Risk factors for the occurrence of retinopathy stage in pregnancy-induced hypertension_Chinese Journal of Ocular Fundus Diseases

Authors：

Hu Li ¹ , Li Donghao ¹ , Liu Zhen ² ,  Wen Yiyi ¹

1. Department of Ophthalmology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150,China;
2. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150,China;

Corresponding author：

Wen Yiyi, Email: 962827913@qq.com

Keywords：

Hypertension; pregnancy-induced; Hypertensive retinopathy; Risk factors

DOI：

10.3760/cma.j.cn511434-20200409-00149

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Objective To observe and analyze the risk factors of retinopathy in patients with hypertension in pregnancy.Methods A retrospective clinical study. From January 2018 to December 2019, 260 patients with hypertension during pregnancy who were hospitalized in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University were included in the study. All patients underwent fundus color photography examination. Their age, gestational age, course of hypertension, past history, number of pregnancy and childbirth, pre-pregnancy body mass index (BMI) and laboratory blood routine, alanine aminotransferase, aspartate aminotransferase, and urea Nitrogen, creatinine, uric acid, serum albumin concentration, and 24-hour urine protein concentration and urine protein content examination results were collected. Among the 260 patients, there were 60 and 200 patients with or without retinopathy in the fundus, respectively. Patients were divided into retinopathy group and no retinopathy group. The comparison of quantitative data between groups was performed by independent sample t test; the comparison of grade data was performed by Mann-Whitney U nonparametric test. The variable with statistical difference between the two groups was the independent variable, and the two-class logistic regression analysis was performed.Results Gestational week (t=4.875), pre-pregnancy BMI (t=2.779), highest systolic blood pressure (t=－4.799), lowest systolic blood pressure (t=－4.797), highest diastolic blood pressure (t=－4.226), minimum diastolic blood pressure (t=－4.226), low and high platelet values and their fluctuations (t=7.701, 2.504, －6.083), serum albumin concentration (t=13.255), aspartic acid transaminase (t=－2.272), urea nitrogen (t=－5.117), creatinine (t=－2.735), uric acid (t=－2.130), 24-hour urine protein concentration (t=－7.801) and 24-hour urine protein (t=－7.567) were compared. The difference was statistically significant (P＜0.05). Logoistic regression analysis showed that pre-pregnancy BMI, maximum systolic blood pressure, low platelet value, and serum albumin were related to the occurrence of retinopathy of hypertension in pregnancy (P＜0.05).Conclusion High systolic blood pressure, low platelets, and low serum albumin are the risk factors for the occurrence of retinopathy of hypertension in pregnancy.

Citation： Hu Li, Li Donghao, Liu Zhen, Wen Yiyi. Risk factors for the occurrence of retinopathy stage in pregnancy-induced hypertension. Chinese Journal of Ocular Fundus Diseases, 2020, 36(12): 959-963. doi: 10.3760/cma.j.cn511434-20200409-00149 Copy

