Medical management of glaucoma for the pregnant and breastfeeding patient

Authors

  • Gurkaran S. Sarohia, MD Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB
  • Mathew M. Palakkamanil, MD, MPH, FRCSC Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB

DOI:

https://doi.org/10.58931/cect.2023.2228

Abstract

Glaucoma is a progressive optic neuropathy which is relatively uncommon in childbearing age, with a reported prevalence of 0.16% between the ages of 18-40 years. Glaucoma management among pregnant patients presents a challenging scenario to the treating physician. Even with its low prevalence in the United Kingdom, a country-wide survey has revealed that approximately 26% of ophthalmologists reported having treated a pregnant patient with glaucoma. Perhaps due to this low prevalence, 31% of these ophthalmologists reported uncertainty about managing glaucoma in this population. When treating pregnant or breastfeeding patients, one must consider the benefit of treatment for the mother while weighing this against the risks the treatment may pose for the mother and fetus/child. This highlights the importance of having a review which can serve as a reference for physicians when managing glaucoma in pregnant and/or breastfeeding patients.

Author Biographies

Gurkaran S. Sarohia, MD, Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB

Dr. Gurkaran Sarohia completed his MD degree at the University of British Columbia and is currently an ophthalmology resident at the University of Alberta. He has published numerous peer-reviewed articles and presented his vision science research at international conferences. Besides his research endeavours, Dr. Sarohia is interested in global health and medical education.

Mathew M. Palakkamanil, MD, MPH, FRCSC, Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB

Dr. Mathew Palakkamanil completed his MD degree at the University of Calgary followed by a five-year ophthalmology residency at the University of Alberta. Concurrent to this residency training, he completed a Master of Public Health (MPH) with a focus on epidemiology at Harvard University. He then completed a glaucoma fellowship at Dalhousie University in Halifax, Nova Scotia. Dr. Palakkamanil is currently appointed as a Clinical Assistant Professor at the University of Alberta. He is actively involved in the training of medical students, residents, and fellows.

References

Marx-Gross S, Laubert-Reh D, Schneider A, Höhn R, Mirshahi A, Münzel T, Wild PS, Beutel ME, Blettner M, Pfeiffer N. The prevalence of glaucoma in young people: Findings of the population-based Gutenberg Health Study. Deutsches Ärzteblatt International. 2017 Mar;114(12):204. doi:10.3238/ARZTEBL.2017.0204 DOI: https://doi.org/10.3238/arztebl.2017.0204

Vaideanu D, Fraser S. Glaucoma management in pregnancy: a questionnaire survey. Eye. 2007 Mar;21(3):341-3. doi:10.1038/SJ.EYE.6702193 DOI: https://doi.org/10.1038/sj.eye.6702193

Mathew S, Harris A, Ridenour CM, Wirostko BM, Burgett KM, Scripture MD, Siesky B. Management of glaucoma in pregnancy. Journal of Glaucoma. 2019 Oct 12;28(10):937-44. doi:10.1097/IJG.0000000000001324 DOI: https://doi.org/10.1097/IJG.0000000000001324

Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM. A practical guide to the pregnant and breastfeeding patient with glaucoma. Ophthalmology Glaucoma. 2020 Mar 1;3(2):79-89. doi:10.1016/J.OGLA.2019.12.004 DOI: https://doi.org/10.1016/j.ogla.2019.12.004

Sunness JS. The pregnant woman's eye. Survey of ophthalmology. 1988 Jan 1;32(4):219-38. doi:10.1016/0039-6257(88)90172-5 DOI: https://doi.org/10.1016/0039-6257(88)90172-5

Efe YK, Ugurbas SC, Alpay A, Ugurbas SH. The course of corneal and intraocular pressure changes during pregnancy. Canadian Journal of Ophthalmology. 2012 Apr 1;47(2):150-4. doi:10.1016/J.JCJO.2012.01.004. DOI: https://doi.org/10.1016/j.jcjo.2012.01.004

