high risk pregnancy

What Is Considered A High-Risk Pregnancy?

A high-risk pregnancy can be a scary thing. 

You’re not only dealing with the physical effects of being pregnant, but you also have to worry about any complications that may arise during your pregnancy. 

Most of the time, having a baby is a natural process. After a full-term pregnancy, women go into labour on or near their due date and give birth to a healthy baby. 

A day or two later, they leave the hospital to begin day-to-day life with their growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as a high-risk pregnancy.

High-risk pregnancies need to know what risks they are facing and how to take care of themselves to ensure their health and safety before, during, and after the birth of their child. 

It’s a situation every woman wants to avoid. So you’re excited about those trim lines finally appearing on the pregnancy test. 

You scheduled your first appointment, but then your OB/GYN breaks the news: you have a high-risk pregnancy. 

However, this news does not necessarily mean that anything wrong will happen.

A pregnancy is considered high-risk when potential complications could affect the mother, the baby, or both. 

High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby.

In this post, we will discuss what is considered a high-risk pregnancy and some things that can put someone at a higher risk for complications throughout their pregnancy.

What’s a “high-Risk” Pregnancy?

A “high-risk” pregnancy means a woman has one or more things that raise her — or her baby’s — chances for health problems or preterm (early) delivery.

A woman’s pregnancy might be considered high risk if she:

  • is age 17 or younger
  • is age 35 or older
  • was underweight or overweight before becoming pregnant
  • is pregnant with twins, triplets, or other multiples
  • has high blood pressure, diabetes, depression, or another health problem
  • had problems with a previous pregnancy, including premature labour or having a child with a genetic problem or congenital disability

Smoking, taking illegal drugs, and drinking alcohol also can cause health problems for a pregnant woman and her baby.

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What Determines a High-Risk Pregnancy?

Before you panic, know that a high-risk pregnancy does not automatically mean that anything wrong will happen to your baby. 

It simply means that you have a higher chance of pregnancy complications because of a medical condition or other situation. 

Many high-risk pregnancies have no complications and end in happy and healthy moms and babies.

To help ensure your health and safety, your doctor has labelled you as a high-risk pregnancy so you can receive extra attention and care. 

By becoming aware of those risks, you better avoid them.

high risk pregnancy

What Are Its Causes?

Your physician will explain why you are a high-risk pregnancy and answer all your high-risk pregnancy questions. 

Many high-risk pregnancies are entirely unavoidable; it has nothing to do with something you have done. Common unavoidable causes of high-risk pregnancies include:

  • Pregnant women under 17 or over 35 are considered high-risk pregnancies.
  • Being pregnant with multiple babies
  • Having a history of complicated pregnancies, such as preterm labour, C-section, pregnancy loss or having a child with a congenital disability
  • A family history of genetic conditions
  • Having a heart condition
  • Certain conditions such as epilepsy, kidney disease or polycystic ovary syndrome
  • Problems with the structure of the uterus, cervix or placenta
  • Rh sensitization

Risk Factors for High-Risk Pregnancy

Reasons that a pregnancy may be considered high risk include:

Maternal Age. 

One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40.

Medical conditions that exist before pregnancy. Conditions that can pose risks to the mother or baby include:

  • High blood pressure
  • Lung, kidney, or heart problems
  • Diabetes
  • Depression
  • Obesity
  • Autoimmune disease
  • Sexually transmitted diseases (STDs)
  • Long-term (chronic) infections such as human immunodeficiency virus (HIV)
  • A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy.

If you have a medical condition, it’s essential to consult your doctor before you decide to become pregnant. 

Your doctor may run tests, adjust medications, or advise you of things you need to do to protect your health and your baby.

Medical conditions that occur during pregnancy. 

Even if you are healthy when you become pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect you and your baby. 

Three of the more common pregnancy-related problems are:

Preeclampsia is a syndrome that includes high blood pressure, high levels of protein in your urine, and swelling; it can be dangerous or even fatal for the mother or baby if not treated. 

With proper management, however, most women who develop preeclampsia have healthy babies. 

No one is sure what causes preeclampsia. 

You have a higher chance if you’re older, overweight, or if you had high blood pressure or diabetes before you got pregnant. Carrying more than one baby also raises your risk.

