Changes in retinal flow density during and after pregnancy-an optical coherence tomography angiography study

Employing optical coherence tomography angiography (OCTA), recent research has uncovered retinal vascular changes in pregnant women compared to nonpregnant controls. Yet, longitudinal data on retinal OCTA metrics until childbirth are lacking in the current literature, and an understanding of a possible reversibility of these changes remains limited. This prospective study aims to quantify retinal capillary metrics in healthy pregnant women prenatally and postnatally, describing the natural evolution of OCTA metrics during and after pregnancy.

OCTA measurements were performed repeatedly on 52 eyes of 26 healthy, pregnant women, assessing the superficial (SCP), deep (DCP), choriocapillary (CC), and radial peripapillary (RPC) capillary plexus at various intervals during pregnancy and after childbirth. Flow density (FD) within these layers and parameters of the foveal avascular zone (FAZ) were compared throughout pregnancy and in the postpartum period using linear mixed models.

52 eyes of 26 pregnant women were included in the study. Although layer-specific variations in FD throughout the prepartum phase were noted, these changes were statistically insignificant for all investigated capillary plexus and the FAZ (p > 0.05). FD of the DCP, CC and RPC capillary plexus was significantly lower after childbirth in comparison to the prepartum phase (p ≤ 0.04).

The microvascular structure remains stable throughout healthy pregnancies; however, postpartum changes hint toward late vasculo-structural adaptations after childbirth. OCTA can be used to noninvasively to assess microvascular changes associated with pregnancy.