Kumari R, Saha BC, Onkar A, Ambasta A, Kumari A. Management of glaucoma in pregnancy–balancing safety with efficacy. Therapeutic Advances in Ophthalmology. 2021 Jun;13:25158414211022876. doi:10.1177/25158414211022876 DOI: https://doi.org/10.1177/25158414211022876

Mendez-Hernandez C, Garcia-Feijoo J, Saenz-Frances F, Santos-Bueso E, Martinez-de-la-Casa JM, Megias AV, Fernández-Vidal AM, Garcia-Sanchez J. Topical intraocular pressure therapy effects on pregnancy. Clinical Ophthalmology. 2012 Oct 8:1629-32. doi:10.2147/OPTH.S36712 DOI: https://doi.org/10.2147/OPTH.S36712

New FDA Pregnancy Categories Explained - Drugs.com. https://www.drugs. com/pregnancy-categories.html. Accessed November 12, 2022.

Duan L, Ng A, Chen W, Spencer HT, Nguyen J, Shen AY, Lee MS. β-blocker exposure in pregnancy and risk of fetal cardiac anomalies. JAMA Internal Medicine. 2017 Jun 1;177(6):885-7. doi:10.1001/JAMAINTERNMED.2017.0608 DOI: https://doi.org/10.1001/jamainternmed.2017.0608

Frishman WH, Chesner M. Beta-adrenergic blockers in pregnancy. Am Heart J. 1988; 115:147-152. doi:10.1016/0002-8703(88)90530-3 DOI: https://doi.org/10.1016/0002-8703(88)90530-3

Bergman JE, Lutke LR, Gans RO, Addor MC, Barisic I, Cavero-Carbonell C, Garne E, Gatt M, Klungsoyr K, Lelong N, Lynch C. Beta-blocker use in pregnancy and risk of specific congenital anomalies: a European case- malformed control study. Drug Safety. 2018 Apr;41:415-27. doi:10.1007/S40264-017-0627-X DOI: https://doi.org/10.1007/s40264-017-0627-x

Petersen KM, Jimenez-Solem E, Andersen JT, Petersen M, Brødbæk K, Køber L, Torp-Pedersen C, Poulsen HE. β-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study. BMJ Open. 2012 Jan 1;2(4):e001185. doi:10.1136/ BMJOPEN-2012-001185 DOI: https://doi.org/10.1136/bmjopen-2012-001185

Ho JD, Hu CC, Lin HC. Antiglaucoma medications during pregnancy and the risk of low birth weight: a population-based study. British Journal of Ophthalmology. 2009 Oct 1;93(10):1283-6. doi:10.1136/ BJO.2008.157123 DOI: https://doi.org/10.1136/bjo.2008.157123

Pellegrino M, D'Oria L, De Luca C, Chiaradia G, Licameli A, Neri C, Nucci M, Visconti D, Caruso A, De Santis M. Glaucoma drug therapy in pregnancy: literature review and teratology information. service (TIS) case series. Current Drug Safety. 2018 Mar 1;13(1):3-11. doi:10.2174/1574886312666171030125804 DOI: https://doi.org/10.2174/1574886312666171030125804

Razeghinejad MR, Nowroozzadeh MH. Anti‐glaucoma medication exposure in pregnancy: an observational study and literature review. Clinical and Experimental Optometry. 2010 Nov 1;93(6):458-65. doi:10.1111/J.1444-0938.2010.00526.X DOI: https://doi.org/10.1111/j.1444-0938.2010.00526.x

Wagenvoort AM, Van Vugt JM, Sobotka M, Van Geijn HP. Topical timolol therapy in pregnancy: is it safe for the fetus? Teratology. 1998 Dec;58(6):258-62. DOI: https://doi.org/10.1002/(SICI)1096-9926(199812)58:6<258::AID-TERA7>3.0.CO;2-B

Lipitz S, Grisaru D, Libshiz A, Rotstein Z, Schiff E, Lidor A, Achiron R. Intraamniotic prostaglandin F2 alpha for pregnancy termination in the second and early third trimesters of pregnancy. The Journal of Reproductive Medicine. 1997 Apr 1;42(4):235-8.

