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Lyndell Lim, Nathalie Chiam, Richard Stawell, Lucy Busija, Anthony Hall; The Course Of Uveitis In Pregnancy And The Postpartum. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5932.
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To examine the course of non-infectious uveitis during pregnancy.
This is a retrospective case series of patients with known non-infectious uveitis who became pregnant while receiving care at the Ocular Immunology Clinic at the Royal Victorian Eye and Ear Hospital (RVEEH), or at two large private practices in Melbourne, Victoria, Australia. The study was approved by the Human Research and Ethics committee at RVEEH and adhered to the tenets of the Declaration of Helsinki. Uveitis activity during the periods one year before pregnancy, during pregnancy and one year postpartum were recorded. Information on patient demographics, type of uveitis, medication use, sex of child and breastfeeding status were also collected. The events of flare-ups during the pre-pregnancy, pregnancy and postpartum periods were the main outcome measures. Given that the duration of follow-up varied for the pre-pregnancy, pregnancy and postpartum periods, flare-up rates were subsequently calculated per person year of follow-up rather than for the full follow-up period.
The mean age at uveitis diagnosis was 24.6 ± 8.0 years (range: 6.0—38.0), with the mean age at pregnancy being 31.1 ± 4.6 years (range: 21.9—45.3). The mean duration since uveitis diagnosis at the time of the first studied pregnancy was 6.4 ± 6.0 months (range: 0.1—23.6). The follow-up period was between the years of 1985 and 2011, with the average overall follow up per pregnancy being 30.3 ± 5.4 months (range: 12.0—33.0). The rate of flare-up was 1.188 per person year prior to pregnancy, 0.540 per person year during pregnancy and 0.972 per person year in postpartum (p<0.001 for comparison between pre-pregnancy and pregnancy; p=0.002 for comparison between pregnancy and postpartum). Rates of flare-up only began to decrease in the second trimester. After delivery, rates of flare-up rebounded and within six months postpartum, flare-up rates were not significantly different from pre-pregnancy levels (p=0.306). Even so, 19 subjects (40%) were found to have remained inactive within one year postpartum.
Uveitis activity decreased by mid pregnancy, but returned to pre-pregnancy levels within six months postpartum. These findings may be used to adjust uveitis management during pregnancy and the postpartum period.
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