Birth outcomes associated with maternal antiglaucoma medication exposure: a systematic review and meta-analysis

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Background Antiglaucoma medications are indispensable for preserving maternal vision, yet the associations between their use and adverse birth outcomes remain inconclusive. Method The meta-analysis was conducted in accordance with the PRISMA 2020 and MOOSE guidelines. We searched Web of Science, PubMed, Embase, and ScienceDirect for eligible comparative studies. The outcomes were low birth weight (LBW), preterm birth (PB) and congenital anomalies (CA). The pooled results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Influential publication was determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analyses. Publication bias was assessed using funnel plots and Begg’s and Egger’s tests. Results The 8 included studies (11 datasets) were published between 2004 and 2024 and included 3,713 pregnant women with glaucoma. All the included studies were of good to excellent quality. Maternal use of antiglaucoma medications was associated with an increased risk of LBW (OR = 2.12, 95% CI = 1.46 to 3.08, p < 0.001). However, no significant associations were found for the risks of PB (OR = 1.58, 95% CI = 0.81 to 3.07, p = 0.180) or CA (OR = 1.07, 95% CI = 0.24 to 4.77, p = 0.933). Subgroup analysis revealed that mean maternal age was potential source of heterogeneity for the risk of CA (interaction p -value <0.001). No influential publications or significant publication bias was detected across the studies. Conclusion Maternal use of antiglaucoma medications was potentially associated with an increased risk of LBW. In contrast, the evidence regarding PB and CA risk remains inconclusive. However, the preservation of maternal visual function remains a critical priority in certain cases. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/recorddashboard , Identifier CRD420261365100.