Weight Gain From Pregnancy Carries Lower Risk of Worsening Idiopathic Intracranial Hypertension 

Weight gain from pregnancy carries a lower risk of worsening papilledema and vision loss in patients with idiopathic intracranial hypertension (IIH) than weight gain without pregnancy, according to research presented at the North American Neuro-Ophthalmology Society’s 2023 Annual Meeting held in Orlando, Florida from March 11 to March 16, 2023.  

Previous research suggests that weight gain is a risk factor for recurrence of papilledema and vision loss in patients with IIH. In this epidemiological study, researcher Nathan Lambert-Cheatham, DO, and colleagues retrospectively reviewed charts for 13 patients diagnosed with IIH who had at least 2 visits with neuro-ophthalmology while pregnant. The research team compared data from baseline visits before pregnancy, pregnancy visits, and after pregnancy visits.

Compared with baseline, comparisons of Humphrey visual field (HVF) mean deviation (MD), optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), and max OCT RNFL during pregnancy were not significant (P =.51, .62, and .15, respectively). The researchers report that 3 patients had increased papilledema during pregnancy (max average OCT RNFL of 152.5, 129, and 123.5 µm), of which 2 developed new reproducible mild visual field defects (HVF ∆MD -1.78 and -4.49). 

The researchers also report that all patients gained more than the 6% weight gain typically observed in patients who experience recurrent IIH and 11 patients gained more than their weight from initial diagnosis. In addition, 8 patients experienced excess pregnancy weight gain and 6 patients had pharmacologic therapy for IIH discontinued.

“In IIH patients, weight gain appears to carry a lower risk for worsening papilledema and vision loss when associated with pregnancy,” according to the researchers. “This is suggested by the high rate of stable or even decreased disc edema in patients despite medication discontinuation and excess pregnancy weight gain. We postulate these findings may be related to changes in weight distribution or endocrine changes during pregnancy.”

Study limitations include its retrospective design and the small sample size.