Preparing for a High-Risk Pregnancy

A pregnancy is considered high risk if the person giving birth and/or the fetus has an increased chance of experiencing a health problem during pregnancy or delivery, compared to a typical pregnancy.

Factors that may make a pregnancy high risk include preexisting health conditions of the pregnant person, their age, the medications they take, any health conditions they have that are related to the pregnancy or fetus, and their lifestyle factors such as substance use.

A high-risk pregnancy does not necessarily mean something will go wrong; it means that your healthcare provider is likely to monitor the pregnancy more closely and may refer you to specialists, such as a maternal-fetal medicine specialist.

This article will discuss what a high-risk pregnancy is, factors that could lead to a high-risk pregnancy, the medical specialists who may be involved, what to expect in terms of appointments, and how you can support your body and your baby during a high-risk pregnancy.

Defining High-Risk Pregnancy 

A pregnancy is considered high risk if the pregnant person, the fetus, or both have a higher risk for health problems during pregnancy or labor.

The increased risk may stem from a preexisting health condition the pregnant person has or problems with the pregnancy itself. The risk may be known before conception, develop during pregnancy, or happen quickly as the result of an event during pregnancy.

Existing Health Conditions

Certain health conditions experienced by the pregnant person can increase the risk of complications during pregnancy. These may include:

• High blood pressure: If high blood pressure is uncontrolled, there can be an increased risk of damage to the pregnant person's kidneys, low birth weight for the baby, or preeclampsia (a serious condition during pregnancy related to high blood pressure).
• Diabetes: Uncontrolled high blood sugar levels from diabetes can cause problems with the development of the fetus and lead to large babies who are likely to experience low blood sugar shortly after birth.
• Kidney disease: Kidney disease can lead to complications such as preterm labor, low birth weight, and preeclampsia.
• Polycystic ovary syndrome (PCOS): PCOS may increase the risk of pregnancy loss before 20 weeks, gestational diabetes (diabetes during pregnancy), or preeclampsia.
• Thyroid disease: An overactive or underactive thyroid gland could cause brain or heart problems for the baby or poor weight gain.
• Autoimmune disease: Autoimmune conditions, such as multiple sclerosis or lupus, can increase the risk of problems such as preterm birth. Symptoms can flare up, but some birthing parents find that symptoms improve during pregnancy.
• Human immunodeficiency virus (HIV)/AIDS: HIV (the virus that causes AIDS) can be transmitted from the birthing parent to the fetus or baby during pregnancy, birth, or breastfeeding. Effective medications and medical procedures have led to a significant decrease in birthing parent-to-baby transmission (less than 1% in the United States).
• Sexually transmitted infections (STIs): STIs such as syphilis, herpes, and others may affect the baby during pregnancy and/or birth. Screening for and treating STIs before and/or during pregnancy is recommended.
• Obesity: Birthing parents who have obesity have a higher risk of developing high blood pressure, preeclampsia, or diabetes during pregnancy.

This list is not all-inclusive. Other health conditions may increase risks during pregnancy. Talk to your healthcare provider about your medical history and any health conditions you may have.

Health Conditions During Pregnancy

Health conditions or complications may arise during the pregnancy that could lead to the pregnancy being considered high-risk. These may include:

• Pregnancy with multiples: Pregnancy with more than one baby increases the risk of delivery before 37 weeks and babies that are smaller than single babies. Having triplets or more increases the likelihood of needing to have a cesarean delivery (C-section).
• Gestational diabetes: Diabetes developed during pregnancy can cause problems such as preterm labor/delivery or high blood pressure. Healthcare providers can help a pregnant person with gestational diabetes learn to manage the condition.
  
• Preeclampsia and eclampsia: A sudden increase in the birthing parent's blood pressure after 20 weeks (preeclampsia) can cause serious and potentially long-term or fatal problems for the birthing parent and/or baby. Eclampsia (a more serious form of preeclampsia) may cause seizures or lead to coma.
• Conditions affecting the fetus: Genetic conditions, such as Down syndrome, or problems with fetal development, such as congenital heart abnormalities or fetal anemia, can make the pregnancy high risk. In some cases, treatment may be given during pregnancy, such as surgery to repair certain forms of the neural tube condition spina bifida.
  
