Clinical course and ophthalmologic findings in idiopathic intracranial hypertension and pregnancy: a retrospective cohort study

Abstract

Abstract Background: Idiopathic intracranial hypertension (IIH) has its highest prevalence among women of childbearing age. Therefore, it inevitably coincides with pregnancy. Because of physiological maternal changes during pregnancy and because of limited safety data on the available pharmaceuticals, concerns regarding a potential worsening of the disease during pregnancy arise. The literature background is limited to few retrospective studies. The aim of this study was to explore the impact of pregnancy on the visual outcome and on the management of pregnant women with IIH. Methods In this cohort study, IIH patients with documented pregnancies were retrospectively identified by medical database screening. The diagnosis of IIH was based on the revised Friedman criteria. Patient records were reviewed for IIH clinical features, treatment strategy and adherence to therapy. The visual acuity, visual field defects and the grade of papilledema at baseline and after pregnancy were compared. Complications over the course of pregnancy and during delivery were recorded. Results The database screening identified 16 IIH patients (26.8 ± 5.7 years, median = 27 years) with 19 documented pregnancies. The clinical presentation of IIH during pregnancy was similar to that of non-pregnant IIH patients with visual disturbances in 100% and headaches in 94.8% of patients. When comparing the overall visual acuity and the visual field mean deviation at baseline and at follow-up, no significant differences were found. The visual acuity at baseline in women who were diagnosed with IIH during pregnancy was significantly lower than in women who had been diagnosed with IIH prior to conception but improved at the time of follow-up. Papilledema grading improved after pregnancy. The adherence to therapy was low with 68.8% of patients discontinuing therapy. Conclusions Pregnancy did not lead to lasting visual impairment in our cohort of IIH patients, although many patients discontinued therapy during pregnancy. Further prospective studies are necessary to improve the medical care for IIH patients in pregnancy.