(1070) Pregnancy associated hypertension screening with optical coherence tomography angiography

Hypertensive disorders are a common complication in pregnancy, occurring in 6-8% of U.S pregnancies, and often present with a prodrome of ocular manifestations. Optical Coherence Tomography Angiography (OCTA) is a technique for imaging the retina in cross section. As perfusion in the eye decreases, such as in hypertensive disorders, vessels increase in length in order to maintain perfusion in the area. We sought to identify if these subclinical ocular changes on OCTA could predict pregnancy associated hypertension (PAH).


Study Design:

This is a retrospective cohort study of a prospective analysis of pregnant subjects undergoing OCTA after recruitment from a Fetal Diagnostic Unit at a large academic institution between February 2018 and December 2021. Study participants were in the third trimester with a singleton fetus and were categorized as healthy controls with no prior medical history or those who developed PAH. 

The PAH group was defined as those who developed gestational hypertension, preeclampsia with or without severe features, and chronic hypertension with superimposed preeclampsia without concomitant comorbidities such as diabetes, antiphospholipid antibody syndrome or malignancy. OCTA imaging used a 10° × 10° scan pattern centered on the fovea. Perfusion density (PD) and vessel length density (VLD) of the superficial vascular complex (SVC) and deep vascular complex (DVC) were analyzed and compared. To detect PD and VLD differences between groups, a generalized estimating equations model was used to adjust for correlations between two eyes of the same subject.


Results:

Of the cohort of 89 patients (178 eyes), 25 healthy controls were compared to 10 subjects who developed PAH. Patients with PAH trended towards higher VLDs in the entire SVC (17.6 vs 17.9, p = 0.092) and the parafoveal SVC (18.4 vs 17.8, p = 0.121)  (Figure 1).

 


Conclusion:

Though we did not find statistically significant changes, a larger sample size may show that ischemic changes can be seen in the retina of patients who later develop PAH. OCTA may yet prove promising as a screening tool for preeclampsia.