Pregnancy Could Worsen Progression of Retinitis Pigmentosa

The progression of retinitis pigmentosa (RP) could be associated with pregnancy, according to a study published in the American Journal of Ophthalmology.¹ Women who had given birth to children had a higher risk of reaching a visual acuity below 6/24 when compared with women without children.

Pregnancy can affect women in numerous ways, including through ocular changes and complications. These can include changes in corneal thickness, intraocular pressure, and gestational hypertension-related retinopathy as well as affecting preexisting ocular conditions like diabetic retinopathy.² RP is an eye condition characterized by peripheral field constriction and night blindness, with most women who are diagnosed with the condition diagnosed during working and fertile ages. This study aimed to assess whether the progression of RP would worsen during pregnancy.

This study enrolled women from the Moorfields Eye Hospital in London, UK, to conduct the research. All women were aged 30 years or older at their most recent visit, had had children in the past, had an inherited retinal disorder, and had a biallelic rare or likely disease-causing variants in USH2A, the most common gene to cause both RP and Usher syndrome (USH). The database at Moorfields Eye Hospital included all patients who attended the hospital between 1950 and 2024.

Pregnant women could experience progression of retinitis pigmentosa among other ocular conditions | Image credit: Phanphen - stock.adobe.com

All patient data were taken from the electronic health care record. Best corrected visual acuity (BCVA) was measured and converted to LogMAR. BCVA was separated into 4 categories based on LogMAR: 0.2 or higher, 0.3 or higher, 0.7 or higher, and greater than 0.7. Age at registration into the national visual impairment registry was also collected.

There were 142 women included in this study, of which 69% were parous and 31% were nulliparous. The parous group had 53% who had isolated RP and 47% who had USH. The group had a mean (SD) age of 41.7 (13.6) years at baseline and 54 (13.2) years at the most recent visit. The nulliparous group had 54% of patients with isolated RP and 46% who had USH, with an age at baseline of 38.4 (14) years and the age at the most recent visit being 52.7 (13.9) years.

A Cox regression model found that women who had children were 2.74 times more likely to have a BCVA that was worse than LogMAR 0.7 when compared with women who had never had children (95% CI, 1.13-6.65). This risk remained statistically significant at 3.04 (95% CI, 1.23-7.48) times more likely of having a worse BCVA after adjustment. Parous women had 1.64 times the risk of having a BCVA worse or equal to LogMAR 0.7 (95% CI, 0.94-2.85). There were no significant differences found between parous and nulliparous women when it came to their ellipsoid zone width.

There were some limitations to this study. This study had a real-world, retrospective design, which could have introduced confounding effects that were not considered. Vision impairment could have been reported elsewhere in the UK and been missed in the medical records of the hospital. Socioeconomic status and ethnicity were not collected.

The researchers concluded that women who had previously been pregnant had a higher risk of RP if they had RP and USH associated with USH2A. This result, although needing further research, can provide insights for women with these conditions who plan to start a family and allows them to make proper preparations.

References

1. Varela MD, Rashid M, Lopes A, Michaelides M. The effects of pregnancy on disease progression of retinitis pigmentosa. Am J Ophthalmol. Published online November 28, 2024. doi:10.1016/j.ajo.2024.11.016
2. Ataei Y, Randolph J. Ocular changes in pregnancy. January 1, 2022. Accessed December 3, 2024. https://www.aao.org/eyenet/article/ocular-changes-in-pregnancy