Ophthalmic Artery Doppler Indices and Maternal Factors in the Prediction of Preeclampsia in a High‐Risk Obstetric Population: A Prospective Cohort Study
Giselle Odette Noyola‐Landázuri, Francisco Javier Castro‐Apodaca, Ramón Jafit González‐López, Víctor Manuel Martínez‐Vera, Gloria María Peña‐García, Nidia Leon‐Sicairos, Adrian Canizalez‐RomanABSTRACT
Aim
To evaluate the utility of ophthalmic artery Doppler (OAD) indices, combined with maternal clinical factors, mean arterial pressure (MAP), and uterine artery pulsatility index (UtA‐PI), for the prediction of preeclampsia (PE) in a high‐risk obstetric population at 18–24 weeks of gestation.
Methods
Prospective cohort study conducted at a tertiary referral unit (UMAE HGO–CMNO, IMSS, Guadalajara, Mexico) from January to December 2025. Singleton pregnancies with at least one major or two minor PE risk factors per NICE/ACOG guidelines were included. Assessments comprised MAP (bilateral brachial), UtA‐PI (transabdominal Doppler), and OAD quantified as the second‐to‐first peak systolic velocity ratio (R‐PSV 1–2 ) via convex transducer over the right eye; R‐PSV 1–2 > 0.60 was defined as abnormal. Hierarchical logistic regression models and ROC analysis were constructed; significance was set at p < 0.05.
Results
Of 182 women included, 81 had abnormal OAD and 101 had normal OAD. Overall, PE occurred in 24 (13.2%): 20/81 (24.7%) in the abnormal group versus 4/101 (4.0%) in the normal group (OR 7.95, 95% CI 2.59–24.38; p < 0.001). All 16 early‐onset PE cases (< 34 weeks) arose exclusively in the abnormal OAD group (sensitivity 100%, NPV 100%). The full model (clinical + MAP + UtA‐PI + OAD) achieved an AUC of 0.815 (95% CI 0.698–0.909), superior to the clinical‐only model (AUC 0.722). In multivariable analysis, abnormal OAD was the strongest independent predictor (adjusted OR, 6.49; 95% CI 1.91–22.03; p = 0.003).
Conclusions
OAD at 18–24 weeks significantly improves PE prediction in high‐risk pregnancies beyond conventional risk factors. Its perfect sensitivity and NPV for early‐onset PE support its integration into multiparametric second‐trimester screening protocols.