Kids Exposed to Hypertensive Disease of Pregnancy More Liable to Develop High Refractive Error

A new study published in the JAMA Network Open suggests that growing evidence indicates adverse prenatal or intrauterine environments might contribute to the development of high refractive error (RE) later in life. However, the association of maternal hypertensive disorder of pregnancy (HDP) with high RE in offspring during childhood and adolescence remains unknown.

Study Overview

A study was conducted to investigate the association between maternal HDP and overall and type-specific high REs in offspring during childhood and adolescence. This nationwide population-based cohort study included live-born individuals born in Denmark from 1978 to 2018 in the Danish national health registers. Follow-up started at the date of birth and ended at the date of RE diagnosis, 18th birthday, death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 12, 2021, through June 30, 2022.

Maternal HDP (n = 104,952), including preeclampsia or eclampsia (n = 70,465) and hypertension (n = 34,487). The main outcomes were the first occurrence of high RE (hyperopia, myopia, and astigmatism) in offspring. A Cox proportional hazards regression model was used to examine the association between maternal HDP and risk of high RE in offspring from birth until age 18 years, adjusting for multiple potential confounders.

Results

• This study included 2,537,421 live-born individuals, 51.30% of whom were male. During the follow-up of up to 18 years, 946 offspring of 104,952 mothers with HDP (0.90%) and 15,559 offspring of 2,432,469 mothers without HDP (0.64%) were diagnosed with high RE.
• The cumulative incidence of high RE was higher in the exposed cohort than in the unexposed cohort at 18 years of age.
• Offspring born to mothers with HDP had a 39% increased risk of overall high RE. Sibling-matched analysis revealed an increased risk of overall high RE in half siblings and full siblings, but the difference was not significant for the latter.
• The elevated risks were observed for hypermetropia, myopia, and astigmatism.
• The increased risk of high RE persisted among offspring aged 0 to 6 years, 7 to 12 years, and 13 to 18 years, but the difference was not significant for the oldest group.
• When considering both timing of diagnosis and severity of maternal preeclampsia, the highest risk was observed in offspring prenatally exposed to early-onset and severe preeclampsia.

In this cohort study of the Danish population, maternal HDP, especially early-onset and severe preeclampsia, was associated with an increased risk of high RE in offspring during childhood and adolescence. These findings suggest that early and regular RE screening should be recommended for children of mothers with HDP.

Reference

Li M, Huang C, Yang W, et al. Evaluation of Hypertensive Disorder of Pregnancy and High Refractive Error in Offspring During Childhood and Adolescence. JAMA Netw Open. 2023;6(4):e238694. doi:10.1001/jamanetworkopen.2023.8694