Purpose of Review This review provides a comprehensive and systematic analysis of the impact of pregnancy on ocular health, with a particular focus on the interplay between physiological adaptations and pathological complications driven by hormonal, metabolic, and vascular changes. Given the substantial alterations in endocrine and circulatory function during gestation, pregnancy exerts profound effects on various ocular structures, necessitating a deeper understanding of both transient and potentially permanent visual implications. This review seeks to address three critical questions: (1) How do pregnancy-induced hormonal fluctuations influence ocular tissues such as the cornea, retina, and intraocular pressure regulation? (2) What are the short- and long-term consequences of these ocular changes on maternal visual function, and do they predispose to lasting ocular morbidity? (3) What strategies can be employed to optimize the management of ophthalmic diseases during pregnancy while ensuring both maternal and fetal safety? By addressing these questions, this review aims to provide an evidence-based framework for guiding clinical decision-making and advancing research in this field. Recent Findings Accumulating evidence suggests that pregnancy induces a spectrum of ocular changes, including corneal thickening, increased tear film instability due to meibomian gland dysfunction, and a physiologic reduction in intraocular pressure. While these changes are often self-limiting, pregnancy can also exacerbate pre-existing ocular conditions, particularly diabetic retinopathy (DR) and hypertensive retinopathy, necessitating vigilant monitoring and tailored interventions. Recent advancements in artificial intelligence (AI) and machine learning (ML) have demonstrated potential in predicting and managing pregnancy-associated ocular risks, yet further validation and integration into clinical practice are required. Additionally, the safety of ophthalmic medications during pregnancy remains an area of significant concern, as existing guidelines are largely informed by retrospective studies and animal models rather than robust randomized controlled trials. This underscores the urgent need for high-quality research to establish definitive safety profiles for commonly used ophthalmic drugs. Summary Pregnancy induces complex physiological and pathological changes in ocular health through dynamic hormonal, vascular, and immune mechanisms. While many gestational ocular adaptations, such as changes in corneal biomechanics and intraocular pressure, are typically reversible postpartum, certain pathological conditions, including DR and hypertensive retinopathy, may progress and necessitate timely intervention. This review highlights the pressing need for targeted investigations into the molecular and biochemical pathways underlying pregnancy-related ocular alterations, the development of predictive models to assess disease progression in expectant mothers, and the rigorous evaluation of treatment safety. A multidisciplinary approach integrating obstetricians, ophthalmologists, and endocrinologists is essential for optimizing maternal ocular care, minimizing long-term visual sequelae, and enhancing overall pregnancy outcomes.

Pregnancy and Ocular Health: Physiological Changes and Pathological Challenges

期刊论文
发表日期：

2025年3月24日

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Xiaoting Pei,
Zhijie Li

摘要

Purpose of Review

This review provides a comprehensive and systematic analysis of the impact of pregnancy on ocular health, with a particular focus on the interplay between physiological adaptations and pathological complications driven by hormonal, metabolic, and vascular changes. Given the substantial alterations in endocrine and circulatory function during gestation, pregnancy exerts profound effects on various ocular structures, necessitating a deeper understanding of both transient and potentially permanent visual implications. This review seeks to address three critical questions: (1) How do pregnancy-induced hormonal fluctuations influence ocular tissues such as the cornea, retina, and intraocular pressure regulation? (2) What are the short- and long-term consequences of these ocular changes on maternal visual function, and do they predispose to lasting ocular morbidity? (3) What strategies can be employed to optimize the management of ophthalmic diseases during pregnancy while ensuring both maternal and fetal safety? By addressing these questions, this review aims to provide an evidence-based framework for guiding clinical decision-making and advancing research in this field.

Recent Findings

Accumulating evidence suggests that pregnancy induces a spectrum of ocular changes, including corneal thickening, increased tear film instability due to meibomian gland dysfunction, and a physiologic reduction in intraocular pressure. While these changes are often self-limiting, pregnancy can also exacerbate pre-existing ocular conditions, particularly diabetic retinopathy (DR) and hypertensive retinopathy, necessitating vigilant monitoring and tailored interventions. Recent advancements in artificial intelligence (AI) and machine learning (ML) have demonstrated potential in predicting and managing pregnancy-associated ocular risks, yet further validation and integration into clinical practice are required. Additionally, the safety of ophthalmic medications during pregnancy remains an area of significant concern, as existing guidelines are largely informed by retrospective studies and animal models rather than robust randomized controlled trials. This underscores the urgent need for high-quality research to establish definitive safety profiles for commonly used ophthalmic drugs.

Summary

Pregnancy induces complex physiological and pathological changes in ocular health through dynamic hormonal, vascular, and immune mechanisms. While many gestational ocular adaptations, such as changes in corneal biomechanics and intraocular pressure, are typically reversible postpartum, certain pathological conditions, including DR and hypertensive retinopathy, may progress and necessitate timely intervention. This review highlights the pressing need for targeted investigations into the molecular and biochemical pathways underlying pregnancy-related ocular alterations, the development of predictive models to assess disease progression in expectant mothers, and the rigorous evaluation of treatment safety. A multidisciplinary approach integrating obstetricians, ophthalmologists, and endocrinologists is essential for optimizing maternal ocular care, minimizing long-term visual sequelae, and enhancing overall pregnancy outcomes.