Dal Pizzol TD, Knop FP, Mengue SS. Prenatal exposure to misoprostol and congenital anomalies: systematic review and meta-analysis. Reproductive Toxicology. 2006 Nov 1;22(4):666-71. doi:10.1016/J.REPROTOX.2006.03.015 DOI: https://doi.org/10.1016/j.reprotox.2006.03.015

Marco De S AL, Brigida C. Latanoprost exposure in pregnancy. Am J Ophthalmol.2004;138. doi:10.1016/j.ajo.2004.03.002 DOI: https://doi.org/10.1016/j.ajo.2004.03.002

Ozawa H, Azuma E, Shindo K, Higashigawa M, Mukouhara R, Komada Y. Transient renal tubular acidosis in a neonate following transplacental acetazolamide. European Journal of Pediatrics. 2001 Apr 1;160(5):321. doi:10.1007/PL00008441 DOI: https://doi.org/10.1007/PL00008441

Merlob P, Litwin A, Mor N. Possible association between acetazolamide administration during pregnancy and metabolic disorders in the newborn. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1990 Apr 1;35(1):85-8. doi:10.1016/0028-2243(90)90146-R DOI: https://doi.org/10.1016/0028-2243(90)90146-R

Worsham GF, Beckman EN, Mitchell EH. Sacrococcygeal teratoma in a neonate: association with maternal use of acetazolamide. JAMA. 1978 Jul 21;240(3):251-2. doi:10.1001/JAMA.1978.03290030069029 DOI: https://doi.org/10.1001/jama.240.3.251

Falardeau J, Lobb BM, Golden S, Maxfield SD, Tanne E. The use of acetazolamide during pregnancy in intracranial hypertension patients. Journal of Neuro-Ophthalmology. 2013 Mar 1;33(1):9-12. doi:10.1097/WNO.0B013E3182594001 DOI: https://doi.org/10.1097/WNO.0b013e3182594001

Lee AG, Pless M, Falardeau J, Capozzoli T, Wall M, Kardon RH. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. American Journal of Ophthalmology. 2005 May 1;139(5):855-9. doi:10.1016/J.AJO.2004.12.091 DOI: https://doi.org/10.1016/j.ajo.2004.12.091

American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. doi:10.1542/PEDS.108.3.776 DOI: https://doi.org/10.1542/peds.108.3.776

Morselli PL, Boutroy MJ, Bianchetti G, Zipfel A, Boutroy JL, Vert P. Placental transfer and perinatal pharmacokinetics of betaxolol. European Journal of Clinical Pharmacology.1990 May;38:477-83. doi:10.1007/BF02336687 DOI: https://doi.org/10.1007/BF02336687

Lustgarten JS, Podos SM. Topical timolol and the nursing mother. Archives of Ophthalmology. 1983 Sep 1;101(9):1381-2. doi:10.1001/ARCHOPHT.1983.01040020383008 DOI: https://doi.org/10.1001/archopht.1983.01040020383008

Madadi P, Koren G, Freeman DJ, Oertel R, Campbell RJ, Trope GE. Timolol concentrations in breast milk of a woman treated for glaucoma: calculation of neonatal exposure. Journal of Glaucoma. 2008 Jun 1;17(4):329-31. doi:10.1097/IJG.0B013E31815C3A5B DOI: https://doi.org/10.1097/IJG.0b013e31815c3a5b

Söderman P, Hartvig P, Fagerlund C. Acetazolamide excretion into human breast milk. British Journal of Clinical Pharmacology. 1984 May;17(5):599. DOI: https://doi.org/10.1111/j.1365-2125.1984.tb02399.x

Downloads

Published

2023-05-17

How to Cite

1.
Sarohia GS, Palakkamanil MM. Medical management of glaucoma for the pregnant and breastfeeding patient. Can Eye Care Today [Internet]. 2023 May 17 [cited 2024 Jul. 24];2(2):21–26. Available from: https://canadianeyecaretoday.com/article/view/2-2-sarohia_et_al

Issue

Section

Articles