What is a High-Risk Pregnancy?

Pregnancy is an exciting journey, but for some women, it comes with added challenges. A high-risk pregnancy means there’s a greater chance of complications for the mother, the baby, or both. The good news? With early monitoring, healthy habits, and the right medical support, many women with high-risk pregnancies go on to have safe deliveries and healthy babies.

What Does a High-Risk Pregnancy Mean?

A high-risk pregnancy is a pregnancy that carries an increased risk of health problems for the mother, the baby, or both. While all pregnancies come with health risks, some are more likely to lead to potential complications and require extra care for the mother or the baby. 

That said, a higher-risk pregnancy does not necessarily mean that you or your baby will encounter health problems. With the right care and medical support, many mothers with high-risk pregnancies go on to have normal labor experiences and deliver healthy babies. 

High-Risk Pregnancy Age  

Women are born with a limited number of eggs in their ovaries. In the mid-to-late-30s, both the quantity and the quality of the eggs decline. Additionally, women aged 35 years and older more frequently experience age-related health complications that result in a higher rate of pregnancy-related complications, and therefore, these women are considered high-risk in terms of pregnancy. 

A pregnancy after 35 is called “advanced maternal age” (AMA). This term has replaced the earlier term “geriatric pregnancy.”

Common Causes and Risk Factors

According to the American College of Obstetricians and Gynecologists and the National Institute of Child Health and Human Development, many factors can increase risks during pregnancy, including: 

• Young or old maternal age: Women above the age of 35 or below 18 are at a higher risk of pregnancy-related complications.  

• An unhealthy lifestyle: Smoking cigarettes, drinking alcohol, and the use of substances during pregnancy, such as illicit drugs and alcohol, can contribute to health problems, including low birth weight, premature labor, and premature birth.  

• Medical conditions: Certain health conditions, such as diabetes, high blood pressure, heart disease, and thyroid disease, may increase the health risks in a pregnancy. 

• Being overweight or obese: Having a high BMI can complicate the labor and delivery process, potentially increasing the chances of a miscarriage or stillbirth. Being overweight or obese during pregnancy can also increase the risk of gestational diabetes. 

• Multiple gestation (multiple pregnancies): Women carrying multiple babies at once (twins, triplets, etc) are considered high risk due to a greater chance of complications to both mother and baby. The most common complications of these pregnancies include preterm delivery, anemia, high blood pressure, miscarriage, twin-to-twin transfusion syndrome, and birth defects. 

Common Complications 

Pregnancy-related health conditions can increase the risks associated with a pregnancy, such as: 

High Blood Pressure and Preeclampsia  

Preeclampsia is the development of high blood pressure during pregnancy and is often associated with protein in the urine. Eclampsia is the more severe form of preeclampsia that occurs as a result of untreated high blood pressure and is characterized by the sudden onset of seizures. These conditions can increase the risk of pregnancy loss, preterm birth, organ failure, or stroke.  

Gestational Diabetes  

Gestational diabetes occurs when diabetes is diagnosed for the first time during pregnancy. According to the Centers for Disease Control and Prevention (CDC), gestational diabetes increases the risk for preterm labor, preeclampsia, and cesarean section (C-section delivery).   

Maternal Infections

Infectious diseases caused by a virus, bacteria, or fungus, such as HIV or viral hepatitis, can pose risks to both the mother and baby.

Cervical Length

An ultrasound can be done to measure the length of the cervix if symptoms of preterm labor are present. If the cervical length is between 25 and 29 mm, close monitoring with regular ultrasounds is needed throughout the pregnancy. If the cervix is less than 25 mm before 24 weeks of pregnancy, a procedure called cervical cerclage may be performed to help prevent preterm birth. 

Amniotic Fluid Complications

Oligohydramnios, or low amniotic fluid levels, is a serious condition that can raise the risk of birth defects and stillbirth. The severity of the polyhydramnios determines the course of treatment and the risk for preterm labor or cesarean delivery. 

Fetal Growth Restriction

Fetal growth restriction is a condition in which the baby is smaller than expected for the baby's gestational age. This might lead to various short and long-term complications. 

Placental Issues  

Placental abruption is a serious complication that involves the premature separation of the placenta from the uterine lining. It can be life-threatening to both the baby and the mother.

Fetal Anemia

This is a rare health problem in which the baby's red blood cell count falls below normal while the baby is still developing in the womb. 

Symptoms and Warning Signs to Watch For  

It's important to see your doctor as soon as possible if you experience any of the following symptoms while pregnant: 

• Decreased fetal activity

• Vaginal bleeding

• Abdominal pain 

• Difficulty breathing or rapid breathing

• Severe headaches

• Blurred vision

• Fever and feeling ill

• Swelling of the face, fingers, or legs 

Depending on your condition and symptoms, your doctor may schedule certain tests and examinations. These may include ultrasounds, genetic screening, lab tests, or fetal heart rate monitoring. 