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3.	Păun VA, Ionescu ZR, Voinea L, et al. Ocular posterior pole pathological modifications related to complicated pregnancy: a review[J]. Rom J Ophthalmol, 2017, 61(2): 83-89. DOI: 10.22336/rjo.2017.16.
4.	Bakhda RN. Clinical study of fundus findings in pregnancy induced hypertension[J]. J Family Med Prim Care, 2016, 5(2): 424-429. DOI: 10.4103/2249-4863.192364.
5.	苟文丽. 妊娠期高血压疾病[M]//乐杰. 妇产科学. 7 版. 北京: 人民卫生出版社, 2008: 92-99.Gou WL. Pregnancy induced hypertension disease[M]//Le J. Obstetrics and gynecology. 7 th ed. Beijing: People's Medical Publishing House, 2008: 92-99.
6.	Rosenthal JM, Johnson MW. Management of retinal diseases in pregnant patients[J]. J Ophthalmic Vis Res, 2018, 13(1): 62-65. DOI: 10.4103/jovr.jovr_195_17.
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8.	雷宁玉, 李法升, 考华婷, 等. 血浆内皮素、一氧化氮与妊娠高血压综合征眼底视网膜血管病变关系的临床研究[J]. 中华眼底病杂志, 2004, 20(1): 12-15. DOI: 10.3760/j.issn:1005-1015.2004.01.004.Lei NY, Li FS, Kao HT, et al. Relationship between endothelin and nitric oxide in plasma with retinopathy in the pregnancy-induced hypertension[J]. Chin J Ocul Fundus Dis, 2004, 20(1): 12-15. DOI: 10.3760/j.issn:1005-1015.2004.01.004.
9.	Wang Z, Zou Y, Li W, et al. Application of optical coherence tomography and contrast sensitivity test for observingfundus changes of patients with pregnancy-induced hypertension syndrome [J/OL]. Medicine (Baltimore), 2015, 94(44):e1641[2015-11-06]. https://pubmed.ncbi.nlm.nih.gov/26554764/. DOI: 10.1097/MD.0000000000001641.
10.	王志学, 邹媛媛, 李文英, 等. 妊娠高血压综合征患者眼底及光相干断层扫描图像特征及其与患者自觉眼部症状和全身病情程度的相关性[J]. 中华眼底病杂志, 2015, 31(5): 430-434. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.005.Wang ZX, Zou YY, Li WY, et al. Ocular optical coherence tomography characteristics of pregnancy-induced hyper tension syndrome and its correlation with ocular symptoms and degree of the systemic disease[J]. Chin J Ocul Fundus Dis, 2015, 31(5): 430-434. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.005.
11.	王丽娜, 刘增业, 黑璐宁, 等. 妊娠高血压综合征患者共焦激光扫描炫彩眼底成像和光相干断层扫描图像特征[J]. 中华眼底病杂志, 2020, 36(1): 29-32. DOI: 10.3760/cma.j.issn.1005-1015.2020.01.007.Wang LN, Liu ZY, Hei LN, et al. The image characteristics of multispectral scanning laser imaging and optical coherence tomography in patients with pregnancy induced hypertension syndrome[J]. Chin J Ocul Fundus Dis, 2020, 36(1): 29-32. DOI: 10.3760/cma.j.issn.1005-1015.2020.01.007.
12.	Benschop L, Schalekamp-Timmermans S, Roeters van Lennep JE, et al. Gestational hypertensive disorders and retinal microvasculature: the Generation R Study[J/OL]. BMC Med, 2017, 15(1): 153[2017-08-14]. https://pubmed.ncbi.nlm.nih.gov/28803548/. DOI: 10.1186/s12916-017-0917-2.
13.	张承芬, 董方田. 妊娠高血压综合症的眼底改变[M]//张承芬. 眼底病学. 2版. 北京: 人民卫生出版社, 2013: 616-619.Zhang CF, Dong FT. Fundus changes in pregnancy induced hypertension syndrome[M]//Zhang CF. Diseases of Ocular Fundus. 2 nd ed. Beijing: People's Medical Publishing House, 2013: 616-619.
14.	Zhang ZZ, Lu JM, Qin XH. Case report: optical coherence tomography can find typical features in pregnancy-induced hypertension with retinopathy[J]. Optom Vis Sci, 2019, 96(5): 372-375. DOI: 10.1097/OPX.0000000000001369.
15.	Patel N, Riordan-Eva P, Chong V. Persistent visual loss after retinochoroidal infarction in pregnancy-induced hypertension and disseminated intravascular coagulation[J]. J Neuro ophthalmol, 2005, 25(2): 128-130. DOI: 10.1097/01.WNO.0000166062.81107.88.
16.	Vigil-De Gracia P, Ortega-Paz L. Retinal detachment in association with pre-eclampsia, eclampsia, and HELLP syndrome[J]. Int J Gynecol Obstet, 2011, 114: 223-235. DOI: 10.1016/j.ijgo.2011.04.003.
17.	Kishi S, Tso MO, Hayreh SS. Fundus lesions in malignant hypertension. Ⅰ. A pathologic study of experimental hypertensive choroidopathy[J]. Arch Ophthalmol, 1985, 103(8): 1189-1197. DOI: 10.1001/archopht.1985.01050080101029.
18.	Percival SP. Ocular findings in thrombotic thrombocytopenic purpura (Moschcowitz’s disease)[J]. Br J Ophthalmol, 1970, 54(2): 73-78. DOI: 10.1136/bjo.54.2.73.
19.	Chen H, Tao F, Fang X, et al. Association of hypoproteinemia in preeclampsia with maternal and perinatal outcomes: a retrospective analysis of high-risk women[J]. J Res Med Sci, 2016, 21: 98. DOI: 10.4103/1735-1995.193170.
20.	Takahashi H, Hisano M, Sago H, et al. Hypoproteinemia in the second trimester among patients with preeclampsia prior to the onset of clinical symptoms[J]. Hypertens Pregnancy, 2014, 33(1): 55-60. DOI: 10.3109/10641955.2013.837172.

