Children of Mothers With HDP Have Greater Risk of Overall, Specific High Refractive Error

Children of mothers with hypertensive disorder of pregnancy (HDP) should be screened early and regularly for refractive error (RE), suggest study findings published in JAMA Network Open.

The Danish study of nationwide registries estimated a 39% greater risk of high RE among children of mothers with HDP, a complication that affects 5% to 10% of pregnancies. This includes overall risk, as well as specific risks for hyperopia, myopia, and astigmatism.

The study adds to existing data pointing to HDP being associated with short- and long-term consequences in pregnant women and their children.

“Previous studies reported that maternal HDP may be associated with abnormal visual development and eye disease in offspring. A case-control study with 77 children showed that mothers of children with congenital myopia were more likely to have hypertension during pregnancy,” detailed the researchers. “However, whether or to what extent prenatal exposure to maternal HDP is associated with increased risk of overall high RE and specific types of RE, including myopia, hyperopia, and astigmatism, in offspring in childhood and adolescence remains unknown.”

Data from over 2 million children born over 4 decades showed that 0.90% of the 900 children of mothers with HDP and 0.64% of the 2.4 million children of mothers without HDP received a diagnosis of high RE throughout 18 years of follow-up.

The increased risk of high RE was highest among children of mothers with early-onset and severe preeclampsia (HR, 2.59; 95% CI, 2.17-3.08), and the risk spanned across age groups between birth and 12 years. The researchers observed an HR of 1.51 (95% CI, 1.38-1.65) among patients aged 0 to 6 years and an HR of 1.28 (95% CI, 1.11-1.47) among patients aged 7 to 12 years. While there was an increased risk observed among patients aged 13 to 18 years (HR, 1.16; 95% CI, 0.95-1.41), the difference was not significant.

The researchers cited several possibilities for their findings, including changes in serum levels of circulation antiangiogenic factors among women with HDP, which may have an impact on ocular microvascular structure and ocular blood flow in their children. They also noted that HDP can cause excessive oxidative stress and inflammation throughout pregnancy, subsequently impacting various organ systems. Preeclamptic pregnancy also increases the risk of preterm birth, which carries a higher risk of RE due to placental dysfunction.

“In addition, risk of myopia was slightly greater among offspring aged 7 to 12 years, which may be due to the accompanying academic burden and worse eye habits,” wrote the researchers. “It is important to note that maternal HDP was associated with increased risk of all types of RE in offspring in our study, although the HRs were slightly different among different subtypes,” the study authors wrote. “This suggests that maternal HDP may be associated with short- and long-term abnormal refractive regulation through adverse intrauterine environment and with increased risk of high RE from birth to adolescence.”

The researchers also performed a sibling-matched analysis, which showed a significant increased risk of overall high RE in half siblings (HR, 1.21; 95% CI, 1.05-1.39) and an increased, but nonsignificant increase in full siblings (HR, 1.15; 95% CI, 0.99-1.34). Increased risk was seen among hypermetropia (HR, 1.41; 95% CI, 1.30-1.52), myopia (HR, 1.30; 95% CI, 1.10-1.53), and astigmatism (HR, 1.45; 95% CI, 1.22-1.71).

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