Introduction to HIGH RISK PREGNANCY

What defines a high-risk pregnancy?

Some pregnancies are high-risk because of a problem that develops during the pregnancy.
Others are deemed high-risk because of an existing health issue. If you have a chronic condition,
you may be aware that becoming pregnant carries additional risks.

Being told your pregnancy is high-risk can be a shock, and you may have many different feelings
about it. You might find it tough to enjoy being pregnant because you read or hear about things
that could potentially go wrong. But don’t let it discourage you. Being high-risk does not guarantee
a hard time.

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. It often
requires specialized care from specially trained providers.

Some pregnancies become high risk as they progress, while some women are at increased risk
for complications even before they get pregnant for a variety of reasons.

Early and regular prenatal care helps many women have healthy pregnancies and deliveries
without complications.

High-risk pregnancy risk factors

You may be considered high-risk if you had difficulties during a previous pregnancy – if you
delivered early, for example. While this doesn't mean you’ll have the same experience again, your
provider will want to keep a close eye on your progress.

Many different factors can make a pregnancy high-risk, however. These include the following.

Maternal age. Becoming pregnant for the first time at age 35 or older increases your changes of
some complications and health problems. Age 17 and younger is considered to be a high-risk
pregnancy age, as well.

Medical conditions present prior to pregnancy. If you are trying to get pregnant and have a
chronic illness, see a healthcare provider so you can be as healthy as possible before you
conceive. These pre-existing conditions include:

 Blood disorders. When you have a condition like sickle cell disease or thalassemia, the
strain of pregnancy can worsen your illness. There are also potential dangers for your
baby during pregnancy and after delivery if your condition is passed down.
 Chronic kidney disease (CKD). Pregnancy can place extra stress on your kidneys.
Having CKD increases your risk of miscarriage, high blood pressure, preeclampsia and
delivering early.

 Depression. Left untreated, depression is also linked to some health risks for the baby.
And while certain depression meds are associated with issues, as well, don’t stop taking
them without first speaking to a provider. Stopping carries risks, too. It's important to know
that some women experience increased symptoms of anxiety and depression during
pregnancy, but your doctor can help you manage your condition with treatments that are
safe for both you and your baby.

 High blood pressure. Many people with high blood pressure have perfectly normal
pregnancies. However, if left untreated, your baby may grow more slowly than usual or be
delivered early. Other complications related to high blood pressure include preeclampsia
and placental abruption, a serious condition in which the placenta partially or completely
separates from the uterus before a baby is born.

 HIV or AIDS. Your baby can become infected with either condition before birth, during
delivery, or when you breastfeed. Fortunately, medication can dramatically reduce this
risk.

 Lupus. Preterm delivery, preeclampsia, and low birth weight are risks connected to lupus,
an autoimmune disease that often causes fatigue and joint swelling. Pregnancy may also
increase the likelihood of your disease flaring up or worsening. Multiple sclerosis is
another immune-related disorder that can lead to complications.

 Obesity. Having a body mass index (BMI) of 30 or higher prior to becoming pregnant puts
you at greater risk for developing gestational diabetes, type 2 diabetes, and high blood
pressure during your pregnancy. When it’s time to give birth, you're more likely to need
your labor induced or have a cesarean delivery.

 Polycystic ovary syndrome (PCOS) or uterine fibroids. These conditions cause

growths to form in your reproductive system. With PCOS, cysts form in your ovaries. If you
have fibroids, benign tumors form in and around the uterus. Either can increase the risk of
 c-section. People with PCOS may be more prone to preeclampsia and gestational
diabetes, as well.

 Thyroid disease. Having either an underactive thyroid (hypothyroidism) or an overactive

thyroid (hyperthyroidism) during pregnancy can cause problems for you and your baby if
the condition isn't controlled. These issues can include miscarriage, preeclampsia, low
birth weight, and having your baby early.

 Type 1 or type 2 diabetes. If your diabetes isn't managed well, you are at higher risk of
complications including high blood pressure or preterm labor, and delivering a significantly
bigger-than-average baby (macrosomia). Your baby may have problems with breathing,
low glucose levels, and jaundice. Their chance of developing birth defects is also greater.

