Maternal Hypertensive Disorder in Pregnancy and Childhood Strabismus in Offspring

Hui Zhu, PhD^1,2,3; Xue You, MM^2,3; Yu Jing, MM¹; et al

Yiyuan Chen, MM^2,3; Yangqian Jiang, PhD^2,3,4; Yuan Lin, PhD^2,3,4,5; Tao Jiang, PhD^2,3,6; Rui Qin, PhD^2,3; Hong Lv, PhD^2,3,5; Qun Lu, PhD^2,4; Cong Liu, PhD^2,3; Xin Xu, PhD^2,3,4; Yuxin Liu, MM^2,3; Tianyu Sun, PhD^2,3; Mengting Jiang, MM^2,3; Bo Xu, PhD^2,3; Xiumei Han, PhD^2,3; Jiaping Chen, PhD^2,3; Yue Jiang, PhD^2,3; Xiaoyu Liu, PhD^2,3; Kun Zhou, PhD^2,3; Guangfu Jin, PhD^2,3,5; Hongxia Ma, PhD^2,3,5; Zhibin Hu, PhD^2,3,5; Hu Liu, PhD¹; Jiangbo Du, PhD^2,3,5; for the China National Birth Cohort Study Group

Author Affiliations Article Information

JAMA Netw Open. 2024;7(7):e2423946. doi:10.1001/jamanetworkopen.2024.23946

Key Points

Question  Is there an association between maternal hypertensive disorder of pregnancy (HDP) and childhood strabismus in offspring?

Findings  In this cohort study that included 3117 children, offspring born to mothers with HDP had an 82% higher overall risk of strabismus at 3 years of age, and offspring with maternal preeclampsia and poorly controlled blood pressure had the highest risk.

Meaning  These findings suggest that early screening of strabismus might be recommended for offspring born to mothers with HDP, especially those with maternal preeclampsia or poorly controlled blood pressure.

Abstract

Importance  Maternal hypertensive disorder in pregnancy (HDP) might affect ocular health in offspring; however, its association with strabismus remains unclear.

Objective  To examine the association of maternal HDP with overall and type-specific strabismus in offspring.

Design, Setting, and Participants  In the Jiangsu Birth Cohort study, a population-based study in China, pregnant women were recruited from April 24, 2014, to November 30, 2018. A total of 6195 offspring had maternal HDP diagnosis information, of whom 3078 were excluded due to having no information on ocular alignment or due to having ocular diseases other than strabismus or refractive error. Offspring underwent ocular examinations at 3 years of age, completed May 21, 2022. Data were analyzed from May 28, 2022, through December 15, 2023.

Exposure  Maternal HDP, categorized into hypertension and preeclampsia or with blood pressure (BP) well controlled (systolic BP, <130; diastolic BP, <80 mm Hg) and poorly controlled (systolic BP, ≥130; diastolic BP, ≥80 mm Hg).

Main Outcomes and Measures  The primary outcome was the incidence of strabismus in offspring. Poisson generalized linear mixed models were used to estimate the association between maternal HDP and strabismus.

Results  Among the included 3117 children (mean [SD] age, 36.30 [0.74] months; 1629 boys [52.3%]), 143 (4.6%) were exposed to maternal HDP and 368 (11.8%) had strabismus. Offspring exposed to maternal HDP had an 82% increased risk of overall strabismus (relative risk [RR], 1.82 [95% CI, 1.21-2.74]), an 82% increased risk of exophoria (RR, 1.82 [95% CI, 1.11-3.00]), and a 136% increased risk of intermittent exotropia (RR, 2.36 [95% CI, 1.13-4.93]) compared with unexposed offspring. When considering the type of maternal HDP, the risk for all strabismus was high for offspring exposed to preeclampsia (RR, 2.38 [95% CI, 1.39-4.09]) compared with unexposed offspring. When considering the BP control level of maternal HDP, the risk for all strabismus was high for offspring born to mothers with HDP and poorly controlled BP (RR, 2.07 [95% CI, 1.32-3.24]) compared with unexposed offspring.

Conclusions and Relevance  These findings suggest that maternal HDP is associated with an increased risk of offspring strabismus. Early screening of strabismus might be recommended for offspring with maternal HDP. Further exploration of the underlying mechanism of the association between HDP and strabismus is warranted.