Correlation between maternal preeclampsia and severe retinopathy of prematurity

Maternal preeclampsia is a frequent cause of premature birth. Retinopathy of prematurity (ROP) remains one of the leading causes of preventable childhood blindness, which occurs frequently in middle-income countries where improvements in the perinatal care have increased survival rates of very low birth weight (VLBW) infants. In the past, the uncontrolled use of oxygen therapy accounted for most cases of ROP. More recently, the most important risk factors for ROP have become low birth weight and short gestational age.
While many studies have evaluated postnatal factors that contribute to ROP, the role of antenatal or maternal risk factors has been poorly investigated. Gotsch et al reported an antiangiogenic state in patients with preeclampsia resulting from changes in the concentrations of circulating angiogenic factors. Because ROP is a vasoproliferative disease, an antiangiogenic state in mothers with preeclampsia might protect the infant from ROP. However, the association between preeclampsia and ROP has never been assessed up to date.
A Brazilian group has conducted a prospective cohort study to evaluate maternal and perinatal factors for their association with the development of any stage and severe ROP, and to verify whether these factors are independent from birth weight and gestational age.
In total, 324 preterm neonates with birth weight ?1500 g and gestational age ?32 weeks were evaluated. Multiple maternal and perinatal factors were analyzed for association and confounding by multiple logistic regression analysis.
The mean birth weight of enrolled infants was 1128±240 g, and the mean gestational age was 29.7±1.9 weeks. Twenty four newborns (7.4%) presented severe ROP; 97 (29.9%) had ROP of any stage, and 227 (70.1%) had no ROP. Multivariable statistical analysis showed that low gestational age and blood transfusion are significant risk factors for any stage of ROP, whereas preeclampsia and complete antenatal steroid treatment course reduced the risk by 60% and 54%, respectively. Preeclampsia reduced the risk for severe ROP by 80%, whereas being small for gestational age (SGA) increased this risk by 437% The ROP rate reported in this study is low, even for countries with established standards of excellence in perinatal care. Complete antenatal steroid treatment and maternal preeclampsia were protective factors for any stage of ROP, and maternal preeclampsia was the only significant protective factor for severe ROP needing treatment in VLBW infants. In line with previous findings, SGA was not independently associated with development of any stage of ROP but we found an association with severe ROP. The results of this study are in agreement with other studies suggesting that low gestational age and birth weight are the most important risk factors for ROP. In addition, they also provide information about antenatal risk factors associated with ROP pointing to the protective role of preeclampsia and antenatal steroid treatment from any stage ROP.

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