Hypertensive Disorders of Pregnancy and the Long-Term Risk of Maternal Retinal and Ophthalmic Disease: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with increased long-term risk of maternal cardio-metabolic disease, but links with future retinal diseases remain unclear. OBJECTIVE The objective of this study is to synthesise the published literature on HDP and subsequent retinal and other ophthalmic disease. SEARCH STRATEGY Databases including PubMed, Embase, Web of Science, and Cochrane Library were searched to March 2026 following a pre-registered PROSPERO protocol, CRD42024589508. SELECTION CRITERIA These included: a population of parous women, exposure to HDP at least once, at least one primary outcome (retinal disease) or secondary outcome (other ophthalmic disease). Women with pre-pregnancy retinal/ophthalmic diseases were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently screened studies, extracted data, and assessed bias using an adapted Newcastle-Ottawa tool. Random-effects meta-analyses were performed. RESULTS Of 5673 studies retrieved, 13 were eligible for inclusion (2 450 072 participants). HDP was associated with increased risk of diabetic retinopathy (aRR 3.54, 95% CI 2.19-5.74), particularly after preeclampsia (aRR 4.24, 95% CI 3.51-5.12). HDP-exposed women were also at higher risk of non-diabetic retinopathy (aRR 3.65, 95% CI 1.18-11.33), retinal detachment (aRR 1.54, 95% CI 1.28-1.86), and retinal vascular occlusion (aRR 2.09, 95% CI 1.55-2.81). HDP-exposed women may also be at risk of hypertensive retinopathy and central serous chorioretinopathy, but aRRs did not reach statistical significance. Across individual studies, HDP-exposed women were reported to be at increased risk of cataract extraction, non-infectious uveitis, and choroidal neovascular age-related macular degeneration. CONCLUSION Women who experience HDP may be at future risk of retinal and other ophthalmic diseases, particularly diabetic retinopathy. Further observational research is required to confirm these associations.