The effect of pregnancy on the course of uveitis in single and multiple pregnancies

Purpose To explore the effect of pregnancy on the clinical course, outcome, and treatment in multiparous women with non-infectious uveitis. Methods Retrospective study of women with a history of non-infectious uveitis and pregnancies prior to and during disease course. Disease activity and severity 1-year prior pregnancy, during pregnancy, and 1-year postpartum were recorded as well as patients’ and diseases’ characteristics. The main outcome measures included the rate and severity of uveitis attacks and the effect on ocular complications and therapies. Results Included were 32 women (70 pregnancies, mean of 2.6 pregnancies/patient), with a mean follow-up time of 6.5 years. The most common uveitis types were anterior (31%) and pan-uveitis (31%). Flare-ups were more frequent in the year prior to pregnancy, in the first trimester, and in the postpartum period and decreased markedly during pregnancy. Women who experienced a flare-up during pregnancy had a higher rate of flare-ups in the year prior pregnancy than those who did not experience a flare-up during pregnancy ( p -0.047). The rate of flare-ups 12 months’ postpartum was also higher compared to women without any flare-up during pregnancy ( p = 0.01). Severity of flare-ups in the postpartum period was worse in women who experienced a flare-up during pregnancy compared to women without flare-ups ( p = 0.001). The severity of flare-ups was higher in the first pregnancy compared to subsequent pregnancies. Conclusions Women who had active or non-controlled uveitis prior to pregnancy have higher disease activity and severity during pregnancy as well. The first pregnancy seems to behave differently from subsequent pregnancies, in terms of disease severity.