Impact of Pregnancy and the Postpartum Period on Noninfectious Uveitis Flare-Ups

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PURPOSE: The course of noninfectious uveitis (NIU) in the context of the immunological changes that occur throughout pregnancy and the postpartum period is not well established. This study investigates the effect of pregnancy on the risk of NIU flare-ups and examines how the frequency of flare-ups varies across the trimesters of pregnancy and the postpartum period. These findings may help ophthalmologists identify high-risk periods and improve tailored counseling for patients. METHODS: This retrospective cohort study matched patients with NIU into pregnant and non-pregnant groups. Patients were drawn from the Optum Labs Data Warehouse, with follow-up extending through pregnancy and postpartum periods. The primary outcome was the hazard ratio (HR) of NIU flare-ups estimated by the Andersen-Gill model. Other outcomes included the incidence rate (IR) of NIU flare-ups per 1,000 person-years (PY). RESULTS: A total of 2,810 women (1,405 pregnant and 1,405 matched non-pregnant) were included. Flare-up rates in the pregnant cohort were highest in the first trimester (IR, 67.5 per 1,000 PY) and the first 3 months postpartum (IR, 50.7 per 1,000 PY), with lower rates in the second (IR, 37.3 per 1,000 PY) and later postpartum (IR, 23.7 per 1,000 PY). Pregnancy was associated with a non-significant reduction in overall NIU flare-up risk (HR, 0.86; 95% CI, 0.61-1.24). CONCLUSION: While the overall reduction in flare-up risk during pregnancy was not significant, risk varied by time period. Risk was highest in the first trimester and early postpartum period, warranting closer monitoring of disease activity during these intervals.

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