What Makes a Pregnancy High Risk?

Pregnant Woman Sits with Doctor

There are several factors that can make a pregnancy high risk, including a mother’s existing health conditions, age, lifestyle, being pregnant with multiples, and health issues that are conditions of pregnancy.

While there is no formal definition of a high-risk pregnancy, they typically involve increased risk of illness or even death for the mother or baby, or increased risk of complications before and after delivery for either mother, baby, or both. Being diagnosed with a high-risk pregnancy DOES NOT mean that you won’t end up with a healthy & happy baby (or babies!)

Most pregnancies are normal and problem free: High-risk complications only occur in 6% to 8% of all pregnancies.

What is a high-risk pregnancy?

A high-risk pregnancy is one where health concerns are noted that can threaten the health or life of the mother or her unborn child, or both.

What happens if I’m diagnosed with a high-risk pregnancy?

High-risk pregnancies require extra care in order to have a healthy and successful pregnancy and delivery. Depending on the risk or severity of the high-risk pregnancy, care by a specialist such as a maternal-fetal medicine (MFM) doctor, or a perinatologist, may be recommended.

A specialist may take over a case or may work with your current healthcare provider to ensure both mother and baby are healthy and safe as the pregnancy progresses.

Depending on the severity, extra monitoring may be required including:

  • More frequent office visits
  • Additional or more frequent testing:
    • Specialized or targeted ultrasound. This type of fetal ultrasound — an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus — targets a suspected problem, such as abnormal development.
    • Amniocentesis. During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 15 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
    • Chorionic villus sampling (CVS). During this procedure, a sample of cells is removed from the placenta. Typically done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
    • Cordocentesis. Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders, blood conditions and infections.
    • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you’re at risk of preterm labor.
    • Lab tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
    • Biophysical profile. This prenatal test is used to check on a baby’s well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your health care provider.

What Symptoms Should I Watch for With My High-Risk Pregnancy?

Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

  • Vaginal bleeding
  • Severe headaches
  • Pain or cramping in the lower abdomen
  • Watery vaginal discharge — in a gush or a trickle
  • Regular or frequent contractions — a tightening sensation in the abdomen
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision

How to Reduce High-Risk Pregnancy Complications

Even if you don’t have an existing health problem, many doctors recommend a preconception appointment with your health-care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems. These include:

  • Getting at least 400 micrograms of folic acid daily beginning before and continuing through pregnancy
  • Getting proper immunizations
  • Eating a healthy diet and maintaining proper weight
  • Getting regular physical activity, unless advised otherwise by your doctor
  • Avoiding cigarettes, alcohol, and drugs (except for medications approved by your doctor)
  • See your doctor regularly

If I Have a High-Risk Pregnancy, Will My Baby Be Okay?

It’s natural for a high-risk pregnancy to cause anxiety over the health and wellness of the baby. Good prenatal care makes it possible to still have a healthy baby even if the pregnancy is high-risk. Keep the lines of communication open with your doctor and talk to him or her about your concerns and anything you can do to keep yourself and your baby as healthy as possible.

What Are My Delivery Options for My High-Risk Pregnancy?

It’s often difficult to predict which pregnancies will become high risk or when a high-risk condition might occur. That’s why planned home births typically aren’t recommended.

Receiving news that your pregnancy is considered high-risk can be incredibly scary. It’s normal to feel concerned, scared, depressed, or anxious. You may be reluctant to think about the future or even nervous about attending prenatal visits for fear you’ll hear bad news.

It’s important with a high-risk pregnancy to continue attending your appointments. Stress and anxiety can also affect your pregnancy so it’s important to try your best to reduce anxiety.