• Previous preterm labor or delivery: If the birthing parent went into labor or gave birth before 37 weeks with a previous pregnancy, they are at a higher risk for preterm labor or birth during the current pregnancy.
• Previous miscarriages: Birthing parents who have had three or more previous miscarriages may need to be more closely monitored.
• Problems with fetal growth: Fetal growth restriction, also called intrauterine growth restriction, can be due to a number of factors, including health problems with the birthing parent or fetus, smoking, infection, or substance use. Often, a cause is not identified.
• Twin-to-twin transfusion syndrome: When identical twins share a placenta, the blood flow can become uneven between the fetuses.
• Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: HELLP is related to preeclampsia and can cause low levels of platelets (a blood cell involved in clotting), a breakdown of red blood cells, and liver damage.
• Placental abruption: The separation of the placenta from the uterus before birth can cause bleeding.
• Placenta accreta: Blood vessels and other parts of the placenta can grow too deeply into the wall of the uterus.
• Premature rupture of the membranes: The amniotic sac can rupture before 37 weeks and before the start of labor.
  
• Imbalance of amniotic fluid: Too much or too little of the fluid surrounding the fetus can be associated with complications for the pregnant person and/or fetus.
  

Some infections may also cause complications during pregnancy, including:

• Cytomegalovirus (CMV): A herpes virus
• Chorioamnionitis: An infection of the membranes that contain the amniotic fluid
• Listeria: A bacterial infection usually caused by eating contaminated food
• Toxoplasmosis: A parasitic infection often found in the feces of cats and other animals
• Zika: A virus spread by certain types of mosquitoes
  
• Group B streptococcus: A bacterial infection
• Hepatitis B and C: Viruses that affect the liver
• Fifth disease (slapped cheek syndrome): A common childhood virus
• Rubella (German measles): A viral infection that can be prevented by vaccination and that can cause eye problems (cataracts), deafness, heart problems, and brain damage in the baby if the pregnant person contracts it during pregnancy
  

Certain Medications

If you are taking certain medications, your healthcare provider may suggest alternative treatment, or make a plan to monitor you. These medications may include the psychiatric medication lithium, and the anti-seizure medications Dilantin (phenytoin), Depakene (valproic acid), and Tegretol (carbamazepine).

Don't stop taking your medication or change your treatment plan without first talking to your healthcare provider.

Age of Birthing Parent

Birthing parents who are very young, such as teenagers, are more likely than adults to experience risks such as:

• High blood pressure related to pregnancy
• Anemia (a low number of healthy red blood cells)
• Preterm labor and delivery
• Being unaware they have an STI
• Being less likely to receive prenatal care

First-time birthing parents who are over age 35 also have a higher chance of certain risks, such as:

• Pregnancy-related high blood pressure
• Gestational diabetes
• Ectopic pregnancy (implantation of the fertilized ovum outside of the uterus, resulting in a nonviable pregnancy that can be life-threatening for the pregnant person)
• Pregnancy loss
• C-section
• Prolonged labor
• Labor that does not advance
• Complications during delivery, such as bleeding
• Genetic conditions in the fetus, such as Down syndrome
• A higher likelihood of having a preexisting condition
• Preeclampsia (over age 40)
• Pregnancy with multiples
• Preterm labor
• Low birth weight of the baby

Lifestyle Factors

Some lifestyle factors can increase the risk for pregnancy complications, including:

• Alcohol use: Consuming alcohol while pregnant can lead to problems with the baby, including fetal alcohol spectrum disorders (FASDs), which may cause physical, intellectual, and developmental disabilities. Alcohol during pregnancy also can also increase the risk of pregnancy loss and sudden infant death syndrome (SIDS).
• Tobacco use: Smoking during pregnancy may increase the risk of preterm labor, certain birth abnormalities, changes to the baby's immune system, pregnancy loss, and SIDS. Secondhand smoke can also put the health of the pregnant person and fetus at risk.
  
• Substance use: Smoking cannabis during pregnancy may interfere with the fetus's brain development and could cause long-term problems. Using illicit drugs can harm the fetus in a number of ways and may increase the risk of stillbirth.

