Treatment of glaucoma in pregnant women and breastfeeding mothers is different than in other adult patients. All because most of the preparations used in the treatment of glaucoma belong to the group of drugs that can harm the fetus. Check out what is the treatment of glaucoma in pregnant women and nursing mothers.

Studies show that during pregnancy there are various types of hormonal changes that may affect intraocular pressure and reduce its level. The reduction in pressure in the eyes may continue for a long time after giving birth. Often, however, in women who have previously been diagnosed and treated with glaucoma, this hormonal lowering of blood pressure is not sufficient to prevent disease progression, and pharmacological treatment is required.

Glaucoma medications can harm the fetus

Most of the preparations used in the treatment of glaucoma belong to the group of drugs that can harm the fetus, therefore the treatment of pregnant women is a very big problem and discussions on this topic are ongoing. A patient who is being treated for glaucoma should always inform a doctor about a planned or present pregnancy, as the continued use of drugs, especially during the first three months of pregnancy, may disturb the development of the fetus. The use of pharmacological treatment during pregnancy has to be considered on an individual basis and applied only when the benefits outweigh the risks, i.e. where the mother may suffer loss of vision if treatment is not continued. In addition, the patient must be instructed on how to instill the drug to prevent them from reaching the nose, from where they are easily absorbed into the bloodstream and can reach the developing fetus through the placenta.

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Treatment of glaucoma in pregnant women

Due to the safety of use during pregnancy, the drugs have been divided into five groups: A, B, C, D and X, where group A are drugs for which no harm to the fetus has been demonstrated, and group X are drugs that are contraindicated in pregnant women. Drug research is conducted on animals, so we do not know much about their real effect on the human body (for obvious reasons, research onpeople).

Antiglaucoma drugs are classified into groups B and C. Brimonidine belongs to group B. Animal studies did not show any negative effects of group B drugs on the fetus. Although brimonidine has been recognized as safe, its negative effects on the central nervous system are observed. It has the ability to cross the placenta and, due to the lack of human studies, its harmful effects cannot be completely excluded.

Other glaucoma medications belong to group C and their teratogenic effects cannot be ruled out. The use of beta-blockers in minimal doses is under consideration. Drugs from the group of prostaglandins, parasympathomimetics and carbonic anhydrase inhibitors should not be used during pregnancy due to the theoretical possibility of causing defects in the baby.

It seems that due to the possibility of harm to the fetus, laser treatment is better. Most often, laser trabeculoplasty is performed, which seems to be completely safe, although it does not lower the intraocular pressure too much and is usually not effective in the development of the trabecular angle development, which can sometimes be found in young pregnant patients.

If the treatment is ineffective, you can consider laser destruction of the ciliary body or surgery.

Treatment of glaucoma in breastfeeding mothers

In the case of glaucoma patients who breastfeed a child, special procedures are also applied. Most medicines pass into breast milk and can cause side effects in babies and even impair their normal development. It is worth knowing that carbonic anhydrase inhibitors and beta receptor blockers are considered to be the safest. However, it is recommended to perform a laser procedure here, which gives a chance to lower the intraocular pressure and reduce the risk of glaucoma progression.

Worth knowing

Due to the difficulties in applying effective treatment in pregnant and breastfeeding patients, more frequent ophthalmological check-ups with intraocular pressure testing and a detailed assessment of the optic nerve disc and the progress of changes in the visual field are recommended. Without assessing the progression of the lesions, the doctor cannot be sure whether the treatment is effective and whether the discontinuation of treatment during pregnancy will not result in the destruction of the optic nerve.

About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. He specializes in modern diagnostics and treatment of glaucoma - that was italso dedicated to her doctoral dissertation defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

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Eye diseases and vision disorders