Gestational diabetes is a type of diabetes that develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies if they follow the treatment plan from their healthcare provider. 

Usually, diabetes resolves after delivery. However, women with gestational diabetes are at increased risk of developing type 2 diabetes and high blood pressure. 

You may need a C-section instead of vaginal birth to prevent injury to your baby. 

Your risk of gestational diabetes goes up if you are over 25, are pregnant with multiples, are overweight, or have had gestational diabetes or a giant baby in the past, or if someone in your family has diabetes.

Depression. Between 14% and 23% of women get depressed during pregnancy. It’s more likely if you’ve been depressed before. 

Pregnancy may be linked to depression because of hormonal changes, exhaustion, stress at home, and a lack of support. 

In turn, depression may be linked with problems during pregnancy and delivery, low birth weight, and preterm birth. 

After birth, depression can make it harder to care for yourself and your baby. Ask your doctor or midwife about treatment with talk therapy or medicine. 

Go over the risks and benefits of taking medicine while pregnant or breastfeeding.

Pregnancy-related issues. 

Often pregnancy is classified as high risk because of issues that arise from the pregnancy itself and have little to do with the mother’s health. These include:

Premature labour is labour that begins before 37 weeks of pregnancy. About 12% of babies born are born early. 

Preemies have higher odds of health problems or developmental delays later on. 

Although there is no way to know which women will have preterm labour or birth, factors place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth.

Multiple births mean you carry more than one baby (twins, triplets, quadruplets, etc.). 

Multiple pregnancies, which are more common as women use more infertility treatments, increase the risk of premature labour, gestational diabetes, and pregnancy-induced high blood pressure. 

These babies have a higher risk for long-term health problems such as delayed development or cerebral palsy. But keep in mind that most multiples are born healthy.

Placenta previa is a condition in which the placenta covers the cervix. The condition can cause bleeding, especially if a woman has contractions. 

If the placenta still covers the cervix close to delivery, the doctor may schedule a cesarean section to reduce bleeding risks to the mother and baby.

Fetal problems, which can sometimes be seen on ultrasound. Approximately 2% to 3% of all babies have a minor or major structural problem in development. 

Sometimes there may be a family history of fetal problems, but these problems are entirely unexpected.

Still, a healthy lifestyle can help reduce your pregnancy risks, even if the cause is unavoidable. To have a healthier pregnancy:

  • Maintain a healthy weight, which includes not being underweight (not too much or too little).
  • Eat a healthy diet (getting plenty of fruits, vegetables, whole grains, lean meats, etc.) Exercise as per your doctor’s recommendations
  • Get rest when you can
  • Limit your caffeine intake
  • Avoid smoking, drinking or illegal drugs
  • Follow your recommended prenatal care
  • See your doctor early in and throughout your pregnancy for prenatal care.
  • Protect yourself from infections. 
  • Wash your hands well and often; do not eat raw meat, fish, or unpasteurized cheese; get any immunizations your doctor recommends, and use condoms to protect against STDs.
  • Reduce stress in your life.

Checking the Fetus in a High-Risk Pregnancy

A biophysical profile (BPP) may be scheduled for women whose pregnancies are considered high-risk. 

This is a test that checks fetal health. It combines a nonstress test (NST) with an ultrasound exam, usually done after the 28th week of pregnancy.

An NST is usually done to evaluate the health of the fetus.

It involves placing a fetal monitor on the mother’s abdomen and interpreting the fetal heart rate in response to fetal movements. 

It generally takes 20 to 30 minutes, and you don’t need to stay overnight in the hospital.

Interpretation of the nonstress test can sometimes be misleading; there is a relatively high rate of false-positive results, which means the test may come back positive when the fetus is well. As a result, it’s hard to decide what to do next.

The BPP makes that less likely by combining the nonstress test with an ultrasound exam. It also takes 30 minutes and can be done on an outpatient basis.

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The ultrasound exam checks four things:

  • Fetal tone
  • Fetal breathing
  • Fetal movements
  • Amniotic fluid volume

Each of these, plus the nonstress test, gets a score from 0 to 2. The scores are added up for a maximum of 10. 

The interpretation of the BPP score depends on the clinical situation. In general, a score of 8 or 10 is considered normal, but a score below eight usually requires further evaluation or delivery of the baby.

