There is an association between maternal hypertensive disorder in pregnancy (HDP) and strabismus in offspring, according to a recent study published in JAMA Network Open.1
Takeaways
- Children born to mothers with hypertensive disorders in pregnancy have an 82% higher risk of developing strabismus.
- Among children with strabismus, 8.5% had latent strabismus, and 3.3% had manifest strabismus, with exophoria and intermittent exotropia being the most common forms.
- Exposure to preeclampsia doubled the risk of strabismus, especially exophoria, in offspring.
- Poorly controlled blood pressure in mothers with hypertensive disorders further increased the risk of strabismus and specific subtypes such as exophoria and intermittent exotropia in children.
- Early screening for strabismus is recommended for children born to mothers with hypertensive disorders during pregnancy to allow for timely intervention.
Strabismus, which is linked to amblyopia, psychological issues, and impaired appearance, is among the most common ocular disorders in children, with a range of 4% to 58.3% for latent strabismus and 0.8% to 5.7% for manifest strabismus. Additional data is needed to determine the etiology and pathogenesis of childhood strabismus.
Approximately 5% to 10% of pregnancies worldwide are impacted by HDP, which often causes aberrant fetal growth and intrauterine oxidative stress. The rate of HDP has also grown over time.2
In 2010, gestational diabetes had a rate of 0.7%, chronic hypertension a rate of 1.2%, and overall HDPs 4.4%. These rates were 1.1%, 2.7%, and 9.4%, respectively, in 2021.
Data has also indicated a potential link between maternal HDP and ocular abnormalities in offspring, indicating a need to evaluate the association with strabismus.1 To evaluate the association between maternal HDP and strabismus, investigators conducted a prospective birth cohort study.
Participants included women in the first trimester of pregnancy following spontaneous conception or assisted reproductive technology (ART) use. Eligibility criteria for offspring included singleton or twin live birth, available maternal HDP diagnosis data, and undergoing ocular examinations at 33 to 39 months of age.1
Births from April 24, 2014, to November 30, 2018, were included in the analysis. Electronic medical records were assessed for exposure data, which included HDP, blood pressure (BP) during labor, and diabetes in pregnancy (DIB). Maternal HDP subtypes included hypertension, preeclampsia, well-controlled BP, and poorly-controlled BP.
Ocular alignment was evaluated using the Hirschberg light reflex test followed by a cover-uncover test and alternate cover test. Investigators defined strabismus as, “the presence of any latent or manifest ocular deviation.” Maternal covariates included age, prepregnancy body mass index (BMI), parity, smoking or alcohol consumption, educational level, and residence.
There were 3117 children included in the final analysis, aged a mean 36.30 months. Mothers were aged a mean 30.40 years and had a mean prepregnancy BMI of 21.38. Maternal HDP was reported in 143 mothers, with 78 having maternal hypertension and 65 having maternal preeclampsia. BP was well controlled in 33, poorly controlled in 103, and unknown in 7.1
Strabismus was reported in 11.8% of children, with 8.5% having latent strabismus and 3.3% having manifest strabismus. Exophoria was reported in 98.1% of children with latent strabismus while esophoria was reported in 1.9%. Intermittent exotropia was reported in 92.2% of children with manifest strabismus, constant exotropia in 3.9%, intermittent esotropia in 1%, and constant esotropia in 2.9%.
The risk of overall strabismus was increased by 82% in offspring exposed to HDP vs unexposed offspring, with a relative risk (RR) of 1.82. For exophoria and intermittent exotropia, the RRs were 1.82 and 2.36, respectively.1
Preeclampsia exposure was also associated with all strabismus, with an RR of 2.38. Additionally, exophoria had an RR of 2.68, indicating an association. However, the association for intermittent exotropia was non-significant at 2.51.
Offspring to mothers with HDP and poorly controlled BP had an increased risk, with an RR of 2.07 for strabismus, 2.13 for exophoria, and 2.61 for intermittent exotropia. DIP was not associated with strabismus.
These results indicated an association between maternal HDP and strabismus risk. Investigators recommended early strabismus screening in offspring born to mothers with HDP.1
Reference
- Zhu H, You X, Jing Y, et al. Maternal hypertensive disorder in pregnancy and childhood strabismus in offspring. JAMA Netw Open. 2024;7(7):e2423946. doi:10.1001/jamanetworkopen.2024.23946
- Krewson C. Rising prevalence of hypertensive disorders of pregnancy reported. June 10, 2024. Accessed July 29, 2024. https://www.contemporaryobgyn.net/view/rising-prevalence-of-hypertensive-disorders-of-pregnancy-reported
