Abstract
Introduction Anti-vascular endothelial growth factor (anti-VEGF) agents may occasionally need to be considered for sight-threatening macular pathology in pregnant women. This is controversial due to the dearth of data on systemic side effects for mother and child.
Aims To explore the visual and safety (obstetric and neonatal) outcomes of anti-VEGF in pregnant women.
Methods Retrospective case series of pregnant women treated with intravitreal anti-VEGF injections at Oxford Eye Hospital between January 2015 and December 2022. We also conducted a systematic review and combined eligible cases in a narrative synthesis.
Results We treated six pregnant women with anti-VEGF for diabetic macular oedema (DMO) (n=5) or choroidal neovascularisation (CNV) (n=1). Four received ranibizumab whilst two (not known to be pregnant) received aflibercept. Patients known to be pregnant underwent counselling by an obstetric physician. Five pregnancies resulted in live births.
Combining our cases with those previously published, treatment of 41 pregnant women (42 pregnancies) has been reported. Indications for treatment included CNV (n=28/41, 68%), DMO (n=7/41, 17%) and proliferative diabetic retinopathy (n=6/41, 15%). Bevacizumab (n=22/41, 54%) and ranibizumab (n=17/41, 41%) were given more frequently than aflibercept (n=2/41, 5%). Many (n=16/41, 40%) were unaware of their pregnancy when treated. Most pregnancies resulted in live births (n=34/42, 81%). First trimester miscarriages (n=5/42, 12%) and stillbirths (n=3/42, 7%) predominantly occurred in women with significant risk factors.
Conclusion Intravitreal anti-VEGF injections may not necessarily compromise obstetric outcomes, although clear associations cannot be drawn due to small numbers and confounders from high rates of first trimester miscarriages and inherently high-risk pregnancies. It may be worth considering routinely investigating pregnancy status in women of childbearing age prior to each injection, as part of anti-VEGF treatment protocols.
