Hypertensive retinopathy in pre-eclampsia and its association with disease severity and neonatal outcomes: A retrospective cohort study

Introduction: Pre-eclampsia (PE) involves systemic endothelial dysfunction and microvascular injury, yet routine obstetric care lacks noninvasive readouts of maternal microvascular health. We evaluated whether hypertensive retinopathy (HR) detected during pregnancy is associated with maternal disease severity and adverse neonatal outcomes. Methods: We performed a retrospective cohort study of singleton pregnancies with PE and at least one ophthalmic assessment during pregnancy. Retinal findings were graded as none, mild, moderate, or severe. Primary outcomes were maternal composite adverse outcome (severe features, HELLP syndrome, eclampsia, admission to intensive care unit) and neonatal composite adverse outcome (indicated delivery <34 weeks, small for gestational below the third percentile, admission to neonatal intensive care unit). Multivariable models adjusted for maternal confounders were performed. Results: Of 584 patients with PE with analyzable data, 182 (31.2%) had any HR (mild 20.4%, moderate 9.8%, severe 1.0%). HR was independently associated with maternal composite adverse outcome (adjusted odds ratio [aOR], 2.21 [95% CI, 1.45–3.36]) and neonatal composite adverse outcome (aOR, 2.40 [95% confidence interval (CI), 1.60–3.60]). HR was linked to earlier delivery (adjusted mean difference, −1.17 weeks) and lower birthweight z score (adjusted β, −0.34). Each one-grade increase in HR was associated with higher odds of both primary outcomes (maternal composite outcome aOR, 1.45 [95% CI, 1.10–1.90]; neonatal composite outcome aOR, 1.53 [95% CI, 1.17–1.99]). Conclusions: In women with PE, HR is common and independently associated with maternal and neonatal adverse outcomes.