1. 李丽, 付强强. 中国妊娠期高血压疾病患病率的meta分析[J]. 中国妇幼保健, 2019, 34(14): 3378-3381. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.14.72.Li L, Fu QQ. A meta-analysis of the prevalence of hypertensive disorders during pregnancy in China[J]. Maternal & Child Health Care of China, 2019, 34(14): 3378-3381. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.14.72.
2. 张惠蓉, 刘家琦, 李凤鸣. 妊娠高血压综合征的眼底改变[M]//张惠蓉. 实用眼科学. 3版. 北京: 人民卫生出版社, 2008: 92-99.Zhang HR, Liu JQ, Li FM. Fundus changes in pregnancy induced hypertension syndrome[M]//Zhang HR. Practical ophthalmology. 3 rd ed. Beijing: People's Medical Publishing House, 2010: 429-430.
3. Păun VA, Ionescu ZR, Voinea L, et al. Ocular posterior pole pathological modifications related to complicated pregnancy: a review[J]. Rom J Ophthalmol, 2017, 61(2): 83-89. DOI: 10.22336/rjo.2017.16.
4. Bakhda RN. Clinical study of fundus findings in pregnancy induced hypertension[J]. J Family Med Prim Care, 2016, 5(2): 424-429. DOI: 10.4103/2249-4863.192364.
5. 苟文丽. 妊娠期高血压疾病[M]//乐杰. 妇产科学. 7 版. 北京: 人民卫生出版社, 2008: 92-99.Gou WL. Pregnancy induced hypertension disease[M]//Le J. Obstetrics and gynecology. 7 th ed. Beijing: People's Medical Publishing House, 2008: 92-99.
6. Rosenthal JM, Johnson MW. Management of retinal diseases in pregnant patients[J]. J Ophthalmic Vis Res, 2018, 13(1): 62-65. DOI: 10.4103/jovr.jovr_195_17.
7. 张梦雨, 佘海澄. 妊娠期高血压疾病眼底病变[J]. 中国医刊, 2018, 53(8): 851-853. DOI: 10.3969/j.issn.1008-1070.2018.08.004.Zhang MY, She HC. Fundus lesions in hypertensive diseases during pregnancy[J]. Chinese Journal of Medicine, 2018, 53(8): 851-853. DOI: 10.3969/j.issn.1008-1070.2018.08.004.
8. 雷宁玉, 李法升, 考华婷, 等. 血浆内皮素、一氧化氮与妊娠高血压综合征眼底视网膜血管病变关系的临床研究[J]. 中华眼底病杂志, 2004, 20(1): 12-15. DOI: 10.3760/j.issn:1005-1015.2004.01.004.Lei NY, Li FS, Kao HT, et al. Relationship between endothelin and nitric oxide in plasma with retinopathy in the pregnancy-induced hypertension[J]. Chin J Ocul Fundus Dis, 2004, 20(1): 12-15. DOI: 10.3760/j.issn:1005-1015.2004.01.004.
9. Wang Z, Zou Y, Li W, et al. Application of optical coherence tomography and contrast sensitivity test for observingfundus changes of patients with pregnancy-induced hypertension syndrome [J/OL]. Medicine (Baltimore), 2015, 94(44):e1641[2015-11-06]. https://pubmed.ncbi.nlm.nih.gov/26554764/. DOI: 10.1097/MD.0000000000001641.
10. 王志学, 邹媛媛, 李文英, 等. 妊娠高血压综合征患者眼底及光相干断层扫描图像特征及其与患者自觉眼部症状和全身病情程度的相关性[J]. 中华眼底病杂志, 2015, 31(5): 430-434. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.005.Wang ZX, Zou YY, Li WY, et al. Ocular optical coherence tomography characteristics of pregnancy-induced hyper tension syndrome and its correlation with ocular symptoms and degree of the systemic disease[J]. Chin J Ocul Fundus Dis, 2015, 31(5): 430-434. DOI: 10.3760/cma.j.issn.1005-1015.2015.05.005.
