of Ophthalmology,150(6), 883–887.
Velázquez, P., Vega, G., & Martínez, M. L. (2010). Morbilidad y mortalidad neonatal asociada a diabetes gestacional. Revista Chilena de Obstetricia y Ginecología,75(1), 35–41.
Zhang, S. J., Li, Y. F., Tan, R. R., et al. (2016). A new gestational diabetes mellitus model: Hyperglycemia-induced eye malformation via inhibition of Pax6 in the chick embryo. Disease Model Mechanisms,9(2), 177–186.
Zhu, Y., & Yang, C. (2016). Prevalence of gestational diabetes and risk of progression to Type 2 diabetes: A global perspective. Current Diabetes Reports,16, 7.
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Alvarez-Bulnes, O., Monés-Llivina, A., Cavero-Roig, L. et al. Ophthalmic Pathology in the Offspring of Pregnant Women with Gestational Diabetes Mellitus. Matern Child Health J 24, 524–529 (2020). https://doi.org/10.1007/s10995-020-02887-6
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DOI: https://doi.org/10.1007/s10995-020-02887-6
Keywords
- Gestational diabetes mellitus
- Ophthalmic pathology
- Strabismus
- Refractive error