  1. Your feelings are valid
  2. Find someone to confide in
  3. Don’t attend ultrasounds or appointments alone
  4. Stay kind to your healthcare provider
  5. Get as much sleep and rest as possible
  6. Find music or TV that can help take your mind off things and calm you down
  7. When you Google, avoid forum posts – these are full of people who often have scary stories but do not return to post their outcome

Existing Health Conditions that May Make Your Pregnancy High Risk

HIV/AIDS

A mother with HIV can pass the disease to a fetus during pregnancy, labor & delivery, and even breastfeeding. Fortunately, there are effective steps that can reduce the chance of spreading HIV from mother to the baby. Medications may be effective for the mother and for the infant, as well as a C-section before the “water breaks”. Also, feeding formula instead of breastmilk can prevent mother-to-child transmission. These steps have led to a dramatic decrease in transmission—to less than 1% in the United States and other developed countries, allowing HIV-positive mom’s to have healthy babies!

High Blood Pressure

Most women with slightly high blood pressure and no instances of other disease have healthy pregnancies and deliveries. High blood pressure can be risky to the mother and fetus as, uncontrolled, it can cause damage to the mother’s kidneys and increase the risk for low birth weight or preeclampsia. It’s recommended that mothers get their blood pressure under control before getting pregnant.

Diabetes

Controlling diabetes is important both for women trying to conceive and women who are pregnant. During the earliest weeks of pregnancy (often before a woman even knows she’s pregnant) high blood sugar levels can cause birth defects. Pregnancy may change a woman’s metabolism which can require extra care or treatment for a healthy birth. Babies whose mother’s have diabetes tend to be large (LGA) and are likely to have low blood sugar soon after birth.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS have higher rates of pregnancy loss before 20 weeks of pregnancy (nearly 3x increase), higher risk of gestational diabetes, preeclampsia, and the need for a C-section. Babies born to women with PCOS also have a greater risk of dying around the time of delivery, or having complications requiring NICU stays.

Kidney Disease

For women with mild kidney disease, pregnancies can be quite healthy. Kidney disease may cause difficulties getting pregnant, and staying pregnant. Women with kidney disease are at risk of preterm delivery, low birth weight babies, and preeclampsia – in fact nearly 1/5 of women who develop preeclampsia in early pregnancy are found to have undiagnosed kidney disease. Additional treatments, changes in diet, medication, and frequent visits are necessary for pregnant women with kidney disease.

Autoimmune Diseases

A woman with an autoimmune disorder such as lupus, multiple sclerosis, etc, is at increased risk for problems during pregnancy. Certain medicines are harmful to the fetus, so working closely with your healthcare provider is very important. Risks include preterm birth, stillbirth, and more.

Thyroid Disease

Overactive or underactive thyroids can cause problems for the fetus such as heart failure, poor weight gain, and even brain development problems. Thyroid problems are usually treatable with surgery or medicine. Thyroid regulation is especially important in the first three months of pregnancy because the developing baby depends on mother’s hormones. Around week 12, a fetus will begin to produce it’s own thyroid hormone. Other risks include preeclampsia, preterm birth, and a higher risk of miscarriage.

Obesity

Obesity is related to a number of risks for poor pregnancy outcomes, such as developing gestational diabetes, LGA fetus, and an increased risk of structural problems with a baby’s heart. Dangers to the mother include an increased risk for sleep apnea and disordered sleep breathing during pregnancy. Obesity occurs when a person’s body mass index is 30 or greater. Losing weight before pregnancy and limiting weight gain during pregnancy can improve pregnancy outcomes for overweight women.

Cancer

While rare, cancer can occur during pregnancy. Breast cancer is the most diagnosed, followed by cervical cancer, thyroid cancer, Hodgkin lymphoma, melanoma, and more. Cancer treatments during pregnancy includes a large team of specialists working together, and determining risks to the mother or fetus as some treatments may harm the fetus.

Heart Disease

If you have a heart condition, it’s important to work with a doctor before becoming pregnant. Some heart conditions may develop during pregnancy such as peripartum cardiomyopathy, hypertension (high blood pressure), myocardial infarction (heart attack), heart murmurs, and arrhythmias. Babies of women with certain heart conditions may be at risk for developing heart defects. Certain medications may not be safe for women to take while pregnant.

Zika Infection

The link between Zika virus infections and birth defects is a fairly recent discovery in the medical world. Infants borh to mothers who were infected with Zika right before or during pregnancy were at higher risk for problems with the brain and nervous system. One of the most noticeable conditions of a baby born to a mother with Zika is microcephaly. Zika infections can also increase the risk of miscarriage and stillbirth.

