Maternal retinal and choroidal microvascular alterations in late-onset fetal growth restriction assessed by optical coherence tomography angiography.

BACKGROUND

Fetal growth restriction(FGR) is a common pregnancy complication leading to adverse perinatal outcomes and long-term developmental risks. Beyond placental insufficiency, increasing evidence suggests that maternal systemic and microvascular alterations may contribute to its pathophysiology. Optical coherence tomography angiography (OCTA) enables non-invasive evaluation of retinal microvasculature and may provide insights into maternal microvascular alterations in pregnancies complicated by FGR.

OBJECTIVE

To assess maternal retinal and choroidal microvascular changes in pregnancies with late-onset FGR and to examine their relationship with Doppler ultrasound parameters.

METHODS

A total of 25 pregnant women with isolated late-onset FGR and 30 healthy pregnant women with appropriate-for-gestational-age(AGA) fetuses were included.OCTA imaging was used to measure retinal and choroidal thickness, vessel density in the superficial and deep capillary plexuses, and foveal avascular zone (FAZ) area.Doppler ultrasound measurements of the umbilical artery(UA) and middle cerebral artery(MCA) pulsatility indices(PI) were also recorded and the cerebroplacental ratio (CPR) was calculated.

RESULTS

The late-onset FGR group exhibited a significantly wider FAZ area and reduced vessel density in both the superficial and deep capillary plexuses compared to the AGA group (p = 0.004,p = 0.019,p = 0.022 respectively). Choroidal thickness was significantly lower in the FGR group (p = 0.022). A positive correlation was observed between the umbilical artery PI and deep capillary plexus vessel density (p: 0.030,r: 0.486). No significant difference was found in the choriocapillaris vessel density between the groups (p = 0.928).

CONCLUSION

Maternal retinal vascular changes detected by OCTA in late-onset FGR may reflect impaired maternal hemodynamic adaptation, providing insight into underlying pathophysiological mechanisms.