What Steps Can I Take to Promote a Healthy Pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you want to do whatever you can to prevent a high-risk pregnancy, stick to the basics. For example:

high risk pregnancy (2)

Schedule a Preconception Appointment.

If you’re thinking about becoming pregnant, consult your healthcare provider. 

They might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before becoming pregnant. 

If you have a medical condition, your treatment might be adjusted in preparation for pregnancy. 

Your health care provider might also discuss your risk of having a baby with a genetic condition.

Seek Regular Prenatal Care.

Prenatal visits can help your health care provider monitor your health and your baby’s health. 

You might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.

Avoid Risky Substances.

If you smoke, quit. Alcohol and illegal drugs are off-limits, too. 

Talk to your health care provider about any over-the-counter and prescription medications or supplements you’re taking.

Do I Need Special Tests?

Depending on the circumstances, your health care provider might recommend:

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.

Prenatal Cell-Free DNA (CFDNA) Screening. 

During this procedure, DNA from the mother and fetus is extracted from a maternal blood sample, and the fetal DNA is screened for the increased chance of specific chromosome problems.

Invasive Genetic Screening. 

Your health care provider might recommend amniocentesis or chorionic villus sampling (CVS). 

During amniocentesis, a fluid sample that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. 

After week 15 of pregnancy, amniocentesis can identify certain genetic conditions and severe abnormalities of the brain or spinal cord (neural tube defects). 

During CVS, a sample of cells is removed from the placenta. Typically done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.

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 labour.

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 ultrasound is used to check on a baby’s well-being. It might involve only ultrasound to evaluate fetal well-being or fetal heart rate monitoring (nonstress test) depending on the ultrasound results.

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. 

The decision to pursue these tests is up to you and your partner. Discuss the risks and benefits with your healthcare provider.

Preventing and Treating 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 becoming pregnant. 

At this appointment, your doctor may recommend steps you can take to reduce the risk of specific problems. These include:

  • Getting at least 400 micrograms of folic acid daily, starting before and continuing through pregnancy
  • Getting recommended 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)
  • Taking only the over-the-counter and prescription medicines that your doctor or midwife has OK’d for you
  • Seeing your doctor regularly
  • Working with them to manage problems such as diabetes, depression, high blood pressure, or infection

If your pregnancy is considered high risk, your doctor may refer you to a perinatologist. 

Also called a maternal-fetal medicine specialist, a perinatologist is an obstetrician with special training in high-risk pregnancy care. 

This specialist will work with your other doctors, nurses, and other health care professionals to ensure the best possible outcome for both you and your baby.

What Else Do I Need to Know About High-Risk Pregnancy?

Talk to your health care provider about managing any medical conditions you experience during pregnancy and how your health might affect labour and delivery. 

Contact your health care provider if you have:

  • Vaginal bleeding or watery vaginal discharge
  • Severe headaches
  • Pain or cramping in the lower abdomen
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision
  • Sudden or severe swelling in the face, hands or fingers
  • Fever or chills
  • Vomiting or persistent nausea
  • Dizziness
  • Thoughts of harming yourself or your baby

A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.

What Should I Do If I’m at Risk?

If you are labelled as a high-risk pregnancy, you and your doctor will work together to create a prenatal care plan that helps keep you and your baby safe

This plan may include the following high-risk pregnancy tips:

  • Additional prenatal appointments, tests or ultrasounds
  • A meeting with a genetic counsellor
  • A discussion with a maternal-fetal medicine physician who specializes in high-risk pregnancies
  • A healthy diet plan
  • A plan for safe exercise (or no exercise)
  • Smoking cessation help
  • In extreme cases, bed rest at home or in a hospital

Your doctor may also tell you to look out for specific symptoms, such as bleeding, pain or contractions. Of course, you should always call your doctor if you experience these symptoms.

Conclusion

High-risk pregnancies can feel like high-stress pregnancies. Though you might feel scared or anxious, try to find ways to reduce your stress and enjoy your pregnancy. For example, you can try out prenatal yoga, meditation or other calming techniques.

Remember that your physician’s number one goal is to protect the health of you and your baby. Therefore, always follow their advice and never be afraid to ask a question.

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