Abstract
Purpose of Review
This article is a review of studies relating to glaucoma in pregnancy. It also examines medical, laser, and surgical options specific to the particular needs of this population.
Recent Findings
In general, there is limited data on management of glaucoma in pregnancy, and no guidelines for treatment have been established. In one recent case series, pregnant women exposed to glaucoma medications were found to have no difference in pregnancy or fetal/neonatal outcomes compared with a control group. There are no available data for the use of the newer intraocular pressure (IOP) lowering agents (latanoprostene bunod, netarsudil) in pregnant women. Recent case reports describe various surgical interventions to treat glaucoma in pregnancy.
Summary
Pregnant women with glaucoma must be monitored closely, and their treatment should include collaboration with their obstetrician. No predictions can be made regarding the course of their IOP or glaucoma. Management has to be determined on a case by case basis.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Gupta P, Zhao D, Guallar E, Ko F, Boland MV, Friedman DS. Prevalence of glaucoma in the United States: the 2005-2008 national health and nutrition examination survey. Invest Ophthalmol Vis Sc. 2016;57:2905–13.
Marx-Gross S, Laubert-Reh D, Schneider A, Höhn R, Mirshahi A, Münzel T, et al. The prevalence of glaucoma in young people. Dtsch Arztebl Int. 2017;114:204–10.
Budenz DL, Barton K, Whiteside-de Vos J, et al. Prevalence of glaucoma in an urban west African population: the Tema eye survey. JAMA Ophthalmol. 2013;13:651–8.
Salim S. Glaucoma in pregnancy. Curr Opin Ophthalmol. 2014;25(2):93–7.
Koren G, Bologa M, Long D, Feldman Y, Shear NH. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol. May 1989;160(5):1190–4.
Maternal–fetal toxicology: a clinicians guide. G. Koren (ed.) Marcel Dekker Inc., New York, 1990.
Nelson K, Holmes LB. Malformations due to presumed spontaneous mutations in newborn infants. N Engl J Med. 1989;320:19–23.
Rossen LM, Ahrens KA, Branum AM. Trends in risk of pregnancy loss among US women, 1990-2011. Pediatr Perinat Epidemiol. 2018;32:19–29.
Sunness JS. The pregnant woman’s eye. Surv Ophthalmol. 1988;32(4):219–38.
Razeghinejad MR, Tai TYT, Fudemberg SJ, Katz LJ. Pregnancy and glaucoma. Surv Ophthalmol. 2011;56(4):324–35.
Agrawal N, Agarwal LT, Lavaju P, Chaudhary SK. Physiological ocular changes in various trimesters of pregnancy. Nepal J Ophthalmol. 2018;10:16–22.
Efe YK, Ugurbas SC, Alpay A, Ugurbas SH. The course of corneal and intraocular pressure changes during pregnancy. Can J Ophthalmol. 2012;47:150–4.
Qureshi IA, Xi XR, Yaqob T. The ocular hypotensive effect of late pregnancy is higher in multigravidae than in primigravidae. Graefes Arch Clin Exp Ophthalmol. 2000;238:64–7.
Meshi A, Armarnik S, Mimouni S, et al. The effect of labor on the intraocular pressure in healthy women. J Glaucoma. 2017;26:59–64.
Qureshi IA. Intraocular pressure and pregnancy: a comparison between normal and ocular hypertensive subjects. Arch Med Res. 1997;28:397–400.
Brauner SC, Chen TC, Hutchinson BT, Chang MA, Pasquale LR, Grosskreutz CL. The course of glaucoma during pregnancy. Arch Ophthalmol. 2006;124:1089–94.
Mendez-Hernandez C, Garcia-Feijoo J, Saenz-Frances F, Santos-Bueso E, Martinez-de-la-Casa JM, Megias AV, et al. Topical intraocular pressure therapy effects on pregnancy. Clin Ophthalmol. 2012;6:1629–32.
Kearns PP, Dhillon BJ. Angle closure glaucoma precipitated by labour. Acta Ophthalmol. 1990;68(2):225–6.
Socha MW, Piotrowiak I, Jagielska I, Kazdepka-Ziemińska A, Szymański M, Duczmal M, et al. Retrospective analysis of ocular disorders and frequency of cesarean sections for ocular indications in 2000-2008 – our own experience. Ginekol Pol. 2010;81:188–91.
