Maternal Risk Factors for Retinopathy of Prematurity in Korea: A Nationwide Population-Based Study

<h2>Abstract</h2><h3>Purpose</h3> To investigate the association between maternal health conditions and the risk of retinopathy of prematurity (ROP) in preterm infants using nationwide population-based data. <h3>Design</h3> Retrospective cohort study. <h3>Participants</h3> A total of 88,111 live preterm births in Korea between January 1, 2014, and December 31, 2017, identified from linked National Health Insurance Service and National Health Screening Program for Infants and Children databases. <h3>Methods</h3> Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for maternal risk factors associated with ROP and treatment-requiring ROP. <h3>Main Outcome Measures</h3> Incidence of any ROP and treatment-requiring ROP. <h3>Results</h3> Of 88,111 preterm infants, 17,181 (19.5%) developed ROP, and 340 (2.0% of ROP cases) required treatment. Maternal diabetes mellitus (aOR, 1.142; <i>P</i><0.001), dyslipidemia (aOR, 1.123; <i>P</i><0.001), hypertension (aOR, 1.092; <i>P</i>=0.023), pelvic and genitourinary diseases (aOR, 1.172; <i>P</i><0.001), and delivery or placental disorders (aOR, 1.463; <i>P</i><0.001) were associated with higher odds of ROP. Among infants with ROP, ovarian dysfunction was associated with increased odds of treatment-requiring disease (aOR, 1.732; <i>P</i><0.001), whereas preeclampsia and gestational hypertension were associated with reduced odds (aOR, 0.465; <i>P</i><0.001). <h3>Conclusions</h3> Multiple maternal conditions were associated with increased risk of any ROP in preterm infants. Among infants with ROP, ovarian dysfunction independently predicted progression to treatment-requiring disease, whereas preeclampsia and gestational hypertension were associated with reduced risk of severe ROP.Recognition of these maternal risk factors may support prenatal counseling, neonatal risk stratification, and targeted ROP screening.