Pregnancy-related risk factors for postpartum onset of glaucoma in pre-pregnancy glaucoma suspect: a retrospective cohort study

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Background/aims To evaluate the risk of postpartum glaucoma development in women with pre-pregnancy glaucoma suspect status and its association with pregnancy-related factors. Methods This retrospective cohort study enrolled patients diagnosed with glaucoma suspect before pregnancy between January 2012 and December 2024. Demographic, obstetric and ophthalmic data were collected. The primary outcome was postpartum glaucoma development. Risk factors were analysed using mixed-effect Cox regression, with Kaplan-Meier and interaction analysis. Results Of 92 patients (184 eyes) 53 patients (57.6%) progressed to glaucoma, with a mean progression time of 2.42±1.97 years. Multivariable Cox regression analysis identified higher mean intraocular pressure (IOP) (HR=1.37, 95% CI 1.26 to 1.49, p<0.001) and pre-eclampsia (HR=4.30, 95% CI 2.33 to 7.93, p<0.001) as independent risk factors, whereas higher pre-pregnancy body mass index (BMI) was protective (HR=0.91, 95% CI 0.83 to 0.99, p=0.037). A significant interaction was observed between pre-eclampsia and mean IOP (HR=1.19, p=0.038). Kaplan-Meier analysis showed an increased cumulative incidence of glaucoma in patients with pre-eclampsia (p=0.022). Conclusion For pre-pregnancy glaucoma suspect, higher mean follow-up IOP and pre-eclampsia increased the risk of postpartum glaucoma development, with a synergistic interaction between the two factors; higher pre-pregnancy BMI appears protective. These findings suggest that enhanced postpartum surveillance with individualised IOP monitoring and risk stratification should be particularly emphasised for glaucoma suspect women with a history of pre-eclampsia.