Association of hypertensive disorders of pregnancy and gestational diabetes mellitus with developing severe retinopathy of prematurity.

Purpose: To evaluate the impact of hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and their combined presence (GDM-HDP) as perinatal risk factors for severe retinopathy of prematurity (ROP).

Methods: The hospital records of all premature infants referred to a tertiary center between 2020 and 2022 were retrospectively reviewed. Infants born to mothers with GDM, HDP, or both were selected for analysis. Demographic variables, perinatal risk factors, as well as clinical and treatment characteristics of the infants were collected and analyzed.

Results: A total of 1161 infants and 2322 eyes, including HDP group (1110 eyes from 555 infants), GDM group (944 eyes from 472 infants), and GDM-HDP group (268 eyes from 134 infants), were enrolled. The mean gestational age (GA) and birth weight (BW) for all infants were 31.6 ± 2.5 weeks and 1572 ± 427 g, respectively. A higher percentage of eyes (76.5%) in the GDM group were classified as ROP or incomplete vascularization compared to the HDP group (71.6%), with the prevalence of severe ROP also higher in the GDM group (13.5%) than in the HDP group (9.9%; P < 0.05 for both comparisons). The rates of ROP and severe ROP were similar between the GDM and GDM-HDP groups. When considering only infants with BW < 1500, the GDM group still exhibited a higher rate of ROP and severe ROP compared to the HDP group. Treatment was required in 17.5% of eyes in the GDM group, 16.8% in the GDM-HDP group, and 13.9% in the HDP group (P = 0.071).

Conclusion: GDM is a higher risk factor for ROP and developing severe ROP than HDP. However, the data indicate that careful monitoring and management of both GDM and HDP during pregnancy may be crucial in mitigating the risk of severe ROP.