Maternal Hypertensive Disorder in Pregnancy and Childhood Strabismus in Offspring
Authors: Zhu Hui , You Xue , Jing Yu , Chen Yiyuan , Jiang Yangqian , Lin Yuan , Jiang Tao , Qin Rui , Lv Hong , Lu Qun , Liu Cong , Xu Xin , Liu Yuxin , Sun Tianyu , Jiang Mengting , Xu Bo , Han Xiumei , Chen Jiaping , Jiang Yue , Liu Xiaoyu , Zhou Kun , Jin Guangfu , Ma Hongxia , Hu Zhibin , Liu Hu , Du Jiangbo , Shen Hongbing , Xia Yankai , Li Jiong , Lu Chuncheng , Zhao Yang , Wu Wei , Chen Minjian , Geng Shanshan , Ding Ye , Huang Lei , Tao Shiyao , Dou Yuanyan , Lei Shuifang , Ke Kang , Zhang Yanjie , Xu Yiqun , Wang Jinghan , Zhu Xianxian , Xue Huixin , Gan Ming , Xiao Shuxin , Wang Weiting , Pi Di , Wang Chang , Zhang Haowen , Yang Bo , Jin Yufan , Zhang Xiao , Xiong Yongbin , Zou Xin , Yong Zheng , Wu Shuting , Qu Yue , Wang Qin , Chen Jie , Liao Ganchong , Pang Liya , Huang Dan , Fu Zhujun , Wang Zijin , Wang Yue , Li Rui , Tong Haohai , Han Shu , Zhao Xiaoyan , Shen Shiya , Wang Yun , Yan Wen , Li Xiaoxiao , Zhao Andi , Chen Danni , Liu Lei , Guo Wei , Qian Yingxiao , Hua Lei , Yan Qi , Zuo Xiaoxia , Zhang Tong , Ni Ziyi , Jing Yu , Zhou Tiantian , Zhu Xiaoqi , Zhou Chenyu , Zhang Yuting , Shi Yunfan , Feng Yuhong , Zhang Chuxuan , Chi Haodong , Sun Fanbo , Cui Jian , Gao Yan , Yao Xinyuan , Li Meng , Si Jiahao , Xu Shasha , Chen Xi , Zhang Jiyu , Zheng Xinyu , Cao Yelongzi , Shao Xiaodong , Liu Shuning , Chen Yuxi , Shu Qin , Li Shiding , Dang Jingsong , Zhang Tao , Ding Ranran , Wu Yuemin , Wang Liyuan , Zhao Ningjing , Yang Jiajia , Zhao Shuoyang , Qian Yichao , Lu Yao , Zhu Yue , Ma Fanfei , Zhang Changqin , Xu Yuxiao , Zhu Yan , Dong Weiyi , Dong Mengqi , Li Zhitong , Sun Jing , Yi Yuxiang , Fu Hongxue , Dou Jie , Gao Wanting , Li Zhuorong , Sun Leyan , Tang Lan , Xu Xinyan , Yang Jingwen , Xue Ping , Huang Shengxiang , Xia Yidan , Gu Sirui , Chen Yaxin , Zhang Yizheng , Chen Qi , Wu Ruize , Shi Anqi , Jiang Yujie , Xu Rui , Mei Linting , Zhu Xuexian , Wang Yiting , Liang Xianyue , Xu Jing , Zhang Zheng , Xu Chengfei , Liu Jin , Wang Yucao , Liang Jinghan , Li Jiaxu , You Junyi , Lin Zhiying , Zhou Wenjie , Yin Zihan , Sun Cheng , Zuo Difei , Zhu Ruini , Deng Qikun , Shi Yujiao , Wang Yujie , Wang Zhen , Fan Xiaoyu , Li Xinying ,   China National Birth Cohort Study Group
Published: July 2024

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, &amp;lt;130; diastolic BP, &amp;lt;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.