Hypertensive Disorders of Pregnancy and the Long‐Term Risk of Maternal Retinal and Ophthalmic Disease: A Systematic Review and Meta‐Analysis

Background: Hypertensive disorders of pregnancy (HDP) are associated with increased long-term risk of maternal cardio-metabolic disease, but links with future retinal diseases remain unclear. Objective: The objective of this study is to synthesise the published literature on HDP and subsequent retinal and other ophthalmic disease. Search Strategy: Databases including PubMed, Embase, Web of Science, and Cochrane Library were searched to March 2026 following a pre-registered PROSPERO protocol, CRD42024589508. Selection Criteria: These included: a population of parous women, exposure to HDP at least once, at least one primary outcome (retinal disease) or secondary outcome (other ophthalmic disease). Women with pre-pregnancy retinal/ophthalmic diseases were excluded. Data Collection and Analysis: Two reviewers independently screened studies, extracted data, and assessed bias using an adapted Newcastle-Ottawa tool. Random-effects meta-analyses were performed. Results: Of 5673 studies retrieved, 13 were eligible for inclusion (2 450 072 participants). HDP was associated with increased risk of diabetic retinopathy (aRR 3.54, 95% CI 2.19–5.74), particularly after preeclampsia (aRR 4.24, 95% CI 3.51–5.12). HDP-exposed women were also at higher risk of non-diabetic retinopathy (aRR 3.65, 95% CI 1.18–11.33), retinal detachment (aRR 1.54, 95% CI 1.28–1.86), and retinal vascular occlusion (aRR 2.09, 95% CI 1.55–2.81). HDP-exposed women may also be at risk of hypertensive retinopathy and central serous chorioretinopathy, but aRRs did not reach statistical significance. Across individual studies, HDP-exposed women were reported to be at increased risk of cataract extraction, non-infectious uveitis, and choroidal neovascular age-related macular degeneration. Conclusion: Women who experience HDP may be at future risk of retinal and other ophthalmic diseases, particularly diabetic retinopathy. Further observational research is required to confirm these associations.