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Maternal diabetes mellitus during pregnancy as a risk factor for strabismus and refractive errors in the offspring-A

Nir Amitai1,2, Tomer Kerman1,2, Tamar Eshkoli3,4

  • 1Faculty of Health Sciences, Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|July 17, 2025
PubMed

Insights

Maternal diabetes during pregnancy increases offspring risk for strabismus and refractive errors (RE). Higher HbA1c levels in mothers correlate with a greater risk of these ocular conditions in children.

Area of Science:

  • Ophthalmology
  • Maternal-Fetal Medicine
  • Public Health

Background:

  • Maternal diabetes during pregnancy is a growing concern.
  • Potential links between maternal glycemic control and offspring ocular development require investigation.

Purpose of the Study:

  • To determine if maternal diabetes during pregnancy is associated with an elevated risk of strabismus and refractive errors (RE) in offspring.
  • To explore the impact of different types of maternal diabetes and glycemic control (HbA1c levels) on these risks.

Main Methods:

  • Retrospective cohort study using electronic medical records from Clalit Health Services (Israel, 2001-2023).
  • Categorization of births based on maternal diabetes status (type 1, type 2, gestational, or no diabetes).
  • Statistical analysis using mixed models and generalized estimating equations to compare ocular conditions and calculate adjusted odds ratios.

Main Results:

  • Over 500,000 maternal-offspring records analyzed.
  • Offspring of diabetic mothers showed a significantly higher prevalence of strabismus (adjusted OR 1.40) and refractive errors (adjusted OR 1.61).
  • Elevated maternal HbA1c levels (>6.5%) were associated with substantially increased risks for both strabismus (adjusted OR 1.78) and refractive errors (adjusted OR 1.97) in offspring.

Conclusions:

  • Maternal diabetes during pregnancy is a significant risk factor for developing strabismus and refractive errors in offspring.
  • Poor glycemic control, indicated by high HbA1c levels, further amplifies this risk.
Abstract

Keywords:
long‐term ophthalmic outcomesmaternal diabetesmaternal glycemic controlocular morbiditypediatric ophthalmologypregnancyrefractive errorsstrabismus

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