What Makes a Pregnancy High-Risk?

Dr. Shrutika Vasudeva, MD, FACOG, with Reiter, Hill & Johnson of Advantia, says “A common question that gets asked is what makes a pregnancy high risk. Now, when planning or anticipating the birth of your baby, every woman hopes for an uneventful pregnancy and an easy delivery. And for most, that’s exactly what happens. However, women can face unexpected difficulties and complications.

“So what makes a high-risk pregnancy, high risk? It is one where—typically—certain risk factors are at play. Such as if you have a history of pre-existing diabetes, perhaps chronic high blood pressure, history of blood clots, rheumatoid arthritis, other autoimmune diseases, any kind of heart disease, or any long-standing infectious diseases such as HIV or hepatitis. Also, if you have a current or previous history of cancer, and especially psychiatric disease.

“One thing that people also forget to realize is sometimes being on medications that are generally safe but cautioned in pregnancy can also make you high risk because they could have fetal effects. Fetal risk factors that can make a pregnancy high risk are of course birth defects, chromosomal problems, genetic syndrome such as fragile X syndrome, cystic fibrosis, and again other inherited diseases as well. And then high-risk things that come along the way in pregnancy are fetal growth restriction, which basically means that the baby’s measuring small during the course of your pregnancy, and fetal anemia.

“Now, there’s also pregnancy related risk factors that can complicate a pregnancy. This includes a history of multiple miscarriages or pregnancy losses, still birth, preeclampsia, placental abruption, perhaps a history of preterm labor or pre-term premature rupture of membranes and whether you have too much amniotic fluid or too little amniotic fluid. And then of course if you’re carrying multiple gestations such as twins or triplets that can also of course make you high risk.”

What Qualifies as a High-Risk Pregnancy?

A high-risk pregnancy is one where the baby, mother or both have a higher than average risk of experiencing a pregnancy complication due to either a mother’s pre-existing conditions or health problems that develop during the pregnancy.

Having your pregnancy deemed high-risk does not mean you will experience complications or negative outcomes, just that you are more likely to. Due to this higher risk, your doctor may recommend additional support or monitoring throughout the pregnancy. That monitoring typically includes more frequent ultrasounds, regular blood pressure or urine tests, and genetic testing.

Pre-Existing Health Conditions and Pregnancy Risks

Women with one or more chronic health conditions prior to becoming pregnant, such as diabetes, high blood pressure (hypertension), heart disease, kidney disease, or autoimmune disease are often considered to be high-risk due to these pre-existing conditions. Women who have a history of multiple miscarriages or past pregnancy complications, are 35 or older or those who are obese may also meet the high-risk criteria.

It is important to discuss your health history with your OBGYN and any medications you are taking to manage long-term conditions to help your provider assess your risk and collaborate with other care providers.  

Fetal Factors That Influence Pregnancy Risk

Prior to becoming pregnant, a woman and her partner can choose to undergo carrier screening, which helps assess the likelihood of having a child with a genetic condition such as cystic fibrosis, sickle cell disease or fragile X syndrome. In the first trimester, non-invasive prenatal testing can also help provide information about the likelihood of a fetus having a chromosome condition.

The first ultrasound to confirm a pregnancy will also reveal if the pregnancy is with twins or triplets (multiples). Twin and triplet pregnancies can place additional stress on the mother and uterus. Other tests in the second and third trimesters can reveal whether a baby is experiencing a condition such as fetal growth restriction or anemia.

Each of these fetal factors may influence the likelihood of complications and can cause a pregnancy to be considered high-risk.

Pregnancy-Related Complications to Monitor

Women without long-term health concerns can sometimes develop a condition that makes a pregnancy high-risk, which is why early and ongoing prenatal care is important throughout a pregnancy. Newly diagnosed conditions such as high blood pressure after 20 weeks of pregnancy or gestational diabetes are also in need of close monitoring.

High blood pressure is a concern for pregnant women because it can advance into a more severe condition called preeclampsia in late pregnancy and the postpartum period. Gestational diabetes can also lead to high blood pressure, large birth-weight babies and other complications.

After delivery, a woman who has developed pregnancy-related complications may at higher risk of developing some conditions in the future, so she should consult with her OBGYN and general practitioner to ensure proper monitoring throughout her life.

Supporting a Healthy Pregnancy with High-Risk Factors

If your pregnancy is high-risk, following the schedule of appointments and screening tests recommended by your care team is essential for ensuring the best outcomes for you and your baby.

The same recommendations for a healthy pregnancy usually also apply to high-risk pregnancy. These include:

• Not smoking, vaping or drinking alcohol
• Taking prenatal vitamins
• Eating a healthy diet and staying hydrated
• Getting recommended vaccines
• Practicing safe sex (to reduce infection risk)
• Managing pre-existing conditions
• Maintaining a healthy weight
• Getting regular physical activity (unless your doctor has advised otherwise)
• Watching for signs of the complications that may be associated with your condition

While it is normal to sometimes feel overwhelmed with a high-risk pregnancy diagnosis, if you are regularly feeling anxious, depressed, you can also seek out help from a mental wellness provider or a specialized support group.

When to See a Maternal-Fetal Medicine Specialist

Your OBGYN may recommend that you consult with or that your pregnancy is co-managed by a maternal fetal medicine specialist to ensure your pregnancy benefits from additional testing, expertise and care if you are likely to have or already have a high-risk pregnancy. The MFM & Genetics of Advantia team partners with our OBGYNs to supplement prenatal care as appropriate for your condition and health history.

You can also choose to meet with a genetic counselor or MFM specialist if you are planning a pregnancy to better understand genetic test results, as well as conditions that may impact your pregnancy, and or advise if genetic testing would be helpful to you.

Schedule Your Prenatal Consultation Today

If you are planning a pregnancy or are already pregnant, Advantia Health providers can provide pre-conception consultations or prenatal care in consultation with our MFM & Genetics team as appropriate to your individual needs and health history. Schedule an appointment to begin your healthy pregnancy journey.