Preeclampsia and the risk of cataract extraction in life

Published:November 26, 2016DOI:


      Pregnancy-related risk factors for cataract are understudied, including the possibility that preeclampsia increases the risk of cataract later in life.


      We sought to evaluate the long-term risk of cataract extraction following a preeclamptic pregnancy.

      Study Design

      We carried out a historic cohort study of 1,108,541 women who delivered at least 1 infant in any hospital in the province of Quebec, Canada, from 1989 through 2013, including 64,350 with preeclampsia and 5732 with cataract extractions. We categorized preeclampsia by onset time and severity, and followed up women for up to 25 years after delivery. We calculated the incidence of inpatient cataract extraction for women with and without preeclampsia, and used Cox proportional hazard models to estimate hazard ratios and 95% confidence intervals for later risk of cataract extraction, adjusting for age at first delivery, total parity, metabolic disease, asthma, socioeconomic deprivation, and time period.


      Women with preeclampsia had a higher incidence of cataract extraction compared with no preeclampsia (21.0 vs 15.9/1000) and 1.20 times the risk (95% confidence interval, 1.08–1.34). Women with early-onset preeclampsia had 1.51 times the risk of cataract extraction compared with no preeclampsia (95% confidence interval, 1.14–2.00), whereas women with late-onset preeclampsia had 1.16 times the risk (95% confidence interval, 1.04–1.30). Risk was elevated by about 20% for both severe and mild preeclampsia. Preeclampsia with diabetes was associated with significantly greater risk (hazard ratio, 4.32; 95% confidence interval, 3.60–5.19).


