The Association Between Diabetes Mellitus During Pregnancy and Retinopathy of Prematurity

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case-control study of all premature infants who were born alive and survived the post-delivery hospitalization period in Soroka Medical Center, with either gestational age younger than 32 weeks or birthweight less than 1500 g, during the years 2013-2021. The infants were divided into two groups according to ROP status. Multivariable Generalized Estimating Equations (GEE) were used to analyze the association between ROP and DM, adjusting for potential confounders, including maternal age, diabetes type (GDM vs. pre-gestational DM), gestational age, birthweight (<1250 g), duration of oxygen supplementation, antenatal corticosteroid courses, and birth plurality. Results: During the study period, there were 881 pairs of women and newborns who met the inclusion criteria. The ROP group included 345 infants (39.1%). Twenty-two (6.4%) of the mothers in the ROP group were diagnosed with DM during pregnancy compared with 52 of 536 (9.7%) in the control group (p = 0.082). ROP was associated with oxygen treatment (OR 1.05; 95% CI, 1.03-1.08; p < 0.001), birthweight < 1250 g (OR 2.70; 95% CI, 1.93-3.78; p < 0.001) and advanced maternal age (OR 1.04; 95% CI, 1.01-1.06; p = 0.006). Prenatal steroid treatment was identified as a significant protective factor against ROP (OR 0.73; 95% CI, 0.60-0.89; p = 0.002). No statistically significant association was observed between maternal DM and ROP (OR 0.62; 95% CI 0.34-1.13; p = 0.12). These findings should be interpreted cautiously given the retrospective design and the limited availability of glycemic control data. Conclusions: Maternal diabetes mellitus was not significantly associated with the risk of ROP in this cohort.