Pregnancy-related retinal disorders: clinical features, systemic associations, and management insights

Abstract Background: Pregnancy induces profound hormonal, hemodynamic, and metabolic changes that can trigger or exacerbate retinal disorders, some of which may signal systemic complications. This narrative review summarizes current knowledge on retinal diseases specifically induced or worsened during pregnancy. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Google Scholar up to ۳۱ September ۲۰۲۵, supplemented by manual screening of reference lists of included records. Search terms included “pregnancy”, “preeclampsia”, “eclampsia”, “HELLP syndrome”, “hemolysis, elevated liver enzyme levels, and low platelets syndrome”, “retinal disease”, “retinopathy”, “hypertensive retinopathy”, “serous retinal detachment”, “central serous chorioretinopathy”, “diabetic retinopathy”, “Valsalva retinopathy”, “retinal vein occlusion”, “retinal artery occlusion”, “idiopathic intracranial hypertension”, and “artificial intelligence”. Eligible articles included case reports, case series, observational studies, reviews, and meta-analyses describing retinal conditions specifically induced or worsened during pregnancy. Data were synthesized narratively. Results: Pregnancy can precipitate sight-threatening retinal pathology or accelerate pre-existing disease. Hypertensive retinopathy associated with preeclampsia and eclampsia is among the most clinically significant conditions, presenting with arteriolar narrowing, retinal hemorrhages, cotton-wool spots, and, in severe cases, serous retinal detachment. Metabolic adaptations, particularly in women with pregestational diabetes, may accelerate the progression of diabetic retinopathy, with some patients advancing from nonproliferative to proliferative stages over short intervals. Pregnancy has also been implicated in serous retinal detachment, central serous chorioretinopathy, Valsalva retinopathy, retinal vascular occlusions, and, less commonly, papilledema secondary to idiopathic intracranial hypertension. These disorders range from transient, self-limited entities to sight-threatening events and often reflect systemic pathology, including preeclampsia, eclampsia, or hypercoagulable states. Optical coherence tomography, optical coherence tomography angiography, and fundus photography provide safe, noninvasive diagnostic and monitoring modalities. Artificial intelligence (AI)-based retinal imaging offers accurate, noninvasive assessment of diabetic and hypertensive retinopathy and demonstrates expert-level performance across clinical settings. Management emphasizes stabilization of maternal systemic disease, optimization of glycemic and blood pressure control, and multidisciplinary care. Most conditions improve postpartum, but prompt recognition is essential to prevent permanent visual loss. Conclusions: Pregnancy can precipitate or exacerbate a range of retinal disorders, reflecting the complex vascular, hormonal, and metabolic changes of gestation. Noninvasive imaging, interdisciplinary collaboration, and vigilant monitoring are essential to optimizing maternal and fetal outcomes. Awareness and early detection of pregnancy-associated retinal disorders, together with emerging AI-based tools, may further improve outcomes. Longitudinal studies are needed to establish evidence-based screening and management protocols. Keywords: pregnancies gestation preeclampsia eclampsias hellp syndrome retina hypertensive retinopathies diabetic retinopathies central serous chorioretinopathies retinal vein occlusions retinal artery occlusions idiopathic intracranial hypertension computer vision system machine intelligence