Age and Lifestyle Factors That May Cause a High-Risk Pregnancy

Teenage Pregnancies

Women under the age of 17 who are pregnant are at a greater risk of complications than older women, such as preeclampsia and gestational high blood pressure.

Women Older Than 35

The risk for complications increase once a woman reaches 35, such as preeclampsia and gestational high blood pressure. The risk of miscarriage and genetic defects further increases after age 40.

Alcohol Use

Alcohol is used by approximately 15% of pregnant women. Alcohol may cause preterm labor, decreased production of breast milk, and even an increased risk of spontaneous abortion in the first trimester as much as 4x greater. Alcohol is known to cross the placenta, and is exposed more to the alcohol since they cannot metabolize it out of their system as effectively as mothers. Alcohol affects the development of the central nervous system, and growth of heart, eyes, legs, arms, teeth, ears, palate, and genitalia. Even low levels of alcohol consumption, such as 1 to 2 drinks per week, can exert negative effects on the baby.

Fetal alcohol syndrome may include microcephaly and facial abnormalities.

Fetal alcohol spectrum disorders may include developmental delays, increased rate of attention-deficit/hyperactivity disorder, and mild cognitive impairment.

Tobacco Use

12-20% of pregnant women smoke during pregnancy. Not only is smoking itself harmful to a pregnancy, secondhand smoke can cause problems as well. Smoking can cause:

  • Preterm labor
  • Ectopic pregnancy
  • Vaginal Bleeding
  • Problems with the placenta such as placental abruption and placenta previa
  • Birth defects
  • Low birthweight
  • Miscarriage
  • Stillbirth
  • Sudden infant death syndrome (SIDS)

Drug Use

About 5% of women (1 in 20) use illegal drugs during pregnancy, such as cocaine, ecstasy, meth, heroin, marijuana, or abuse prescription drugs such as opioids. Pregnancy complications that can arise from the use of drugs are:

  • Problems with placenta
  • Preterm labor
  • Miscarriage
  • Stillbirth
  • Premature birth
  • Low birthweight
  • Reduced head circumference (smaller than normal head size)
  • Heart defects
  • Birth defects
  • Infections such as hepatitis C, HIV, and Zika that can affect mothers who share needles and are passed on to their babies
  • Neonatal abstinence syndrome – when a baby goes into drug withdrawal after birth
  • Learning and behavior problems later in life
  • Slower-than-normal growth
  • Sudden Infant Death Syndrome (SIDS)

Conditions of Pregnancy That Cause a High-Risk Diagnosis

Multiple Gestation (Twins & Multiples)

The risk complications increases in women carrying more than one fetus. Common complications include preeclampsia, premature labor, low birth weight, gestational diabetes and preterm birth. More than 1/2 of all twins and as many as 93% of triplets are born at less than 37 weeks gestation. The need for a Cesarean increases with multiples, as does the chance of a placental abruption, and intrauterine growth restriction (IUGR).

Gestational Diabetes

Preeclampsia/Eclampsia

Previous Preterm Birth

Polyhydramnios

Oligohydramnios

Large for Gestational Age (LGA) Baby

Small for Gestational Age (SGA) Baby

Birth Defects

Genetic Conditions

Premature Labor

Placenta Previa

Having a high-risk pregnancy can be worrisome. Just know you’re not alone and that so many high-risk pregnancies deliver happy and healthy babies.

Sources:

  • https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/high-risk-pregnancy/art-20047012
  • https://www.ucsfhealth.org/conditions/high-risk_pregnancy/
  • https://americanpregnancy.org/pregnancy-complications/high-risk-pregnancy/
  • https://www.webmd.com/baby/managing-a-high-risk-pregnancy
  • https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139915/
  • https://www.marchofdimes.org/pregnancy/street-drugs-and-pregnancy.aspx
  • https://www.marchofdimes.org/pregnancy/smoking-during-pregnancy.aspx
  • https://www.endocrineweb.com/conditions/thyroid/thyroid-problems-pregnancy

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