Neuro-ophthalmic Complications of Pregnancy and the Postpartum Period: A Systematic Review of Pathophysiology, Diagnosis, and Clinical Outcomes

Abstract

Neuro-ophthalmic complications during pregnancy and the postpartum period are uncommon but clinically important because visual symptoms may be the first indication of neurological, vascular, hypertensive, or endocrine disease. This systematic review evaluated the pathophysiology, diagnostic features, management considerations, and reported clinical outcomes of pregnancy-related neuro-ophthalmic disorders. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, databases and registers were searched from January 1980 through December 2025. Of 540 records identified, 360 remained after prescreening removal, 112 reports were sought for retrieval, and 103 underwent full-text eligibility assessment; 37 publications were included in the qualitative synthesis. The evidence comprised heterogeneous observational studies, case series, case reports, systematic and narrative reviews, and clinical guidance, precluding meaningful quantitative pooling. Idiopathic intracranial hypertension, cerebral venous sinus thrombosis, posterior reversible encephalopathy syndrome, pituitary disorders, and optic neuritis/neuromyelitis optica spectrum disorder represented the principal clinical domains. Across these conditions, raised intracranial pressure, venous outflow impairment, endothelial dysfunction, sellar or optic-pathway compression, and inflammatory demyelination emerged as recurring, sometimes overlapping mechanisms. Reported visual outcomes ranged from recovery to persistent visual impairment, although outcome definitions and follow-up were inconsistent and much of the pregnancy-specific evidence remained observational or case-based. The reviewed literature therefore suggests physiological overlap rather than establishing a single unified mechanism. Current evidence supports prompt recognition, disorder-specific investigation, and multidisciplinary management, while prospective studies with standardised visual and maternal outcomes are needed to define prognosis and strengthen pregnancy-specific recommendations.