Abstract

Objectives: Pre-eclampsia (PE) is a multisystem pregnancy-specific disorder, and its screening remains a global health priority. The primary goals of this systematic review and meta-analysis were to accumulate all available data to assess the potential added value of maternal ophthalmic artery (OA) Doppler indices in combination with several established biophysical markers for the prediction of preterm and term PE, and to update the current knowledge regarding the clinical relevance of this biophysical marker.

Methods: This systematic review and meta-analysis was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched from inception to 31 January 2025, along with the reference lists of retrieved full-text papers. We included observational studies that reported on the screening performance of OA Doppler indices for predicting PE, preterm PE (< 37 weeks) and term PE (≥ 37 weeks) (primary outcome). Diagnostic accuracy was assessed using pooled area under the summary receiver-operating-characteristics curve (AUC), comparing screening strategies that use maternal factors alone or a combination of maternal factors, uterine artery (UtA) Doppler and mean arterial pressure, with and without the addition of OA Doppler indices.

Results: A total of six peer-reviewed papers were included in this meta-analysis, with a total of 10 408 patients. For the outcome of PE, the pooled AUC for screening using maternal factors alone was 0.71 (95% CI, 0.68-0.75) and the pooled AUC for maternal factors with OA Doppler was 0.79 (95% CI, 0.72-0.87). In cases of preterm PE, the pooled AUC for maternal factors plus OA Doppler was 0.88 (95% CI, 0.82-0.94), while the corresponding figure for women who developed term PE was 0.76 (95% CI, 0.65-0.88). The pooled AUC for the combination of maternal factors and UtA pulsatiliy index (PI) in predicting PE was 0.76 (95% CI, 0.66-0.88), while the pooled AUC for maternal factors, UtA-PI and OA Doppler was 0.85 (95% CI, 0.76-0.94). In cases of preterm PE, the pooled AUC for maternal factors and UtA-PI was 0.84 (95% CI, 0.78-0.91), while the corresponding figure for maternal factors, UtA-PI and OA Doppler was 0.88 (95% CI, 0.82-0.93). In cases of term PE, the pooled AUC of maternal factors and UtA-PI was 0.70 (95% CI, 0.62-0.78), while the corresponding figure for maternal factors, UtA-PI and OA Doppler was 0.77 (95% CI, 0.70-0.85). The pooled AUC for maternal factors, UtA-PI and mean arterial pressure (MAP) in predicting PE was 0.80 (95% CI, 0.61-1.06), and the AUC for maternal factors, UtA-PI and MAP with the addition of OA Doppler was 0.84 (95% CI, 0.61-1.15).

Conclusions: Our study revealed that the addition of OA Doppler to established screening methods may increase the AUC for the outcome of PE and, more precisely, for preterm PE, compared with models not including this marker. However, overlapping 95% CIs limit the robustness and applicability of these results. Since OA assessment is a technically straightforward and precise proxy for the less accessible intracranial circulation, it should be further evaluated by future studies focusing mainly on preterm PE, for which it may be of more value. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.