Abstract
BACKGROUND: The aim of this study was to investigate the association between maternal blood lipid trajectories during pregnancy and myopia in preschool offspring as well as the combined effects of maternal blood lipid trajectories and gestational diabetes mellitus (GDM) on myopia in offspring. METHODS: A prospective cohort design with a nested case‒control component was employed in this study. Visual outcomes in children aged 3–6 years, including both noncycloplegic refraction screening results and clinically validated diagnoses from medical records, were obtained. Maternal blood lipid trajectories were classified using group-based multi-trajectory modelling from repeat measurements of total cholesterol (TC) and triglycerides (TGs) during pregnancy in mothers with and without GDM as a complication. Modified Poisson regression models and generalized linear models were used to assess the associations between the maternal lipid trajectory and offspring myopia. RESULTS: Among the 4043 included mother‒child pairs, four distinct maternal lipid trajectories were identified: Group 1, “consistently normal TC and TG”; Group 2, “keeping normal TC but high TG”; Group 3, “moderately increasing TC and TG”; and Group 4, “highly increasing TC and TG”, accounting for 50.0% (n = 2078), 4.9% (n = 193), 41.0% (n = 1629), and 4.1% (n = 143) of the pairs, respectively. In the prospective cohort analysis, compared with membership in Group 1, membership in Groups 3 and 4 was associated with 21% (95% CI: 1.02–1.44) and 52% (95% CI: 1.06–2.20) increases in the risk of suspected myopia, respectively; when the mother had GDM as a complication, the relative risk was further elevated (RR = 1.52, 95% CI: 1.16–1.99 for “GDM + Group 3”). In the nested case‒control analysis, significant associations were also observed between the maternal lipid trajectory (Group 3: OR = 1.66, 95% CI: 1.02–2.72; Group 4: OR = 9.22, 95% CI: 1.05–80.66) and clinically diagnosed myopia; when the mother had GDM as a complication, these risks substantially increased (OR = 2.83, 95% CI: 1.06–7.59 for “GDM + Group 3”). CONCLUSION: The results of this cohort study suggest that elevated gestational maternal blood lipid levels (including TC and TG levels) throughout pregnancy are associated with an increased risk of preschool myopia in the offspring. When these levels were considered in the context of GDM, the risks were further increased. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12944-026-02863-z.