Retinal Manifestations of Gestational Hypertension and Preeclampsia: A Systematic Review

Introduction: Gestational hypertension and preeclampsia are major causes of maternal and perinatal morbidity worldwide, with systemic vascular changes that also affect the ocular circulation. Retinal findings in these conditions include arteriolar narrowing, hemorrhages, exudates, and, in severe cases, serous retinal detachment. Identifying ocular manifestations offers a non-invasive window into systemic disease severity and progression. Objective: To systematically review recent evidence on retinal manifestations in gestational hypertension and preeclampsia, evaluating their prevalence, correlation with systemic severity, and prognostic implications. Secondary objectives include assessing diagnostic methods and the role of ophthalmic imaging in clinical management. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Inclusion criteria comprised studies published in the last 5 years involving pregnant women diagnosed with gestational hypertension or preeclampsia, with reported retinal outcomes assessed by fundoscopy, OCT, or angiography. Exclusion criteria included case reports, animal studies, and editorials. Data were extracted and risk of bias assessed using RoB 2 and ROBINS-I, with certainty graded via GRADE. Results and Discussion: From 1,432 records screened, 27 studies met eligibility criteria. The most common retinal findings were arteriolar narrowing, hemorrhages, cotton-wool spots, and choroidal thickening. OCT studies revealed subclinical macular edema and retinal nerve fiber layer alterations. Severe preeclampsia was consistently associated with higher prevalence of retinal vascular changes, correlating with adverse maternal and fetal outcomes. Evidence quality was moderate to high, with consistent findings across different populations. Conclusion: Retinal manifestations are reliable indicators of systemic vascular involvement in gestational hypertension and preeclampsia. Incorporating ophthalmologic evaluation, particularly OCT, may improve risk stratification and management in high-risk pregnancies. Multidisciplinary strategies involving obstetricians and ophthalmologists are warranted to optimize maternal and neonatal outcomes.