You may also be recommended for further consultations with medical professionals, such as a maternal-fetal medicine specialist. These specialists are well-trained to provide comprehensive care to mothers who have high-risk pregnancies. 

Early Recognition 

Prenatal care is crucial to a healthy pregnancy with the best outcome. Scheduling prenatal appointments and routine checkups with your medical provider or obstetrician can help with the early detection of any potential fetal problems, such as genetic conditions, blood disorders, neural tube defects, growth problems, or other complications that might increase the risk of pregnancy complications. 

Management and Treatment Options

Management of a high-risk pregnancy depends on the reason you are classified as high-risk. It may include: 

• Close monitoring by your OB/GYN.

• Frequent ultrasounds to closely monitor the baby.

• Monitoring blood pressure at home

• Monitoring blood sugar levels at home and administering insulin if necessary

• Careful management of pre-existing medical conditions. 

• Labor induction and cesarean delivery if there are signs of danger.

If you are a high-risk pregnancy, it’s important to keep all prenatal care appointments. This will ensure any complications are diagnosed and treated early and give you the best chance of delivering a healthy baby.

Your OB/GYN may refer you to a maternal-fetal medicine specialist who has special training in taking care of women with high-risk pregnancies. They may also refer you to other specialists for consultations regarding pre-existing medical conditions or pregnancy-related health problems.

Lifestyle and Dietary Adjustments  

Eating a healthy diet can give you and your baby all the important nutrients needed to develop and grow. Here are some dietary recommendations:

Foods to eat:

• Protein-rich foods like lean meats, poultry, fish, eggs, beans, lentils, and tofu. 

• Iron-rich foods like spinach, beetroot, lentils, and fortified cereals. 

• Calcium-rich foods like dairy products, fortified plant-based milks, and leafy green vegetables. 

• Folate (vitamin B9) through foods like leafy green vegetables, citrus fruits, beans, and fortified cereals.

• Healthy fats like avocados, nuts, seeds, and fatty fish. 

• Whole grains like brown rice, oats, and quinoa. 

• A variety of colorful fruits and vegetables for essential vitamins, minerals, and fiber. 

Foods to limit or avoid:

• Unpasteurized dairy products.

• Raw or undercooked seafood.

• Raw or undercooked meat and poultry. 

• Excessive caffeine (stick to less than 200mg of caffeine daily)

• Alcohol.

• Processed foods containing unhealthy fats, sodium, and added sugars. 

• Excessive sodium.

Preparing for a High-Risk Pregnancy  

While all pregnancies come with risks, there are a few things that mothers with high-risk pregnancies can do to increase their odds of a healthy pregnancy and a healthy baby:

• Eat a healthy diet and adhere to any food restrictions, such as avoiding raw fish or undercooked meats during pregnancy. 

• Avoid smoking, drinking alcohol, and using illegal drugs. If necessary, seek medical advice on quitting smoking or alcohol during your pregnancy. 

• Avoid secondhand smoke. 

• Take the necessary precautions to reduce the risk of infections, such as using masks or practicing good hygiene.

• Make sure you get enough sleep and follow tips to help you manage stress. 

• Practice safe sex whenever necessary to reduce the risk of contracting a sexually transmitted disease. 

• Discuss with your doctor to find out if there are any supplements, such as folic acid, that can help increase your chances of a healthy pregnancy. 

• Work with your healthcare provider to closely monitor any pre-existing health conditions like diabetes, depression, seizure disorder, and thyroid dysfunction, and ensure they are well-managed to avoid potential complications. 

• Try to maintain a healthy body weight before and during your pregnancy. You can seek advice from your healthcare professional on how to safely exercise while pregnant. 

If you're concerned, seek medical attention for you and your baby early on in your pregnancy. If you are a high-risk pregnancy, it’s important to establish a rapport and clear communication with your healthcare providers for a collaborative approach.

Coping Strategies 

• Attend the preconception appointment and all prenatal appointments and scans with your partner. 

• Take time off work if you can.

• Share responsibilities and help with household tasks, errands, and childcare. 

• Provide emotional support by listening to your partner's concerns. Validate their feelings and offer encouragement. 

• Spend quality time together, whether it's watching movies, going for walks, or simply relaxing. 

• Learn about the pregnancy, including the specific risks and potential complications associated with a pre-existing medical condition, but avoid obsessing over the information. 

• Connect with other partners through online support groups or communities. 

• Reach out to family and friends for practical help and emotional support. 

• Consider professional counseling if you're struggling to cope. 

• Practice self-care with activities that help you relax and recharge, such as exercise, hobbies, or spending time in nature.

• Maintain a healthy lifestyle and encourage your partner to do the same. 

Communicate openly and honestly about your feelings, concerns, and expectations. Discuss your fears and anxieties and share your worries with your partner and healthcare providers.