Racial and Ethnic Differences in Long-Term Ocular Outcomes Among Individuals With Gestational Diabetes

Introduction: Gestational diabetes mellitus (GDM) disproportionately affects Black and Hispanic or Latino birthing populations, but racial and ethnic differences in long-term ocular complications after GDM are not well characterized.We compared the risk of diabetic retinopathy (DR) and diabetic cataracts (DC) among individuals with GDM across racial and ethnic groups over 10 years.Methods: We conducted a retrospective cohort study using de-identified electronic health record data from the TriNetX US Collaborative Network (N = 182,086 with GDM across 67 healthcare organizations).Individuals with pre-existing type 1 or type 2 diabetes or prior GDM were excluded.We calculated cumulative incidence and incidence rates of DR and DC by race and ethnicity between January 2000 and July 2026.We then performed 1:1 propensity score matching for Black or African American vs. White patients and for Hispanic or Latino vs. White patients, balancing demographics, body mass index (BMI), blood pressure, laboratory values, and medications (standardized mean difference < 0.10).Outcomes were compared using risk ratios (RR), Kaplan-Meier analysis, and hazard ratios (HR).Results: Overall, 1,078 individuals developed DR (0.593%), and 505 developed DC (0.278%).Crude cumulative incidence was highest among Black patients for DC (0.70%) and among Native Hawaiian or Other Pacific Islander (1.32%), Black (1.23%), and American Indian or Alaska Native (1.18%) patients for DR.In matched cohorts of 24,121 patients per group, Black patients had a higher risk than White patients of both DR (RR, 1.62; 95% confidence interval (CI), 1.21-2.18)and DC (RR, 2.26; 95% CI, 1.44-3.56).Time-to-event analyses were consistent (DR HR, 0.68 for White vs. Black patients; 95% CI, 0.50-0.91;DC HR, 0.47; 95% CI, 0.30-0.75).In matched cohorts of 17,600 patients per group, Hispanic or Latino and White patients did not differ significantly in DR (RR, 1.21; 95% CI, 0.77-1.90)or DC (RR, 0.94; 95% CI, 0.46-1.90).Conclusions: Among individuals with GDM, Black patients had a higher risk of DR and DC than matched White patients, although absolute risks were low.We found no significant difference between Hispanic or Latino and White patients, but power was limited by rare outcomes and shorter follow-up.These findings are hypothesis-generating and support further study of ocular outcomes after GDM, including studies with a non-GDM comparison group and longer follow-up.