What the Fundus

A paper published on August 17, 2021 in Diabetalogia, “Association of maternal diabetes during pregnancy with high refractive error in offspring: a nationwide population-based cohort study” analyzed over 2 million people born between 1977 and 2016. It found that these people had a 39% increased risk of having high refractive errors of all types — hyperopia, myopia, and astigmatism.

I encourage you to read it as if gives a number of potential reasons for these findings.

“…elevated levels of maternal serum glucose can lead to hyperglycaemia in the fetal circulation via the placenta. In the fetus, hyperglycaemia may induce vascular endothelial dysfunction and neuropathy. This may result in the leakage or breakdown of the blood–ocular barrier endothelial system, in turn leading to aqueous humour osmotic pressure changes and subsequent RE after birth…”

“…enhanced oxidative stress and inflammatory responses due to hyperglycaemia may damage the retina or optic nerve. Offspring born from diabetic pregnancies (offspring of pregnant women with pre-gestational diabetes or GDM) also likely had significantly lower pericentral macular retinal variables and higher risk of superior segmental optic nerve hypoplasia, compared with offspring born from non-diabetic pregnancies…”

It may mean that you should recommend examining children at younger ages if their mothers experienced gestational diabetes.