title: The influence of visual impairment on pregnancy outcomes.
abstract: OBJECTIVE
  To investigate whether visually impaired women are at higher risk for adverse maternal and perinatal complications, with an emphasis on visual impairment due to autoimmune etiology.
  
  
  METHODS
  A retrospective cohort study compared obstetric, delivery complications and perinatal outcomes of patients with and without a diagnosis of visual impairment in one or both eyes. Multivariable models were conducted to control for confounders.
  
  
  RESULTS
  During the study period (1988-2012), 265,741 deliveries were included; of these 80 (0.03%) occurred in visually impaired patients. These patients were significantly older than the comparison group, and had higher rates of gestational diabetes mellitus (GDM) and severe preeclampsia. Visually impaired women had higher rates of delivery prior to 37 weeks gestation and significantly higher rate of delivery by cesarean section (CS). A multivariable analysis model demonstrated that the risk factor for CS and packed cell transfusion in visually impaired women remained significantly high even after controlling for confounders such as maternal age, ethnicity, etc. (weighted OR = 2.04; 95% CI 1.23-3.37; p = 0.006). However, visual impairment was not an independent risk factor for congenital malformations, using another multivariable model (weighted OR = 1.96; 95% CI 0.99-3.85; p = 0.051). Perinatal outcome was comparable between the groups. The sub-group of visually impaired women due to possible autoimmune etiology was 19.4% and they had higher rates of recurrent miscarriages and CS compared to the other sub-groups.
  
  
  CONCLUSIONS
  Visually impaired pregnant women are at high risk for CS and packed cell transfusion. Nevertheless, perinatal outcome is comparable to the general population.
authors.affiliation: Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel, ofirnok@yahoo.com.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ofir
authors.forename: Roy
authors.initials: R
authors.lastname: Kessous
authors.forename: Nadav
authors.initials: N
authors.lastname: Belfer
authors.forename: Tova
authors.initials: T
authors.lastname: Lifshitz
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D001766:Blindness; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D016640:Diabetes, Gestational / Q000453:epidemiology; D004420:Dystocia; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*