Association of Maternal Gestational Diabetes Mellitus with Infant Visual Acuity Development

BACKGROUNDS: The impact of maternal gestational diabetes mellitus (GDM) and its glycemic subtypes on the early visual development of infants remains unclear. METHODS: Based on Jiangsu Birth Cohort, we included 2,139 infants born to 2041 mothers recruited from 2014 to 2018. Maternal GDM was categorized into three categories based on oral glucose tolerance test results: impaired fasting glucose, impaired glucose tolerance, and comorbid impaired fasting glucose and impaired glucose tolerance. Infants' grating visual acuity was measured at 1 year of age using Teller Acuity Cards II. We used generalized estimating equation models to examine the association between maternal GDM and infant visual acuity, accounting for the dependence of twin observations. We then conducted a metabolomics analysis to explore the metabolic profiles associated with GDM and infant visual acuity. RESULTS: Prenatal GDM exposure was associated with a 70% increase in risk of abnormal visual acuity in infants (RR, 1.7; 95% CI, 1.2-2.3). The increased risks were more pronounced among infants in the comorbid impaired fasting glucose and impaired glucose tolerance group (RR, 3.2; 95% CI, 1.4-7.7), followed by the impaired glucose tolerance group (RR, 1.8; 95% CI, 1.1-3.0) and the impaired fasting glucose group (RR, 1.6; 95% CI, 0.7-3.6), compared with unexposed infants. The metabolomics analysis suggested glycine, serine, and threonine metabolism as an enriched pathway and identified creatine as a metabolite of interest. CONCLUSIONS: Maternal GDM is associated with an increased risk of abnormal grating visual acuity in infants at 1 year of age. Glycine, serine, and threonine metabolism pathways may contribute to this association.