PROGRESSION, TREATMENT, AND OUTCOMES OF RETINAL VASCULAR DISEASES IN PREGNANCY

Abstract

Purpose: To describe patient characteristics, treatment, and pregnancy outcomes in at-risk patients with retinal vascular diseases occurring during pregnancy. Methods: This is a retrospective observational study of pregnant patients seen by a retina specialist or by any ophthalmologist who coded a retinal vascular disease or precursor as the visit diagnosis, at four tertiary care centers. Outcome measures include prevalence of retinal vascular diseases, progression of diabetic retinopathy, treatment of diabetic retinopathy, and adverse pregnancy outcomes. Results: Two hundred nine pregnancies from 176 patients met inclusion criteria. Retinal vascular disease was confirmed in 35% (73 of 209) of pregnancies. Of these, 73% (53) were complicated by diabetic retinopathy, 14% (10) by central serous chorioretinopathy, 11% (8) by hypertensive retinopathy, and 5% (4) by retinal vein occlusion. Twenty-eight percent (16 of 58) of patients with diabetic retinopathy required ophthalmologic treatment during pregnancy or postpartum. Rates of preterm birth (54% vs. 25%, P = 0.0004) and C-section delivery (78% vs. 48%, P = 0.0004) were significantly higher in patients with a retinal vascular disease. Conclusion: Retinal vascular disease was seen in more than one-third of the at-risk pregnancies in this sample and may represent an important obstetric risk factor, as rates of certain adverse pregnancy outcomes were significantly higher in these patients.