High Risk Pregnancy

What are the risk factors for a high-risk pregnancy?

Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk.

Specific factors that might contribute to a high-risk pregnancy include:

• Advanced maternal age. Pregnancy risks are higher for mothers older than age 35.
• Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
• Maternal health problems. High blood pressure, obesity, diabetes, epilepsy, thyroid disease, heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risks.
• Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an unusual placenta position, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and rhesus (Rh) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh positive.
• Multiple pregnancy. Pregnancy risks are higher for women carrying more than one fetus.
• Pregnancy history. A history of pregnancy-related hypertension disorders, such as preeclampsia, increases the risk of having this diagnosis during the next pregnancy. If you gave birth prematurely in your last pregnancy or you’ve had multiple premature births, you’re at increased risk of an early delivery in your next pregnancy. Talk to your health care provider about your complete obstetric history.

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 simply want to do whatever you can to prevent a high-risk pregnancy, stick to the basics. For example:

• Schedule a preconception appointment. If you’re thinking about becoming pregnant, consult your health care provider. Your provider might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become 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 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 development that’s not typical.
• 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 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 serious problems 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 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 ultrasound 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 these tests is up to you and your partner. Discuss the risks and benefits with your health care provider.

What else do I need to know about high-risk pregnancy?

Talk to your health care provider about how to manage any medical conditions you have during pregnancy and how your health might affect labor 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.