Background:

Maternal perinatal diseases often present with a prodrome of ocular manifestations. While eyesight changes are common and often benign in pregnancy, they may sometimes be the earliest sign of an underlying problem. Preeclampsia is a pregnancy disorder characterized by hypertension and proteinuria. Eclampsia describes the presence of seizures in a person with preeclampsia. According to the CDC, the hypertensive disorder, preeclampsia/eclampsia, accounts for 6.6% of maternal deaths in America [1]. It is also a risk factor for fetal complications such as preterm labor, growth restriction, and stillbirth [2]. Earlier diagnosis of preeclampsia could greatly improve both maternal and fetal health. Optical coherence tomography angiography provides a simple, non-invasive way to potentially screen subclinical signs of preeclampsia and other disorders in mothers.

Methods:

This is a retroscpective study on Subjects who meet the eligibility criteria  from the Obstetrics and Maternal Fetal Medicine unit between August 2017 and December 2018. 

Optical coherence tomography images were captured without pharmacologic dilation using the spectral-domain OCTA device. 304 × 304 A scans were taken centered on the fovea. Images with poor quality were excluded. Measures were focused on Foveal Avascular Zone, vascular and perfusion density in the superficial retinal capillary plexus (SCP), vascular and perfusion density in the deep retinal capillary plexus, and the choriocapillaris.  Optical coherence tomography angiography (OCTA) provides photos of individual retinal capillary plexuses allowing for analysis of the perfusion of different levels of the fovea. As such it offers a 3D representation of the vasculature of the eye. OCTA is also non-invasive and safe for use in pregnancies given the lack of dye.

The study is approved by the Institutional Review Board of the University of California-Los Angeles and will adhere to the tenets set forth in the Declaration of Helsinki.

Results:

A total of 82 mothers and 85 infant charts were studied. Mothers with pregnancy complications, high pre-pregnancy BMI (>25), or high maximum prenatal blood pressures showed no significant differences in the deep capillary plexus when compared to healthy pregnant women. There were significant differences in deep capillary plexus between women with significant PMH and women without. A more in-depth analysis of the patients past medical history is needed before ascertaining the extent in which this data will be predictive.

Conclusion

The use of Optical Coherence Tomography Angiography could help in early detection of hypertensive disorders and other illnesses in high risk pregnancies. This simple non invasive eye exam could help preduct the risk of developing pregnancy and fetal complications.