Treatment of glaucoma in pregnancy

(Date of issue: February 2016. Version: 2)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What is it?

Glaucoma is an eye condition that is usually caused by abnormally high levels of fluid in the eyeball. This leads to an increase in pressure within the eyeball that can damage the optic nerve and result in sight loss.

A number of medicines are used to treat glaucoma. These include beta-blockers such as timolol, betaxolol, carteolol, and levobunolol; prostaglandin analogues such as latanoprost, bimatoprost, travoprost and tafluprost; sympathomimetics such as brimonidine and apraclonidine; miotics such as pilocarpine; and carbonic anhydrase inhibitors such as acetazolamide, brinzolamide, and dorzolamide. These medicines work by reducing the pressure within the eye. Most are given as eye drops, although some are in tablet form. Some people might require a combination of medicines to fully control their glaucoma.

Is it safe to use glaucoma treatments in pregnancy?

There is no yes or no answer to this question. When deciding whether to use glaucoma treatments during pregnancy it is important to weigh up how necessary they are to your health and eyesight against any possible risks to you or your baby, some of which might depend on how many weeks pregnant you are.

It is important to appropriately treat glaucoma in pregnancy as untreated or poorly controlled glaucoma can lead to permanent loss of vision or blindness. Your doctor is the best person to help you decide which glaucoma treatment is best for you and your baby.

Pregnant women using eye drops to treat glaucoma can reduce the amount of medicine that might be absorbed into the bloodstream by applying pressure with the finger at the inner corner of the eye for one minute or more after applying the drops, or gently closing the eyelids for one or two minutes after use.

What if I have already used glaucoma treatments during pregnancy?

If you have taken any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and to make sure that you are taking the lowest dose that works.

Are any specific glaucoma treatments advised for use in pregnancy?

There are currently no official UK guidelines for the treatment of glaucoma in pregnancy. This is because many glaucoma treatments have either not been studied at all in pregnant women, or the information available is insufficient to assess whether a particular treatment is likely to affect an unborn baby.  Untreated glaucoma can lead to permanent loss of vision and it is therefore also important to consider any risk to the mother of changing treatment during pregnancy, or if planning a pregnancy.

Medicines in eye drop form are likely to enter the bloodstream (and therefore reach the baby) in smaller amounts than if taken by mouth and would therefore be preferred for use in pregnancy if appropriate for the treatment of the mother’s glaucoma. 

Each specific glaucoma treatment will have its own risks and benefits. It is important that you discuss your treatment options with your doctor, ideally in advance of pregnancy.

Can using glaucoma treatments in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

It is not currently possible to say whether use of glaucoma treatments in pregnancy might increase the risk of birth defects in the baby.  Where studies exist for a specific treatment, they are either too small or too few in number to be useful in assessing any risk. However, timolol, a medicine commonly used to treat glaucoma comes from a family of medicines called beta-blockers, which are routinely used in pregnancy to treat high blood pressure and have therefore been relatively well studied. Studies of beta-blockers as a group have not provided conclusive evidence that use during pregnancy causes birth defects in the baby. Although very little information is available on timolol specifically, any possible risk to the baby from the eye drop form of timolol is likely to be small. In general, more research on use of glaucoma treatments in pregnancy is required.

Can taking using glaucoma treatments in pregnancy cause miscarriage or stillbirth?

There are no studies that have investigated rates of miscarriage or stillbirth following use of glaucoma treatments in pregnancy. Research into these pregnancy outcomes is therefore required.

Prostagladin analogues like latanoprost when taken by mouth can cause contractions of the womb. Because this could theoretically lead to pregnancy loss, use of prostaglandin analogues is sometimes avoided during pregnancy. However, the concentrations of these medicines that enter the bloodstream following use in eye drop form are much lower than when taken by mouth. Your doctor will be able to advise you on the risk and benefits of use of specific glaucoma treatments during pregnancy.

Can using glaucoma treatments in pregnancy cause preterm birth or my baby to be small at birth (low birth weight)?

A single small study of a mixed group of around 240 women using various glaucoma treatments provided no evidence of an increased risk of preterm birth. However the risk of having a low birth weight baby was increased in women using glaucoma treatments. Further large studies that examine different glaucoma treatments separately are required before we can say whether use of glaucoma treatments increases the risk of preterm birth or low birth weight in the baby.

Can using glaucoma treatments in pregnancy cause learning and behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

There are currently no scientific studies that have examined learning and behaviour in children of women who used glaucoma treatments during pregnancy.

Will my baby need extra monitoring during pregnancy or after delivery?

Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Using glaucoma treatments in pregnancy is not expected to cause problems that would require extra monitoring of your baby.

Babies born to women who used beta-blockers in late pregnancy might be closely monitored after birth to ensure that they are not experiencing adverse effects of beta-blocker exposure such as low heart rate, low blood sugar, and low blood pressure. Babies experiencing these effects might require treatment and support for a few hours or days after delivery.

Are there any risks to my baby if the father has used glaucoma treatments?

No studies have specifically investigated whether glaucoma treatments used by the father can harm the baby through effects on the sperm, however most experts agree that this is very unlikely. More research on the effects of medicine use in men around the time of conception is needed.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.  

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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