Chiang Yi-Ting, Chen Jie-Hong, Chen Kuo-Hu
Department of Medical Education, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan.
Int J Mol Sci. 2025 May 29;26(11):5220. doi: 10.3390/ijms26115220.
Pregnancy orchestrates profound neurological, hormonal, and anatomical transformations in the maternal brain, preparing it for caregiving and infant bonding. Neuroimaging reveals structural changes such as gray matter reductions and white matter reorganization during pregnancy, followed by partial recovery postpartum. These adaptations are modulated by fluctuating levels of estradiol, progesterone, prolactin, and oxytocin, which coordinate neuroplasticity and behavioral readiness. At the molecular and cellular levels, pregnancy hormones drive synaptic remodeling, neurogenesis, and glial activity. Together, these changes support maternal motivation, attachment, and responsiveness, highlighting the maternal brain's dynamic plasticity across gestation and the postpartum period. Also, pregnancy induces profound physiological changes, particularly in vascular, hormonal, and neurologic systems, to support maternal and fetal health. While these adaptations are essential, they can predispose pregnant individuals to various neurologic and ophthalmic pathologies. This review explores how pregnancy-related changes-including hypercoagulability, pituitary enlargement, hormonal fluctuations, and immunological modulation-contribute to conditions such as stroke, idiopathic intracranial hypertension, preeclampsia-associated visual disturbances, and demyelinating disorders like neuromyelitis optica spectrum disorder and multiple sclerosis. Additionally, ocular manifestations of systemic diseases like diabetic retinopathy and thyroid orbitopathy are discussed. Understanding these complex interactions is critical for prompt recognition, accurate diagnosis, and appropriate management of vision-threatening and neurologically significant complications during pregnancy. Nevertheless, many aspects of physiological and pathological changes during and after pregnancy remain unknown and warrant further investigation.
怀孕会使母体大脑发生深刻的神经、激素和解剖学变化，使其为照顾婴儿和建立母婴联系做好准备。神经影像学显示，孕期会出现灰质减少和白质重组等结构变化，产后会部分恢复。这些适应性变化受雌二醇、孕酮、催乳素和催产素水平波动的调节，这些激素共同协调神经可塑性和行为准备状态。在分子和细胞水平上，孕期激素驱动突触重塑、神经发生和神经胶质活动。这些变化共同支持母体的动机、依恋和反应能力，凸显了母体大脑在整个孕期和产后的动态可塑性。此外，怀孕会引发深刻的生理变化，尤其是在血管、激素和神经系统方面，以支持母体和胎儿的健康。虽然这些适应性变化至关重要，但它们会使孕妇易患各种神经和眼科疾病。本文综述探讨了与怀孕相关的变化，包括高凝状态、垂体增大、激素波动和免疫调节，如何导致中风、特发性颅内高压、先兆子痫相关的视觉障碍以及视神经脊髓炎谱系障碍和多发性硬化症等脱髓鞘疾病。此外，还讨论了糖尿病视网膜病变和甲状腺眼病等全身性疾病的眼部表现。了解这些复杂的相互作用对于及时识别、准确诊断和适当处理孕期威胁视力和具有神经学意义的并发症至关重要。然而，孕期及产后生理和病理变化的许多方面仍不为人知，值得进一步研究。