Medical conditions that occur during pregnancy. It's also possible for problems to develop
after conception, even if you're usually fit and healthy. These issues include:

 Birth defects. About 3 percent of babies have a birth defect, a health problem present at
birth that develops during pregnancy. Some can be detected by ultrasound or by genetic
testing before delivery. If a birth defect is suspected or diagnosed, you and your baby will
be monitored more closely during pregnancy. You may need to give birth at a hospital with
pediatric specialists available to care for your baby immediately.

 Genetic conditions. Sometimes, gene changes can result in your baby having disorders
like cystic fibrosis or spina bifida, or chromosomal conditions such as Down Syndrome.
Depending on the issue, your baby may need extra care in the womb or right after
delivery. A genetic counselor can help you understand these conditions and how they
might affect your family.

 Gestational diabetes. This is diabetes that develops during pregnancy. Gestational

diabetes can usually be controlled by eating a healthy diet and following your treatment
plan, which may include taking medication, such as insulin. Uncontrolled gestational
diabetes can raise your risk of preterm birth, high blood pressure, and preeclampsia.

 Growth problems. Your provider will track your baby's growth by measuring your belly at
each visit. If your baby's growth is too slow, you may need extra monitoring, and you may
need to have your baby early.
  Infections. Becoming ill with certain diseases while you’re pregnant can raise the chances
of birth defects. These include syphilis, hepatitis and chickenpox.

 Multiples. Carrying more than one baby at a time strains your body. So, if you become
pregnant with twins or higher-order multiples (three or more babies), you'll receive extra

care during your pregnancy.  Women with multiple gestations are at high risk for

preeclampsia, preterm labor and birth, hydramnios, hyperemesis gravidarum, anemia,

and antepartal hemorrhage.

 Abnormal placenta position. In most pregnancies, the placenta is located in the upper or
side part of the uterus. When you have a condition called placenta previa, it’s positioned
towards the bottom, blocking all or part of the cervix. With placental abruption, it
prematurely splits from the uterine wall altogether. Either can cause severe bleeding and
preterm labor.

 Preeclampsia. A serious condition that typically begins during the second half of
pregnancy, preeclampsia occurs when you develop high blood pressure and protein leaks
into your urine. It can slow the rate of your baby's growth and negatively affect your health.
Giving birth is the only cure. If you develop preeclampsia, you may need to have your
baby early.

Tobacco, alcohol and drugs

Smoking tobacco or drinking alcohol raises your risk of pregnancy problems. So does using
marijuana, taking illegal drugs or misusing prescription drugs. That’s because these substances
can easily make it into the placenta.

 Tobacco. Smoking can damage your baby’s lungs and brain. It also boosts the chances
of low birth weight, premature birth and stillbirth.

 Alcohol. Drinking during pregnancy increases the risk of miscarriage, stillbirth and fetal

alcohol spectrum disorders (FASDs). There is no good time or safe amount of alcohol to
drink when you’re pregnant.

 Cocaine. Cocaine use during pregnancy is associated with maternal migraines and
seizures, premature membrane rupture, and separation of the placental lining from the
uterus prior to delivery. Pregnancy is accompanied by normal cardiovascular changes,
and cocaine use exacerbates these—sometimes leading to serious problems with high
 blood pressure (hypertensive crises), spontaneous miscarriage, preterm labor, and
difficult delivery. Cocaine-using pregnant women must receive appropriate medical and
psychological care—including addiction treatment—to reduce these risks
 Drugs. Regular substance use can have serious consequences. Some drugs are linked to
birth defects and low birth weight, which can cause health problems in the long term. Your
baby may also suffer from withdrawal symptoms after birth, such as sleep problems,
vomiting, and seizures.

It’s crucial to be open and honest with your healthcare provider about smoking, drinking, and drug
use. They can help you get the support you need.

High-risk pregnancy testing

There isn’t a single test that can tell you if your pregnancy is high-risk. Instead, your provider will
take into account your age, previous pregnancies, health history and current health status. You’ll
also undergo many tests to monitor the health of you and your baby, and to check for potential
troubles.

Some of these tests are screenings performed routinely for all pregnancies. Others are diagnostic
tests, done to identify a specific health problem if a provider suspects something is wrong.

There are many different kinds of screenings and diagnostic tests. For example:

 A maternal blood pressure reading screens you for preeclampsia.

