Maternal hypertensive disorders of pregnancy tied to risk for ocular issues in offspring

Key takeaways:

• Children born to mothers with a hypertensive disorder of pregnancy had higher risk for all forms of strabismus.
• Risk was higher when mothers also had poorly controlled blood pressure.

Maternal hypertensive disorders of pregnancy are associated with increased risk for overall and type-specific strabismus, including exophoria and intermittent exotropia, in offspring at age 3 years, researchers reported.

“Growing evidence has shown that maternal hypertensive disorders of pregnancy [HDP] might be related to ocular abnormalities and diseases in offspring, including narrower retinal microvasculature, thinner retina, larger optic cup, refractive error, retinopathy of prematurity and amblyopia,” Hui Zhu, PhD, with the department of ophthalmology at The First Affiliated Hospital with Nanjing Medical University in Nanjing, China, and colleagues wrote in JAMA Network Open. “Some studies have explored the association of maternal HDP with offspring strabismus, but the findings were preliminary and inconsistent.”

For the cohort study, researchers analyzed data from 3,117 children (52.3% boys) who underwent ocular exams at age 3 years. The mothers and offspring were participants in the Jiangsu Birth Cohort, a subset of the China National Birth Cohort Study that assesses the influence of perinatal and early life exposures on child health.

The primary outcome was incidence of strabismus in offspring.

Within the cohort, 4.6% of children were exposed to an HDP and 11.8% had strabismus.

Compared with offspring not exposed to an HDP, those who were exposed were 82% more likely to develop overall strabismus (RR = 1.82; 95% CI, 1.21-2.74), 82% more likely to develop exophoria (RR = 1.82; 95% CI, 1.11-3), and 136% more likely to develop intermittent exotropia (RR = 2.36; 95% CI, 1.13-4.93).

In analyses stratified by HDP type, risk for strabismus was increased for offspring exposed to preeclampsia (RR = 2.38; 95% CI, 1.39-4.09) compared with unexposed offspring.

Additionally, risk for all strabismus was high for offspring born to mothers with an HDP with poorly controlled blood pressure (RR = 2.07; 95% CI, 1.32-3.24), compared with unexposed offspring.

The researchers noted that a maternal HDP might increase risk for strabismus by damaging binocular vision through several mechanisms, including placental hypoxia that could lead to permanent structural changes in the fetal brain, or via increased inflammation and exaggerated oxidative stress in fetal circulation, which may damage fetal neurons.

“Offspring born to mothers with an HDP might be recommended for early screening of strabismus, especially those with maternal preeclampsia or poorly controlled BP,” the researchers wrote. “The underlying mechanism of the association between maternal HDPs and strabismus in offspring warrants further exploration.”