Children of Mothers with Gestational Diabetes Exhibit Altered Ocular Microvascularature

Researchers recommend closer monitoring of offspring born to mothers with gestational diabetes due to the potential of altered ocular microvasculature, which may precede the development of diabetic eye disease. Previous research has shown that significant changes in both retinal and choroidal blood flow occur in diabetic patients, particularly with the development of diabetic retinopathy. These images from the study show how OCT-A can identify “flow voids” (in green) within the choriocapillaris. Photo: Shen S, et al. Transl Vis Sci Technol. 2025;14(10):36. Click image to enlarge. The ocular health of children born to mothers with gestational diabetes mellitus (GDM) is an underdeveloped yet intriguing area of research, especially considering their elevated risk of developing prediabetes or diabetes later in life. A group of researchers in China recently aimed to investigate whether these children exhibit changes in ocular microvasculature. Using OCT angiography (OCT-A), they carried out a population-based cross-sectional study that compared the microvascular parameters of the macular retina and choriocapillaris between children exposed to GDM and non-exposed controls. The team observed several differences in measurements of the deep vascular complex (DVC) and choriocapillaris (CC) between the two groups, suggesting the need to recommend more frequent and comprehensive eye examinations for these children. The researchers used data from a total of 681 seven-year-olds who were examined in the Nanjing Eye Study, among whom 41 children (6.0%) had been exposed to GDM during pregnancy. They analyzed each child’s OCT-A scans to obtain quantitative parameters of ocular microvasculature, focusing on the DVC and CC.The results of the study revealed significant differences between the GDM-exposed group and the controls. Specifically, the children with a history of maternal gestational diabetes exhibited an increased vessel density in the deep vascular complex, particularly in the parafoveal temporal quadrant, where vessel density was reported at 53.6% compared to 51.9% in the control group. Additionally, the area of the flow voids in the CC was somewhat larger in the GDM group with measurements of 17.9% vs. 17.4% in the non-GDM group. The size of choriocapillaris flow voids was also larger in the GDM group (4.33 pixels vs. 4.21 pixels in controls).The larger size and area of flow voids in the choriocapillaris of children exposed to GDM suggests “that these offspring might have already had reduced CC blood perfusion before they developed diabetes or diabetic retinopathy,” the researchers wrote in their paper. Therefore, they noted, “CC perfusion might serve as an early screening biomarker of diabetes or DR in GDM offspring.”It is interesting to note that no significant differences were observed in macular thickness or superficial vascular complex measurements, suggesting that the effects of GDM are more prominent in the deeper vascular structures.The researchers explained that previous research has reported mixed results regarding retinal blood flow in diabetic eyes without retinopathy, with some studies showing increased blood flow while others found no significant differences compared to healthy eyes. The findings of one in particular suggest that retinal blood flow may initially increase in diabetic eyes without DR as a compensatory mechanism for potential hypoxia, declining as the condition progresses to more severe stages of DR. The researchers commented, “We also speculate that the increased vessel density of the DVC in the parafoveal temporal quadrant in GDM offspring found in our study might be a compensation for the decreased blood flow in CC to maintain oxygen supply to the outer retina.”Overall, these findings highlight that maternal gestational diabetes may lead to alterations in ocular microvasculature that could have implications for the ocular health of affected children, emphasizing the need for vigilant eye examinations in this population. The researchers concluded by noting, “Although these differences might not reach statistical significance after adjusting for multiple comparisons, our findings indicate an underlying biological phenomenon worthy of further investigation in larger, confirmatory studies.”Click here for the journal source. Shen S, Zhu X, Chen W, et al. Ocular microvascular changes in offspring born to mothers with gestational diabetes mellitus: the Nanjing eye study. Transl Vis Sci Technol. 2025;14(10):36.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.