 A fetal ultrasound can be used as either a screening or a diagnostic test. It is used to

check your baby’s growth, for example, or to look for birth defects.

 An amniocentesis is a diagnostic test that involves drawing amniotic fluid from the area
around your fetus. It can detect some genetic conditions or brain abnormalities.

How does being high-risk affect my care?

Having a high-risk pregnancy often means going to more prenatal appointments and getting extra
provider attention. You may even see a maternal-fetal medicine (MFM) doctor, a physician
specially trained for these cases.

Your situation will determine the exact care you and your baby receive. You might see your MFM
doctor just once, or regularly throughout your pregnancy, in which case they will work with your
medical team as the months roll on.

How to manage a high-risk pregnancy and lower the risk of complications

When you have a high-risk pregnancy, you may worry about your baby experiencing
complications. This is common and completely normal. Fortunately, you can take steps to reduce
the chances of pregnancy complications – beginning with getting good prenatal care.

Here’s how to give your baby the best possible start:

 Think ahead. If you’re not yet pregnant and believe you may have a high-risk pregnancy,
schedule a preconception visit with your healthcare provider. Aim to do this at least a few
months before you start trying to conceive. This will give you time to make any
recommended lifestyle changes.

 Be open and honest with your provider about your health status. At your first prenatal
visit, tell your healthcare provider about past and current medical problems, medications
you're taking, and difficulties you had in previous pregnancies. Keep the lines of
communication open throughout your pregnancy and alert a provider right away if you
experience new, unusual or severe symptoms.

 Attend all prenatal visits. Listen to your provider's advice and make sure you stick to any
treatment plans.

 Make healthy choices. Follow your provider's nutritional guidance and stay active if
you're able. Keep an eye on weight gain, to ensure you gain a healthy amount. Don't
smoke, drink alcohol, or use illegal drugs.

 Take steps to prevent infections. Wash your hands frequently. Beware of raw meats
and unpasteurized dairy products. Ask someone else to change the cat litter for awhile.
Make sure you’re up to date on immunizations before you start trying to conceive and
speak with a healthcare provider about receiving vaccinations once you’re pregnant.
Vaccinations recommended in pregnancy include:

o The flu (influenza) vaccine

o The COVID-19 vaccine

o The Tdap (tetanus-diphtheria-acellular pertussis) vaccine

  Take medications as prescribed. If you have a prescription, you may need to change it
while you’re pregnant to safeguard your health or your baby’s health. Never stop or start
new meds without your provider’s OK.

 Protect your mental health. This may be a stressful time, so relax and reduce your
stress levels where you can. Ask your partner, family, and friends for support. Speak with
your provider about feelings of sadness, anxiety, or anger, especially if they begin to
interfere with your day-to-day life.

Risk factors for a high-risk pregnancy can include:

 Existing health conditions, such as high blood pressure, diabetes, or being HIV-

positive1
 Overweight and obesity. Obesity increases the risk for high blood pressure,
preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery.
NICHD researchers have found that obesity can raise infants' risk of heart problems at
birth by 15%.3
 Multiple births. The risk of complications is higher in women carrying more than one
fetus (twins and higher-order multiples). Common complications include preeclampsia,
premature labor, and preterm birth. More than one-half of all twins and as many as 93%
of triplets are born at less than 37 weeks' gestation.4
 Young or old maternal age. Pregnancy in teens and women age 35 or older increases
the risk for preeclampsia and gestational high blood pressure. Older than age 35 = It
might take longer to get pregnant. You're born with a limited number of eggs. As you
reach your mid- to late 30s, the eggs decrease in quantity and quality. Also, as you get
older, your eggs aren't fertilized as easily as they were when you were younger.

Women with high-risk pregnancies should receive care from a special team of health care
providers to ensure the best possible outcomes.

OVERVIEW

All pregnancies carry risks. The definition of a “high-risk” pregnancy is any pregnancy that
carries increased health risks for the pregnant person, fetus or both. People with high-risk
pregnancies may need extra care before, during and after they give birth. This helps to reduce
the possibility of complications.

However, having a pregnancy that’s considered high risk doesn’t mean you or your fetus will
have problems. Many people experience healthy pregnancies and normal labor and
delivery despite having special health needs.

