Managing a High-Risk Pregnancy

Most of the time having a baby is a natural process. After a full-term pregnancy, women go into labor on or near their due date and give birth to a healthy baby. A day or two later they leave the hospital to begin day-to-day life with their growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as a high-risk pregnancy.

A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby.

Risk Factors for High-Risk Pregnancy

Reasons that a pregnancy may be considered high risk include:

Maternal age. One of the most common risk factors for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40.

Medical conditions that exist before pregnancy. Conditions that can pose risks to the mother or baby include:

• High blood pressure
• Lung, kidney, or heart problems
• Diabetes
• Depression
• Obesity
• Autoimmune disease
• Sexually transmitted diseases (STDs)
• Long-term (chronic) infections such as human immunodeficiency virus (HIV)

A history of miscarriage, problems with a previous pregnancy, and a family history of genetic disorders are also risk factors for a high-risk pregnancy.

If you have a medical condition, it's important to consult your doctor before you decide to become pregnant. Your doctor may run tests, adjust medications, or advise you of things you need to do to protect the health of you and your baby.

Medical conditions that occur during pregnancy. Even if you are healthy when you become pregnant, it is possible to develop or be diagnosed with problems during pregnancy that can affect you and your baby. Three of the more common pregnancy- related problems are:

• Preeclampsia is a syndrome that includes high blood pressure, high levels of protein in your urine, and swelling; it can be dangerous or even fatal for the mother or baby if not treated. With proper management, however, most women who develop preeclampsia have healthy babies. No one is sure what causes preeclampsia. You have a higher chance if you’re older, if you’re overweight, or if you had high blood pressure or diabetes before you got pregnant. Carrying more than one baby also raises your risk.
• Gestational diabetes is a type of diabetes that develops during pregnancy. Women with gestational diabetes may have healthy pregnancies and babies if they follow the treatment plan from their health-care provider. Usually, the diabetes resolves after delivery. However, women with gestational diabetes are at increased risk of developing type 2 diabetes and high blood pressure. You may need a C-section instead of vaginal birth to prevent injury to your baby. Your risk of gestational diabetes goes up if you are over 25, are pregnant with multiples, are overweight, or have had gestational diabetes or a very large baby in the past, or if someone in your family has diabetes.
• Depression. Between 14% and 23% of women get depressed during pregnancy. It’s more likely if you've been depressed before. Pregnancy may be linked to depression because of hormonal changes, exhaustion, stress at home, and a lack of support. In turn, depression may be linked with problems during pregnancy and delivery, low birth weight, and preterm birth. After birth, depression can make it harder to care for yourself and your baby. Ask your doctor or midwife about treatment with talk therapy or medicine. Go over the risks and benefits of taking medicine while pregnant or breastfeeding.

Checking the Fetus in a High-Risk Pregnancy

A biophysical profile (BPP) may be scheduled for women whose pregnancies are considered high-risk. This is a test that checks fetal health. It combines a nonstress test (NST) with an ultrasound exam, and it's usually done after the 28th week of pregnancy.

An NST is usually done to evaluate the health of the fetus. It involves placement of a fetal monitor on the mother's abdomen and interpretation of the fetal heart rate in response to fetal movements. It generally takes 20 to 30 minutes, and you don’t need to stay overnight in the hospital.

Preventing and Treating Pregnancy Complications

Even if you don't have an existing health problem, many doctors recommend a preconception appointment with your health care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems. These include:

• Getting at least 400 micrograms of folic acid daily, starting before and continuing through pregnancy
• Getting recommended immunizations
• Eating a healthy diet and maintaining proper weight
• Getting regular physical activity, unless advised otherwise by your doctor
• Avoiding cigarettes, alcohol, and drugs (except for medications approved by your doctor)
• Taking only the over-the-counter and prescription medicines that your doctor or midwife has OK’d for you
• Seeing your doctor regularly
• Working with them to manage problems such as diabetes, depression, high blood pressure, or infection

If your pregnancy is considered high risk, your doctor may refer you to a perinatologist. Also called a maternal-fetal medicine specialist, a perinatologist is an obstetrician with special training in high-risk pregnancy care. This specialist will work with your other doctors, nurses, and other health care professionals to ensure the best possible outcome for both you and your baby.

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