Mohammadi SF, Letafat-Nejad M, Ashrafi E, Delshad-Aghdam H. A survery of ophthalmologists and gynecologists regarding termination of pregnancy and choice of delivery mode in the presence of eye diseases. J Curr Ophthalmol. 2017;29:126–32.
Yankowitz J, Niebyl JR. Drug therapy in pregnancy. 3rd Ed. 2001.
Rubin PC, Ramsey M. Prescribing in pregnancy, 4th Ed. 2010.
. Strelow B, Fleischman D. Glaucoma in pregnancy. Curr Opin Ophthalmol. 2020;31(2):114–22 Very recent review; includes minimally invasive surgical considerations.
Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001;45(5):449–54.
Coppens G, Stalmans I, Zeyen T. Glaucoma medication during pregnancy and nursing. Bull Soc Belge Ophtalmol. 2010;314:33–6.
. Pellegrino M, D’Oria L, De Luca C et. al. Glaucoma drug therapy in pregnancy: literature review and teratology information service (TIS) case series. Curr Drug Saf. 2018;13(1):3-11. Large review of pregnant women exposed to topical glaucoma medications.
Ho JD, Hu C-C, Lin HC. Antiglaucoma medications during pregnancy and the risk of low birth weight: a population-based study. Br J Ophthalmol. 2009;93(10):1283–6.
DeSantis M, Lucchese A, Carducci B et. al. Latanoprost exposure in pregnancy. Am J Ophthalmol 2004;138(2):305–306.
Maris PJ Jr, Mandal AK, Netland PA. Medical therapy of pediatric glaucoma and glaucoma in pregnancy. Ophthalmol Clin N Am. 2005;18:461–8.
Worsham F Jr, Beckman EN, Mitchell EH. Sacrococcygeal teratoma in a neonate. Association with maternal use of acetazolamide. JAMA. 1978;240:251–2.
Lee AG, Pless M, Falardeau J, Capozzoli T, Wall M, Kardon RH. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. Am J Ophthalmol. 2005;139:855–9.
Kooner KS, Zimmerman TJ. Antiglaucoma therapy during pregnancy – part II. Ann Ophthalmol. 1988;20:208–11.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208254lbl.pdf
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/207795Orig1s000lbl.pdf
https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208259s000lbl.pdf
Park MH, Moon J. Selective laser trabeculoplasty in fertile women with open angle glaucoma or ocular hypertension. J Korean Ophthalmol Soc. 2007;48:1494–9.
Výborný P, Sičáková S, Flórová Z, Sováková I. Selective laser trabeculoplasty – implication for medicament glaucoma treatment interruption in pregnant and breastfeeding women. Cesk Slov Oftalmol. 2017;73:61–3.
Upadya M, Saneesh PJ. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth. 2016;60:234–41.
Bajwa SJS, Bajwa SK. Anaesthetic challenges and management during pregnancy: strategies revisited. Anesth Essays Res. 2013;7:160–7.
Razeghinejad MR, Masoumpour M, Eghbal MH, et al. Glaucoma surgery in pregnancy: a case series and literature review. Iran J Med Sci. 2016;41:437–45.
Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989;161:1178–85.
Banad NR, Choudhar N, Dikshit S, et al. Trabeculectomy in pregnancy: case studies and literature review. Indian J Ophthalmol. 2020;68:420–6.
Zehavi-Dorin T, Heinecke E, Nadkarni S, Green C, Chen C, Kong YXG. Bilateral consecutive Xen gel stent surgery during pregnancy for uncontrolled early-onset primary open angle glaucoma. Am J Ophthalmol Case Rep. 2019 Jul 11;15:100510.
Ex-PRESS mini-shunt implantation in a pregnant patient with iridocorneal endothelial syndrome. Eur J Ophthalmol 2020;30:NP25–NP28
Wertheim M, Broadway DC. Cyclodiode laser therapy to control intraocular pressure during pregnancy. Br J Ophthalmic. 2002 Nov;86(11):1318–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Diagnosis and Monitoring of Glaucoma
Rights and permissions
About this article
Cite this article
Pickering, TD., Radhakrishnan, S. Glaucoma and Pregnancy. Curr Ophthalmol Rep 8, 152–158 (2020). https://doi.org/10.1007/s40135-020-00239-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40135-020-00239-9