Hypertension Disorder of Pregnancy May Affect Refractive Outcomes in Offspring

Hypertension disorder of pregnancy may increase the risk of high refractive error among children born to women with the disorder, according to a study published in JAMA Network Open.

Researchers included data from 2,537,421 individuals (51.30% boys and men) born between 1978 and 2018 in the population-based cohort study and examined the incidence of high refractive error among participants born to mothers with hypertension disorder of pregnancy (n=104,952) and control group individuals who were born to mothers without the condition (n=2,432,469). Among participants born to mothers with hypertension disorder of pregnancy, a total of 70,465 were born to mothers with eclampsia or preeclampsia compared with 34,487 who were born to mothers with hypertension.

Offspring born to mothers with hypertension disorder of pregnancy had a higher incidence of high refractive error compared with the control group participants (1.12% vs 0.80%), according to the report. Stratified according to disorder, children exposed to hemolysis, elevated liver enzyme level, and low platelet count (HELLP) syndrome (1.55 per 1000 person years) and severe preeclampsia (1.02 per 1000 person years) experienced the greatest risk for developing high refractive error. Compared with the control group, the risk for high refractive error was associated with HELLP (adjusted hazard ratio [aHR], 2.15), severe preeclampsia (aHR, 1.89), unspecified hypertension disorder of pregnancy (aHR, 1.74), preeclampsia (aHR, 1.44), and moderate preeclampsia (aHR, 1.27). Birth to mothers with gestational (aHR, 1.32) or pregestational (aHR, 1.29) hypertension also increased the risk of high refractive error.

Stratified according to refractive error, maternal hypertension disorder of pregnancy was associated with an increased risk of hypermetropia (aHR, 1.41), myopia (aHR, 1.30) astigmatism (aHR, 1.45) or other refractive errors (aHR, 1.60) compared with not having the disorder.

“We observed that early-onset and severe maternal preeclampsia was associated with a higher risk of high [refractive error] in childhood and adolescence,” according to the study authors. “These findings suggest that offspring exposed to early-onset and severe
preeclampsia should be given intense attention to ophthalmic and especially refractive
examinations.”

Study limitations include an inability to examine the role of confounders and the exclusion of data from individuals with less severe refractive errors from the national registry.