Maternal Diabetes Mellitus During Pregnancy as a Risk Factor for Congenital Nasolacrimal Duct Obstruction in the Offspring – a Large-Scale National Study

Objective To investigate whether maternal diabetes mellitus during pregnancy is a risk factor for CNLDO in offspring.Methods This retrospective cohort study utilized electronic medical records from Clalit Health Services (CHS) in Israel, 2010–2023. Neonates were classified as born to diabetic or non-diabetic mothers. Mixed models assessed and compared demographic characteristics and ocular disorders between groups. Generalized estimating equations regression was applied to calculate odds ratios while adjusting for potential confounders.Results 505,928 births were analyzed. CNLDO prevalence was 4.1% among children born to mother with diabetes, compared to 2.9% among children to non-diabetic mothers (OR-1.44, 95% confidence interval [CI] 1.35–1.54; p < .001). Among children to diabetic mothers receiving pharmacological treatment, CNLDO prevalence was 5.2%, while it was 3.7% when managed by diet (OR-1.44, 95% CI 1.26–1.64; p < .001). CNLDO prevalence was 4.7% in children to mothers with HbA1c levels greater than 6.5%, compared to 2.9% when HbA1c levels were below 6.5% (OR-1.62, 95% CI 1.30–2.03; p < .001). After adjusting for confounders, significant association was found between maternal diabetes during pregnancy and CNLDO prevalence in offspring (OR-1.47, 95% CI 1.37–1.58; p < .001).Conclusions Maternal diabetes during pregnancy independently increases CNLDO risk, especially in infants to mothers with more severe diabetes.