Hypertensive disorders of pregnancy in the development of retinopathy of prematurity.

PURPOSE: To determine whether there is an association between hypertensive disease of pregnancy (HDP) and the development of retinopathy of prematurity (ROP). METHODS: This retrospective cohort study was based on the records of an ROP screening registry, which included infants who fulfilled the standard screening criteria for ROP. Analyses included multinomial logistic regression, with sensitivity analyses incorporating inverse probability weighting to account for potential collider bias arising from restriction to preterm infants and subgroups defined by gestational age (GA). RESULTS: In this cohort of 2,100 infants in the registry, 698 (33.2%) developed ROP, and 261 (12.4%) developed severe ROP (type 1 or type 2). Severe HDP (preeclampsia with severe features, HELLP, and eclampsia) was found in 644 infants from mothers (30.7%). The mean GA at delivery was 28.8 ± 2.5 weeks. Across GA, severe HDP was associated with a higher risk of severe ROP compared with normotensive pregnancies up to approximately 28-29 weeks' gestation, with the largest differences observed between 26 and 27 weeks. Among infants born at ≤29 weeks, severe HDP was associated with severe ROP with respect to normotensive births and no ROP (adjusted odds ratio [AOR] = 1.5; 95% CI, 1.0-2.1; P = 0.04). In sensitivity analyses to account for selection into the preterm cohort, results were similar, with severe HDP related to the development of severe ROP (AOR = 1.7; CI, 1.5-2.0, P < 0.01). CONCLUSIONS: The association of HDP with ROP varied with GA. Compared with normotensive pregnancies, severe HDP was a risk factor for severe ROP at earlier GA but not for infants born at 29 weeks' gestation or later.