What High-Risk Pregnancy Doesn’t Mean

Having a high-risk pregnancy does not necessarily mean that:

• Your pregnancy will be more difficult than a typical pregnancy.
• Your future pregnancies will also be high risk.
• You can't have a safe, healthy pregnancy.

Many people with high-risk pregnancies go on to have a typical pregnancy and birth.

Which Providers Oversee High-Risk Pregnancy?

A perinatologist, also called a maternal-fetal medicine specialist, is a physician who has the traditional education in obstetrics and gynecology but also has an additional three years of training to treat pregnancy complications.

You may continue to see your regular healthcare provider and the perinatologist—or your perinatologist may be your primary healthcare provider—for your pregnancy.

Birthing parents with high-risk pregnancies are almost always advised to deliver in a hospital setting so that proper personnel, equipment, and monitoring are ready if needed.

The University of Utah offers a search tool on its website to help locate perinatologists in your area.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provides links to a number of resources on high-risk pregnancies.

High-Risk Pregnancy Appointments, Testing, and Follow-Up  

You may choose to meet with a perinatologist before you become pregnant if you have preexisting risk factors for a high-risk pregnancy. This allows you to discuss anything that needs to be addressed before pregnancy (such as managing blood pressure) and what pregnancy may be like. If applicable, you may choose to do prepregnancy genetic testing.

During a high-risk pregnancy, you may need more visits with your healthcare provider than is typical. You will have the standard pregnancy screenings, such as blood pressure checks and urine tests that check for protein and urinary tract infections, but you may be monitored more often. You may also have more than the standard amount of ultrasounds.

Tests that may be run during a high-risk pregnancy include:

• Amniocentesis: A sample of the amniotic fluid is tested to look for chromosome abnormalities.
• Chorionic villus sampling (CVS): Cells from the placenta are tested to look for chromosomal abnormalities and help diagnose genetic disorders.
• Fetal ultrasound: Sound waves are used to produce images of the fetus and surrounding structures and tissues.
• Fetal echocardiograms: Sound waves are used to view the fetus's heart.
• Fetal testing: This may include nonstress tests and other biophysical profiles to monitor the fetus's heart rate and health during pregnancy.

If your baby is born prematurely or has health problems, they may need to spend time at the hospital after birth, often in the neonatal intensive care unit (NICU), where they can receive the specialized care they need.

Amniocentesis

Following your healthcare provider's care directives, including follow-up instructions or appointments, is important.

What to Do If You Have a High-Risk Pregnancy

First, take a deep breath. It's natural to feel a wide array of emotions with a high-risk pregnancy. Talk to your healthcare provider about how you can manage any anxiety you are feeling and ask about resources for support.

What you read online or hear from others may not apply to you. Your healthcare provider can answer your questions, work with you to form a pregnancy and birth plan, and talk you through your concerns.

How to Support Your Body and Baby

High-risk pregnancy can't always be prevented, but as with any pregnancy, it's important to take steps to care for your body and your baby, such as:

• Get early and regular prenatal care.
• Eat a diet that supports your nutritional needs.
• Exercise regularly (if your healthcare provider says it is OK).
• Avoid alcohol, smoking, and substance use.
• Get good dental care.
• Keep all of your healthcare appointments, and follow your healthcare provider's guidance.
• Take your medications (including vitamins) as directed by your healthcare provider, and don't take any medication or supplement, including over-the-counter, without first checking with your provider.
• Take folic acid daily, ideally starting before pregnancy.
• Avoid people who are sick with contagious illnesses.
• Make sure you are up to date on your vaccinations, including flu shot (talk to your provider if you need a vaccine while pregnant).
• Continue to look after your overall health, including managing existing conditions.
• Watch for environmental hazards, like potentially harmful chemicals at home or work.
• Practice stress management techniques.

Summary

A high-risk pregnancy is one in which there is an increased risk of health problems for the birthing parent and/or baby.

A pregnancy may be considered high risk due to factors such as preexisting health conditions in the birthing parent, problems related to the pregnancy, medications the birthing parent may be taking, the age of the birthing parent, or lifestyle factors.

People with a high-risk pregnancy usually need extra monitoring and may have tests, such as an ultrasound, performed more often. A high-risk pregnancy does not necessarily mean you won't have a healthy pregnancy and birth.