Pregnancy-Related Changes in Macular and Ganglion Cell Layer Thickness: A Longitudinal OCT Analysis

Pregnancy induces substantial physiological adaptations that affect the eye. Evidence regarding the effect of normal pregnancy on retinal parameters remains limited and inconsistent. This prospective longitudinal study aimed to evaluate ganglion cell layer (GCL) thickness and macular retinal thickness in healthy women during the third trimester of pregnancy and the postpartum period.

91 right eyes of 91 pregnant women were consecutively recruited between November 2017 and June 2024. All participants underwent comprehensive ophthalmic examination and spectral-domain optical coherence tomography (OCT) imaging. Third trimester and postpartum measurements were compared. GCL thickness was assessed in six macular EDTRS sectors, and retinal thickness was assessed in nine macular EDTRS sectors. Paired comparisons were performed using the Wilcoxon signed-rank test, with Benjamini-Hochberg correction applied for multiple testing.

Postpartum GCL thickness was significantly greater postpartum in all sectors except the inferonasal sector, which nonetheless showed a similar trend. Retinal thickness was also significantly greater postpartum in several parafoveal sectors. Central and perifoveal sectors showed non-significant increases in the same direction.

Normal pregnancy is associated with subtle, region-specific reductions in GCL and macular thickness. These findings support that physiological pregnancy-related changes influence retinal structure even in uncomplicated pregnancies. Larger longitudinal studies are warranted to clarify the mechanisms and clinical significance of these changes.