What are the signs and symptoms of high-risk pregnancy?

Talk to your doctor right away if you experience any of the following symptoms during
pregnancy, whether or not your pregnancy is considered high-risk:

 Abdominal pain that doesn’t go away.

 Chest pain.
 Dizziness or fainting.
 Extreme fatigue.
 The fetus's movement stopping or slowing.
 Fever over 100.4°F.
 Heart palpitations.
 Nausea and vomiting that’s worse than normal morning sickness.
 Severe headache that won’t go away or gets worse.
 Swelling, redness or pain in your face or limbs.
 Thoughts about harming yourself or the fetus.
 Trouble breathing.
 Vaginal bleeding or discharge.

At what age is a pregnancy considered high risk?

People who get pregnant for the first time after age 35 have high-risk pregnancies. Research
suggests they’re more likely to have complications than younger people. These may include
early pregnancy loss and pregnancy-related health conditions such as gestational diabetes.

Young people under 17 also have high-risk pregnancies because they may be:

 Anemic.
 Less likely to get thorough prenatal care.
 More likely to have premature labor or birth.
 Unaware they have sexually transmitted infections (STIs).

What are the potential complications of high-risk pregnancy?

A high-risk pregnancy can be life-threatening for the pregnant person or fetus. Serious
complications can include:

 Preeclampsia (high blood pressure from pregnancy).

 Eclampsia (seizure from pregnancy).
 Preterm delivery.
 Cesarean delivery (C-section).
 Excessive bleeding during labor and delivery, or after birth.
 Low or high birth weight.
 Birth defects.
 Problems with the fetus's brain development.
 Neonatal intensive care unit admission for your baby.
 Intensive care unit admission for you.
 Miscarriage.
 Stillbirth.

How is high-risk pregnancy diagnosed and monitored?

Getting early and thorough prenatal care is critical. It’s the best way to detect and diagnose a
high-risk pregnancy. Be sure to tell your healthcare provider about your health history and any
past pregnancies. If you do have a high-risk pregnancy, you may need special monitoring
throughout your pregnancy.

Tests to monitor your health and the health of the fetus may include:

 Blood and urine testing to check for genetic conditions or certain congenital conditions
(birth defects).
 Ultrasonography, which uses sound waves to create images of the fetus to screen for
congenital conditions.
 Monitoring to ensure the fetus is getting enough oxygen, such as a biophysical
profile, which monitors their breathing, movements and amniotic fluid using ultrasound,
and a non-stress test, which monitors their heart rate.

MANAGEMENT AND TREATMENT

How is high-risk pregnancy managed?

Management for a high-risk pregnancy will depend on your specific risk factors. Your care plan
may include:

 Closer follow-up with your obstetrician.

 Consultation with a maternal fetal medicine (high-risk pregnancy) specialist.
 Consultation with other medical specialists.
 More ultrasounds and closer fetal evaluation.
 Home blood pressure monitoring.
 Careful monitoring of medications used to manage preexisting conditions.

If your health or the health of the fetus is in danger, your healthcare provider may
recommend labor induction or a C-section.

PREVENTION

How can I prevent a high-risk pregnancy?

You can reduce your risk of pregnancy complications by:

 Avoiding drugs and alcohol.

 Identifying potential health risks before getting pregnant. Tell your doctor about your
familial and personal medical history.
 Maintaining a healthy body weight before pregnancy.
 Managing any preexisting health conditions you may have.
 Making sure any long-term medications are safe to take during pregnancy.
 Quitting smoking.
 Planning pregnancies between the ages of 18 and 34.
 Practicing safe sex.

OUTLOOK / PROGNOSIS
What’s the prognosis (outlook) for people with high-risk pregnancy?

Many people who have high-risk pregnancies don’t experience any problems and deliver
healthy babies. But they may be at a higher risk for health problems in the future, including:

 Complications during future pregnancies.

 Postpartum depression.
 High blood pressure.
 Cardiovascular disease.
 Type 2 diabetes.
 Stroke.

Some high-risk pregnancies can increase a child’s risk of:

 Behavioral problems.
 Breathing disorders.
 Gastrointestinal diseases.
 Growth and developmental delays.
 Mental health conditions.
 Neurological disorders.
 Obesity and diabetes.
 Vision, hearing or dental problems.