OP-02 Intravitreal anti vascular endothelial growth factor injections in pregnancy: a case series and systematic review of the literature

• Published in: BMJ open ophthalmology Vol. 9; no. Suppl 1; p. A1
• Main Authors: Ong, Ariel Yuhan, Kiire, Christine, Frise, Charlotte, Bakr, Yasmin, de Silva, Samantha R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.03.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Diabetes; Miscarriage; Obstetrics; Pregnancy; Systematic review; Vascular endothelial growth factor; Women in Vision UK Winter Meeting 2023 – Abstracts
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjoo-2024-WVUK.2

IntroductionAnti-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.AimsTo explore the visual and safety (obstetric and neonatal) outcomes of anti-VEGF in pregnant women.MethodsRetrospective 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.ResultsWe 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.ConclusionIntravitreal 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.