Abstract
BackgroundRetinopathy of prematurity (ROP) is a significant morbidity in preterm babies. Multiple risk factors for severe ROP have been extensively studied, however, only a few studies have included maternal diabetes mellitus (MDM) in their assessment. ROP and diabetic retinopathy are both retinal vascular diseases in which there is leakage and/or neovascularization from damaged retinal vessels. Diabetes may affect ROP development; however, there are conflicting results on the association between MDM and ROP.ObjectiveTo determine if MDM is an independent risk factor for clinically significant ROP (ROP > Stage II) in neonates weighing less than 1500g.Design/MethodWe conducted a retrospective cohort study of neonates weighing <1500g who were delivered or transferred into our institution from 2007 through 2017. Logistic regression was used to analyze the association between severe ROP and MDM. The risks for the different stages of ROP from MDM were compared using chi-square linear trend test.ResultsWe extracted 883 paired maternal-neonatal data. The mean (standard deviation) gestational age and birthweight were 28.5 (2.9) weeks and 1052.7 (300.9) grams, respectively. Of the 883 mothers, 72 (8.2%) had DM. The incidence of ROP and severe ROP was 42.4% (374/883) and 6.5% (57/883) respectively. The odds ratio comparing MDM and severe ROP was 3.47 [95% CI: 1.51–7.96]; p<0.01). Compared to Stage I, the risk of MDM in infants with ROP increased from 1.49 in Stage II ROP to 2.59 in Stages III&IV. Severe ROP was associated with infant steroid use (OR: 5.92 [95% CI: 2.83–12.38]; p <0.01), sepsis (OR: 2.13 [95% CI: 1.09–4.14]; p = 0.03) chorioamnionitis (OR: 1.90 [95% CI: 1.03–3.50]; p = 0.04), and maternal steroid use (OR: 0.51 [95% CI: 0.32–0.79]; p<0.01).ConclusionMaternal diabetes is associated with ROP and the strength of association increased with increasing severity of ROP.
Highlights
Retinopathy of prematurity (ROP), formerly known as retrolental fibroplasia, represents a significant morbidity in the preterm babies as it remains one of the important causes of blindness nationally and globally
The odds ratio comparing maternal diabetes mellitus (MDM) and severe ROP was 3.47 [95% CI: 1.51–7.96]; p
Maternal diabetes is associated with ROP and the strength of association increased with increasing severity of ROP
Summary
Retinopathy of prematurity (ROP), formerly known as retrolental fibroplasia, represents a significant morbidity in the preterm babies as it remains one of the important causes of blindness nationally and globally. The “first epidemic” was observed in the 1940s and 1950s among premature babies in the United States and Western Europe with uncontrolled use of supplemental oxygen as the primary risk factor. The “second epidemic” was observed in the 1970s as a result of increased survival rates of extremely premature babies who incidentally experienced more cases of acute severe ROP compared to the larger neonates. This provided more evidence that low birth weight and prematurity are primary risk factors for ROP. Diabetes may affect ROP development; there are conflicting results on the association between MDM and ROP
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