Limited Independent Impact of Maternal Age on Early Childhood Ophthalmic Morbidity: A Nationwide Population-Based Cohort Study.

Abstract

To evaluate the independent effect of advanced maternal age (AMA) on pediatric ophthalmic morbidity, invasive interventions, and healthcare costs. Nationwide, population-based cohort study PARTICIPANTS: A total of 2,500,044 mother-infant pairs from a national health insurance database, followed from birth to 5 years of age. A health-screening subgroup of 365,494 pairs with detailed maternal metabolic and lifestyle data was analyzed to control for potential confounding. Mother-infant pairs were categorized by maternal age (<35 vs ≥ 35 years) and birth status (term/normal birth weight [NBW] vs preterm or low birth weight [LBW]). Cox proportional hazards models and Poisson or negative binomial regression models were used to estimate adjusted hazard ratios (HRs) and incidence rate ratios (IRRs) for ophthalmic outcomes, invasive procedures, and healthcare utilization. Models were sequentially adjusted for neonatal factors, socioeconomic status, maternal comorbidities, and maternal metabolic and lifestyle variables. Composite ophthalmic morbidity (amblyopia, strabismus, congenital cataract), retinopathy of prematurity (ROP), invasive ophthalmic procedures, ophthalmic outpatient visits, hospitalizations, and ophthalmology-related healthcare costs. Among Term/NBW infants, older maternal age was associated with a lower risk of composite ophthalmic morbidity (adjusted HR, 0.93; 95% CI, 0.92-0.94), primarily driven by a reduced hazard of strabismus. However, this did not translate into reductions in invasive procedures or hospitalization rates. In contrast, Preterm/LBW status was the primary driver of all ophthalmic risks (HRs 1.52-1.81) and procedures (IRRs 1.84-2.00) regardless of maternal age. Among term/NBW infants, higher ROP diagnosis rates observed in the AMA group (adjusted HR 1.331; 95% CI, 1.211-1.450) were not accompanied by increased ROP-related invasive treatment. Apparent differences in ophthalmology-related healthcare costs across maternal age groups were attenuated and no longer significant after adjustment for maternal metabolic health. Advanced maternal age is not an independent biological determinant of early pediatric ophthalmic disease or treatment-requiring morbidity. In the absence of prematurity or low birth weight, children born to older mothers are not at increased risk of early ophthalmic disorders. These findings provide evidence-based reassurance for older mothers and support counseling that emphasizes perinatal health status rather than maternal age itself.