Optical coherence tomography angiography A window into retinal health in anemic pregnant women

Title : Optical coherence tomography angiography A window into retinal health in anemic pregnant women

Abstract:

Introduction: Anaemia is one of the most common medical complications in pregnancy, affecting over 40% of pregnant women globally, with iron deficiency accounting for 90-95% of cases^. It is associated with serious maternal risks—such as fatigue, preterm labour, and postpartum haemorrhage—as well as adverse foetal outcomes including low birth weight and developmental delays^. Although blood tests diagnose anaemia, they do not enable frequent monitoring of severity or treatment response.

Optical Coherence Tomography Angiography (OCTA), a rapid non-invasive tool, may reveal ocular changes before symptoms appear and allows quantitative assessment of retinal and choroidal vasculature (e.g., FAZ, perfusion density), aiding early detection and prevention of adverse outcomes. Previous studies have demonstrated reduced vessel density and altered FAZ morphology in patients with chronic anaemia. However, limited data exist on retinal vascular changes in anaemia specific to pregnancy, a condition often of shorter duration but high physiological demand.

Aim and Objectives: To evaluate retinal microvascular and optic nerve head alterations in anaemic pregnant women using OCTA, compared with healthy controls.

To assess and compare retinal microvascular changes (Foveal Avascular Zone (FAZ), Perfusion Density (PD) in superficial and deep capillary plexuses, and Flow Deficit (FD) in the choriocapillaris) and Optic nerve head changes using Optical Coherence Tomography Angiography (OCTA) in anaemic pregnant women (PA) versus healthy pregnant controls (HC).

To assess trimester-specific differences in the above Optical Coherence Tomography Angiography (OCTA)parameters in anaemic pregnant women diagnosed in the first trimester (PA FT) & second/third trimester (PA ST) compared to healthy pregnant controls(HC).

To explore correlations between hemoglobin levels and OCTA metrics, determining if lower Hb values predict more pronounced microvascular changes.

Inclusion Criteria: Age >= 18 years with a Singleton pregnancy with anemia as case group & age matched healthy pregnant women as controls.

Exclusion Criteria:

1. Hypertension during pregnancy
2. Pregestational diabetes
3. Anaemia caused by chronic diseases (e.g., cancers, tuberculosis)
4. History of ocular surgery
5. Presence of ocular diseases, including Cataracts, Glaucoma, Fundus changes due to pathological myopia

Materials and Methods:

Study Design: A Case–Control Study

Study Duration: 1 year

Study Method: Convenient sampling.

Study Population: Pregnant women with or without anemia who visit R. L. Jalappa Hospital and Research, Kolar.

Sample Size: 76 in each group

Results: Age Distribution Comparison Between Two Groups

Retinal microvascular changes due to anemia begin early in pregnancy.

• Changes do not significantly worsen in 2nd or 3rd trimester—except flow density, which suggests gradual adaptation/exhaustion of retinal circulation.
• OCTA can detect subtle functional blood flow changes before structural changes.

Significant Change

• FD Central (CC %) decreases from 4.31 --> 3.83
• Indicates reduction in choriocapillaris perfusion as pregnancy advances.
• Mild but non-significant change
• FAZ Perimeter shows slight increase.
• No trimester-based difference
• FAZ Area, FAZ Circularity, PD Central, PD Outer

Optic nerve thickness and retinal nerve fiber layer (RNFL) parameters did not show statistically significant variation between groups.

Conclusion: OCTA provides a non-invasive, quantitative method to evaluate retinal and optic nerve head changes in anaemic pregnant women.

This study may establish ocular biomarkers for early detection and monitoring of anaemia, offering a valuable adjunct to traditional blood tests.

Early recognition of such changes could aid in preventing adverse maternal and foetal outcomes, and support the integration of OCTA into routine antenatal care for high-risk pregnancies.

Biography:

Dr. Chaitra M. C is an Associate Professor in the Department of Ophthalmology at SDUMC, Kolar, with over 14 years of distinguished experience in comprehensive ophthalmic care, teaching, and research. She completed her MS in Ophthalmology and further enhanced her academic portfolio with a Postgraduate Diploma in Medico-Legal Systems (PGDMLS) and a PGDQMHHO in Quality Management of Hospital and Healthcare Organizations from Symbiosis University, Pune. She is also a Member of the National Academy of Medical Sciences (MNAMS).

Dr. Chaitra has contributed extensively to scientific literature, with 40+ publications in indexed journals, and is actively involved in academic, clinical, and administrative responsibilities. Her areas of interest include cataract, cornea, ocular trauma, and medical education. She continues to play a vital role in advancing quality eye care and training future clinicians.