Evaluation of Hypertensive Disorder of Pregnancy and High Refractive Error in Offspring During Childhood and Adolescence

Abstract

ImportanceGrowing evidence indicates that 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.ObjectiveTo investigate the association between maternal HDP and overall and type-specific high REs in offspring in childhood and adolescence.Design, Setting, and ParticipantsThis 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.ExposuresMaternal HDP (n = 104 952), including preeclampsia or eclampsia (n = 70 465) and hypertension (n = 34 487).Main Outcomes and MeasuresThe 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.ResultsThis 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 (1.12%; 95% CI, 1.05%-1.19%) than in the unexposed cohort (0.80%; 95% CI, 0.78%-0.81%) at 18 years of age (difference: 0.32%; 95% CI, 0.25%-0.40%). Offspring born to mothers with HDP had a 39% increased risk of overall high RE (hazard ratio [HR], 1.39; 95% CI, 1.31-1.49). Sibling-matched analysis revealed an increased risk of overall high RE in half siblings (HR, 1.21; 95% CI, 1.05-1.39) and full siblings (HR, 1.15; 95% CI, 0.99-1.34), but the difference was not significant for the latter. The elevated risks were observed for 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). The increased risk of high RE persisted among offspring aged 0 to 6 years (HR, 1.51, 95% CI, 1.38-1.65), 7 to 12 years (HR, 1.28; 95% CI, 1.11-1.47), and 13 to 18 years (HR, 1.16; 95% CI, 0.95-1.41), 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 (HR, 2.59; 95% CI, 2.17-3.08).Conclusions and RelevanceIn 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.

Analysis of factors related to the development of ocular biometric parameters in Chinese children aged 6–10 years: a cross-sectional study

“…In addition to factors commonly associated with myopia in the literature, such as outdoor activities, 15 16 we also included less frequently reported factors, such as preterm birth, maternal gestational hypertension, maternal gestational diabetes mellitus, history of incubator treatment in infancy and history of blue light therapy in infancy. 17 18 In contrast to the findings of previous studies, 19 we found that maternal gestational hypertension (OR=0.148) was a protective factor against myopia. Li et al 19 found that hypertensive disorders during pregnancy, especially early-onset and severe pre-eclampsia, were associated with an increased risk of high refractive errors in children during childhood and adolescence.…”

“… 17 18 In contrast to the findings of previous studies, 19 we found that maternal gestational hypertension (OR=0.148) was a protective factor against myopia. Li et al 19 found that hypertensive disorders during pregnancy, especially early-onset and severe pre-eclampsia, were associated with an increased risk of high refractive errors in children during childhood and adolescence. This may be related to the changes in circulating antiangiogenic factors caused by gestational hypertension 20 21 and the effects of excessive oxidative stress and inflammation on refractive development.…”

“…Nevertheless, the relationship between pregnancy-induced hypertension and high myopia in children merits further attention. 19 However, pregnancy-induced hypertension did not influence ocular biometric parameters. These findings indicate that hypoxia caused by hypertension leads to the abnormal development of other fetal ocular structures, such as the retina, 17 25 and thus indirectly affects the risk of myopia rather than directly affecting the AL, ACD or CCT.…”