Overview of High Risk Pregnancy

Dominique W. Brooks
Pregnant woman at doctor checkup

A pregnancy is considered high-risk if there is a condition present that increases the chances that the woman or the baby may have a health problem. If you understand the reasons for a high-risk pregnancy and what to expect, you can better take care of yourself and your baby.

What Is Considered High Risk?

There are a number of conditions or factors that may put you at high risk during a pregnancy. Some of them are pre-existing issues while others may first appear during pregnancy.

High risk pregnancy issues include:

  • Maternal age: The risks of pregnancy are higher for women 35 and older but women who will be under 17 when they deliver are also at increased risk.
  • Medical conditions before pregnancy: Issues like high blood pressure, diabetes, kidney issues, heart problems, or sexually transmitted diseases can make a pregnancy more risky.
  • Lifestyle: Smoking, drinking alcohol, or using illicit drugs increase the risk level of a pregnancy.
  • Weight: Being overweight or underweight before pregnancy can be a risk factor.
  • Pregnancy history: If you have a history of preterm labor or other pregnancy problems, you may be at higher risk for complications in future pregnancies.
  • Multiples pregnancy: It you are having twins or higher level multiples, you are considered a high risk pregnancy.
  • Complications during pregnancy: Problems with the uterus, cervix, or placenta can place your pregnancy at risk. Too much amniotic fluid, or too little fluid, or Rh compatibility issues can also increase the risks of a pregnancy. Problems with the fetus can also increase the risk as well. High blood pressure or diabetes (gestational diabetes) that may occur in pregnancy are additional challenges.

What Happens During a High Risk Pregnancy?

Once it has been established that you are at high risk, you will typically need to be followed by a team of specialists to manage your condition. Some of the specialists on your care team might include:

  • Obstetrician
  • Perinatologists or Maternal-Fetal Specialists
  • Neonatologists
  • Medical geneticists
  • Pediatric surgeons
  • Perinatal nurses
  • Diagnostic imaging team
  • Other pediatric specialists
  • Other medical specialists for the mom as needed

Each high-risk pregnancy may not require each part of this care team; it depends on the specific situation.

During a typical pregnancy, the expectant mom goes to the OB/GYN around once a month until the third trimester when the visits increase to every two weeks. At 36 weeks, the patient is usually seen every week until the baby is born. However, in a high risk pregnancy, your number of visits will increase.

You may still keep your regular appointments with your obstetrician, but you will likely have to visit the perinatologist several times and get several imaging and lab tests during your pregnancy. Depending on your health situation, you may still have to follow up with your medical specialists like your kidney doctor if you have kidney disease or your cardiologist if you have a heart problem.

Your doctors will want to keep a close eye on you and your baby to make sure things are developing as normally as possible.

Will I Need Any Tests?

Most women who are high risk will have more tests than a low-risk pregnancy. Some of the tests that you may need include:

  • Ultrasound: Most low-risk pregnancies have one ultrasound during the pregnancy. However, high-risk pregnancies usually have more than one to track development.
  • Amniocentesis: In this test, the doctor will sample the amniotic fluid - usually around 15 weeks - so that the fluid can be examined. Genetic tests can be done at this time. This procedure has a small risk of pregnancy loss.
  • Chorionic villus sampling (CVS): Sometimes, the doctor will take some cells from the placenta itself between weeks 10 and 12. These cells can be used to determine if there is a genetic problem in the pregnancy. This procedure has a small risk of pregnancy loss.
  • Cordocentesis: This test is also called percutaneous umbilical blood sampling where a sample of blood is removed from the umbilical cord. This blood can be tested for infections and genetic changes. This procedure has a small risk of pregnancy loss as well.
  • Biophysical profile: This test uses both fetal ultrasound and fetal heart rate monitoring to check on the baby's status.
  • Cervical length measurement: Using an ultrasound, your doctor may measure the length of your cervix if there is a concern about preterm labor.
  • Lab tests: You may need a number of lab tests - for example, monitoring your blood sugar levels or measuring your blood count levels - depending on your health condition.

You may not need all of these tests or you may need different ones. You and your health care team will decide which tests you need.

Increase the Odds for a Healthy Pregnancy

Just because you are high-risk does not mean that you won't have a healthy pregnancy. You should attend your doctors' appointments and follow your doctor's orders, of course. Other things you can do to promote a healthy pregnancy include:

  • Healthy diet: You should eat a healthy diet with more folic acid, iron, calcium, and other nutrients. If you have diabetes or other condition that may affect your diet, you should check with your doctor; you may need some help from a nutritionist.
  • Weight gain: Gaining the appropriate amount of weight during your pregnancy can help outcomes for you and your baby. Work with your health care provider to determine the right weight gain goal for you.
  • Lower stress levels: While a high risk pregnancy is by nature somewhat more stressful than a low-risk pregnancy, you have to try to lower your anxiety levels for the health of your baby. Talk to your doctor about stress-relieving methods including mediation, yoga, calming imagery that you can use to lower your stress.
  • Watch what you take: You should stop smoking. Drinking during pregnancy may cause problems with your baby. Illicit drugs are not good for you or the developing baby. Your doctor should know about any nutritional supplements that you are taking or that you are thinking about taking during your pregnancy; some therapies may not be helpful and may actually be harmful during pregnancy.

Birth Options

In many cases, high risk pregnancies may limit your birth options. Depending on your condition, you will probably be discouraged from a home birth because of the potential danger to you and the baby.

Conditions that may limit the possibility of a home birth:

  • Diabetes or high blood pressure
  • Preeclampsia
  • Multiple pregnancies

Discuss this with your physicians to get information and figure out your options.

Also, you may find that you need a C-section as well, depending on your health status. Some placental or uterine problems may preclude vaginal births. Again, you will have the opportunity to discuss this with your health care team; in most cases, the plans for your baby's birth will be established earlier in your pregnancy.

Once High-Risk, Always High-Risk?

If you are high risk with one pregnancy, will you be high risk with another one? It depends on the reason for the high-risk designation in the first place. If you have a medical condition like heart disease or diabetes, you will always be high risk.

Some problems may follow you throughout each pregnancy. If you had certain pregnancy-caused issues like placenta previa, you may not be high risk during your next pregnancy if you don't have the same issue. Your doctor will check you closely during subsequent pregnancies to make the determination of high risk.

You should work with your care team before you get pregnant again to optimize your future pregnancies.

Taking Precautions

If you receive a high risk diagnosis, this does not necessarily mean you will lose your baby or the baby will be born with health problems. The majority of all high risk pregnancies result in the birth of healthy babies.

What a high risk pregnancy diagnosis does mean is that it's even more important that you adhere to the advice of your OB provider and stick to a schedule of regular obstetric exams throughout your entire pregnancy. The precautions you take today may mean a world of difference.

Overview of High Risk Pregnancy