      Women with preeclampsia, particularly preeclampsia of early onset or with diabetes, may have greater risk of cataract later in life. The underlying pathways linking preeclampsia with cataract require further investigation.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Phipps E.
        • Prasanna D.
        • Brima W.
        • Jim B.
        Preeclampsia: updates in pathogenesis, definitions, and guidelines.
        Clin J Am Soc Nephrol. 2016; 11: 1102-1113
        • Cain M.A.
        • Salemi J.L.
        • Tanner J.P.
        • et al.
        Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes.
        Am J Obstet Gynecol. 2016; 215: 484.e1-484.e14
        • Chen C.W.
        • Jaffe I.Z.
        • Karumanchi S.A.
        Pre-eclampsia and cardiovascular disease.
        Cardiovasc Res. 2014; 101: 579-586
        • Craici I.
        • Wagner S.
        • Garovic V.D.
        Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?.
        Ther Adv Cardiovasc Dis. 2008; 2: 249-259
        • Bourne R.R.A.
        • Stevens G.A.
        • White R.A.
        • et al.
        Causes of vision loss worldwide, 1990-2010: a systematic analysis.
        Lancet Glob Health. 2013; 1: e339-e349
      1. Yanoff M. Duker J.S. Ophthalmology. 4th ed. Elsevier Saunders, Philadelphia (PA)2014
        • Lindblad B.E.
        • Håkansson N.
        • Philipson B.
        • Wolk A.
        Metabolic syndrome components in relation to risk of cataract extraction: a prospective cohort study of women.
        Ophthalmology. 2008; 115: 1687-1692
        • Rautiainen S.
        • Lindblad B.
        • Morgenstern R.
        • Wolk A.
        Total antioxidant capacity of the diet and risk of age-related cataract: a population-based prospective cohort of women.
        JAMA Ophthalmol. 2014; 132: 247-252
        • Prokofyeva E.
        • Wegener A.
        • Zrenner E.
        Cataract prevalence and prevention in Europe: a literature review.
        Acta Ophthalmol. 2013; 91: 395-405
        • Truscott R.J.W.
        Age-related nuclear cataract–oxidation is the key.
        Exp Eye Res. 2005; 80: 709-725
        • Shinohara T.
        • White H.
        • Mulhern M.L.
        • Maisel H.
        Cataract: window for systemic disorders.
        Med Hypotheses. 2007; 69: 669-677
        • Wang S.B.
        • Mitchell P.
        • Plant A.J.H.
        • et al.
        Cataract surgery is more prevalent and occurs at an earlier age in a high cardiovascular risk cohort: comparison with the Blue Mountains eye study.
        Int J Cardiol. 2016; 212: 72-75
        • Feng Y.
        • Xu J.
        • Zhou Q.
        • et al.
        Alpha-1 antitrypsin prevents the development of preeclampsia through suppression of oxidative stress.
        Front Physiol. 2016; 7: 176
        • Roos N.M.
        • Wiegman M.J.
        • Jansonius N.M.
        • Zeeman G.G.
        Visual disturbances in (pre)eclampsia.
        Obstet Gynecol Surv. 2012; 67: 242-250
        • Mol B.
        • Roberts C.
        • Thangaratinam S.
        • et al.
        Lancet. 2016; 387: 999-1011
        • Tuzcu Z.B.
        • Asicioglu E.
        • Sunbul M.
        • et al.
        Circulating endothelial cell number and markers of endothelial dysfunction in previously preeclamptic women.
        Am J Obstet Gynecol. 2015; 213: 533.e1-533.e7
        • Kvehaugen A.S.
        • Dechend R.
        • Ramstad H.B.
        • et al.
        Endothelial function and circulating biomarkers are disturbed in women and children after preeclampsia.
        Hypertension. 2011; 58: 63-69
        • Auger N.
        • Le T.U.N.
        • Park A.L.
        • Luo Z.-C.
        Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study.
        BMC Pregnancy Childbirth. 2011; 11: 67
      2. Ministère de la Santé et des Services sociaux.
        Cadre normatif du système Med-Écho (Maintenance et exploitation des données pour l'étude de la clientèle hospitalière). Gouvernement du Québec, Québec, Québec2016: 1-259
        • Melamed N.
        • Ray J.G.
        • Hladunewich M.
        • et al.
        Gestational hypertension and preeclampsia: are they the same disease?.
        J Obstet Gynaecol Can. 2014; 36: 642-647
        • Magee L.
        • Pels A.
        • Helewa M.
        • et al.
        Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary.
        J Obstet Gynaecol Can. 2014; 36: 416-441
        • Auger N.
        • Fraser W.
        • Healy-Profitós J.
        • Arbour L.
        Association between preeclampsia and congenital heart defects.
        JAMA. 2015; 314: 1588-1598
        • Howe C.J.
        • Cole S.R.
        • Westreich D.J.
        • et al.
        Splines for trend analysis and continuous confounder control.
        Epidemiology. 2011; 22: 874-875
        • Lau B.
        • Cole S.
        • Gange S.
        Competing risk regression models for epidemiologic data.
        Am J Epidemiol. 2009; 170: 244-256
        • Zheng Selin J.
        • Orsini N.
        • Ejdervik Lindblad B.
        • Wolk A.
        Long-term physical activity and risk of age-related cataract: a population-based prospective study of male and female cohorts.
        Ophthalmology. 2015; 122: 274-280
        • Kanthan G.L.
        • Wang J.J.
        • Burlutsky G.
        • et al.
        Exogenous estrogen exposure, female reproductive factors and the long-term incidence of cataract: the Blue Mountains eye study.
        Acta Ophthalmol. 2010; 88: 773-778
        • Klein B.E.
        • Klein R.
        • Lee K.E.
        Reproductive exposures, incident age-related cataracts, and age-related maculopathy in women: the Beaver Dam eye study.
        Am J Ophthalmol. 2000; 130: 322-326
        • Zetterberg M.
        Age-related eye disease and gender.
        Maturitas. 2016; 83: 19-26
        • Tian Y.
        • Wu J.
        • Xu G.
        • et al.
        Parity and the risk of cataract: a cross-sectional analysis in the Dongfeng-Tongji cohort study.
        Br J Ophthalmol. 2015; 99: 1650-1654
      3. American Academy of Ophthalmology. Frequency of ocular examinations–2015. Available at: Accessed June 21, 2016.

        • Auger N.
        • Luo Z.C.
        • Nuyt A.M.
        • et al.
        Secular trends in preeclampsia incidence and outcomes in a large Canada database: a longitudinal study over 24 years.
        Can J Cardiol. 2016; 32: 987.e15-987.e23