11. 王丽娜, 刘增业, 黑璐宁, 等. 妊娠高血压综合征患者共焦激光扫描炫彩眼底成像和光相干断层扫描图像特征[J]. 中华眼底病杂志, 2020, 36(1): 29-32. DOI: 10.3760/cma.j.issn.1005-1015.2020.01.007.Wang LN, Liu ZY, Hei LN, et al. The image characteristics of multispectral scanning laser imaging and optical coherence tomography in patients with pregnancy induced hypertension syndrome[J]. Chin J Ocul Fundus Dis, 2020, 36(1): 29-32. DOI: 10.3760/cma.j.issn.1005-1015.2020.01.007.
12. Benschop L, Schalekamp-Timmermans S, Roeters van Lennep JE, et al. Gestational hypertensive disorders and retinal microvasculature: the Generation R Study[J/OL]. BMC Med, 2017, 15(1): 153[2017-08-14]. https://pubmed.ncbi.nlm.nih.gov/28803548/. DOI: 10.1186/s12916-017-0917-2.
13. 张承芬, 董方田. 妊娠高血压综合症的眼底改变[M]//张承芬. 眼底病学. 2版. 北京: 人民卫生出版社, 2013: 616-619.Zhang CF, Dong FT. Fundus changes in pregnancy induced hypertension syndrome[M]//Zhang CF. Diseases of Ocular Fundus. 2 nd ed. Beijing: People's Medical Publishing House, 2013: 616-619.
14. Zhang ZZ, Lu JM, Qin XH. Case report: optical coherence tomography can find typical features in pregnancy-induced hypertension with retinopathy[J]. Optom Vis Sci, 2019, 96(5): 372-375. DOI: 10.1097/OPX.0000000000001369.
15. Patel N, Riordan-Eva P, Chong V. Persistent visual loss after retinochoroidal infarction in pregnancy-induced hypertension and disseminated intravascular coagulation[J]. J Neuro ophthalmol, 2005, 25(2): 128-130. DOI: 10.1097/01.WNO.0000166062.81107.88.
16. Vigil-De Gracia P, Ortega-Paz L. Retinal detachment in association with pre-eclampsia, eclampsia, and HELLP syndrome[J]. Int J Gynecol Obstet, 2011, 114: 223-235. DOI: 10.1016/j.ijgo.2011.04.003.
17. Kishi S, Tso MO, Hayreh SS. Fundus lesions in malignant hypertension. Ⅰ. A pathologic study of experimental hypertensive choroidopathy[J]. Arch Ophthalmol, 1985, 103(8): 1189-1197. DOI: 10.1001/archopht.1985.01050080101029.
18. Percival SP. Ocular findings in thrombotic thrombocytopenic purpura (Moschcowitz’s disease)[J]. Br J Ophthalmol, 1970, 54(2): 73-78. DOI: 10.1136/bjo.54.2.73.
19. Chen H, Tao F, Fang X, et al. Association of hypoproteinemia in preeclampsia with maternal and perinatal outcomes: a retrospective analysis of high-risk women[J]. J Res Med Sci, 2016, 21: 98. DOI: 10.4103/1735-1995.193170.
20. Takahashi H, Hisano M, Sago H, et al. Hypoproteinemia in the second trimester among patients with preeclampsia prior to the onset of clinical symptoms[J]. Hypertens Pregnancy, 2014, 33(1): 55-60. DOI: 10.3109/10641955.2013.837172.

Chinese Journal of Ocular Fundus Diseases

Risk factors for the occurrence of retinopathy stage in pregnancy-induced hypertension

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