Pregnancy may bring about persistent changes to the eye
Key takeaways:
- Pathological changes to the eye can take weeks or months to resolve.
- Eye care clinicians should educate patients about the need for care before, during and after pregnancy.
Hormonal changes can cause physiological and pathological changes in the eye, and eye care providers should monitor pregnant patients well past delivery, according to a literature review published in Clinical and Experimental Optometry.
To explore pregnancy-related effects on the eye, as well as on vision, that could present in routine eye care, Bao N. Nguyen, BOptom, PhD, senior researcher in optometry and vision sciences at the University of Melbourne, and colleagues searched several databases for relevant articles published since 1993 that included pregnancy and at least one of a variety of ocular keywords.
“What is particularly important for routine pregnancy eye care is knowledge of the timing of uncomplicated pregnancy-related changes, ie, when they occur during the gestational period, including at which trimesters the changes are observed, when they might peak and whether changes are short-lived or might extend past pregnancy,” the authors wrote.
Nguyen and colleagues noted that hormones produced during pregnancy can play an important role in modulating different functions in the eye, including ocular surface homeostasis, tear production and cell and nerve regeneration.
In their review, the authors found that relaxin and human chorionic gonadotropin peaked in the first trimester, whereas estrogen, progesterone, prolactin and oxytocin peaked in the third trimester.
They also found that patients experienced onset of melasma and larger choroidal luminal area in the first trimester, followed by increased corneal thickness and curvature, reduced IOP and increased incidence of central serous chorioretinopathy in the second trimester, as well as worsening of diabetic retinopathy for those with preexisting diabetes. In the third trimester, patients experienced increased retinal thickness, increased choroidal thickness and increased prevalence of dry eye disease with gestational age.
Nguyen and colleagues wrote that most physiological changes to the eye usually resolve in the post-partum period. However, pathological changes that are new-onset or worsen during pregnancy vary in timing and duration and can last weeks or months after pregnancy.
“There is scope for primary eye care clinicians to systematically follow women in the post-partum period, well past the typical timeframe of maternal systemic health follow-up, considering that some effects on the eye are reportedly still present years after the end of pregnancy,” the authors wrote. “Currently or previously pregnant women (or those planning to become pregnant) and other health professionals should be educated about the importance of seeking eye care before, during and after pregnancy.”
Perspective
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This study examined the physiological and pathological ocular changes that occur during and after pregnancy, providing invaluable insights for eye care practitioners. According to the study, several ocular changes, including melasma, dry eye disease, unstable refractive error and decreased IOP, occur during pregnancy, with the majority of these changes occurring within the second and third trimesters.
This highlights the need for primary eye care practitioners to regularly screen and monitor pregnant women for these changes, both during and after pregnancy. This will ensure that appropriate education, health sensitization, advice and reassurance about any potential ocular changes are provided to the patients and other health care professionals involved in their care.
Although many pregnancy-associated changes are temporary and resolve postpartum, the exact duration for these changes to fully regress after pregnancy remains unclear. Therefore, future longitudinal studies should be conducted to monitor these changes over time to better understand their timelines. Being aware of the ocular implications of pregnancy will enable eye care professionals to provide comprehensive care to this group of patients.
It was also observed that the study did not explore ocular changes in cases of pregnancy loss (miscarriage or termination), which limits its applicability in that context.
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