• Diabetes
• Diet and Nutrition
• Fitness and Exercise
• Getting Pregnant
• Prenatal Care
• Thyroid Health

Will Your Pregnancy Be High-Risk? Plan Ahead

Almost every mother-to-be hopes for a trouble-free pregnancy and birth.

And while most babies arrive without a hitch, sometimes things happen that can create a higher potential for complications for mom, baby or both. 

A high-risk pregnancy is not always cause for alarm, but it does require extra precautions and specialized care to avoid problems and danger down the road. 

Your best bet for limiting your risk is to know the risk factors well in advance of getting pregnant, and to work with your medical team to address potential problems up-front.

“At Risk” or “High Risk?”

There are actually two categories of patients who face risk during pregnancy, says David McKenna, MD, a specialist in maternal and fetal medicine at Perinatal Partners in Dayton.

In one category are mothers who are “at risk” but not necessarily “high risk.” This means they go into the pregnancy with factors that may or may not end up becoming a problem, like being over the age of 35.  

“It doesn’t necessarily mean anything will go wrong,” says Dr. McKenna. “It just means we need to keep a close eye on mom and baby.”

In the other category are mothers who are actually “high risk” as soon as they conceive. In these cases, a woman has known maternal, obstetrical, surgical or medical problems like diabetes, high blood pressure, or complications from previous births. 

“The healthier you are, and the sooner you can get in to start planning, the better.”

Risk Factors Before Pregnancy

A number of pre-existing conditions and lifestyle habits could place your pregnancy at risk. The more of these you have, the more likely you and your baby will encounter problems during pregnancy and birth.

If any of these apply to you, talk to your doctor before you conceive so you can develop a plan that ensures your good health well in advance of pregnancy.

Risk factors include:

• Being under 18 or over 35
• Heart disease
• High blood pressure
• Kidney problems
• Thyroid problems
• Sexually transmitted diseases
• Diabetes that is present prior to pregnancy.
• Cancer
• Autoimmune diseases (such as lupus)
• Blood disorders
• Being overweight or underweight
• Problematic past pregnancies
• Previous premature birth
• Having had fertility problems
• Alcohol and drug abuse 
• Smoking

Risks That Arise During Pregnancy

Some problems develop during pregnancy, not prior. These include:

• Pre-eclampsia (high blood pressure, or hypertension, which can harm the mother’s liver, kidneys and brain)
• Gestational diabetes (diabetes that develops during pregnancy)
• Pre-term labor (labor that starts before week 37)
• Placenta previa (a placenta that lies unusually low in the uterus, covering the cervix, which can cause bleeding and early delivery)
• HELLP syndrome (a rare but life-threatening liver disorder)
• Hyperemesis gravidarum (extreme nausea and vomiting) 
• Being pregnant with multiples (two or more babies at the same time) 

What Are the Consequences?

Left untreated, these risk factors and conditions can harm you, your baby or both of you. The results vary depending on the cause. For your baby, potential complications include:

• Premature birth
• Abnormally low or high birth weight
• Intellectual disabilities
• Genetic disorders
• Lung problems
• Birth defects
• Stillbirth

For mom, risk factors could lead to:

• Kidney damage
• Miscarriage
• Heart failure
• Excessive bleeding during labor
• Prolonged labor (more than 20 hours)

Planning Ahead

If you know or suspect you may be at risk, Dr. McKenna advises that you talk to your doctor before trying to get pregnant. “Meet with a maternal-fetal specialist (a physician who specializes in complicated or high-risk pregnancies), or ask your OB/GYN for advice,” he says. “Both high-risk and at-risk pregnancies require a customized plan, based on the baby’s condition and the mother’s unique circumstances. Once you’re pregnant, we can try to optimize your care, but planning in advance is the ideal approach.”

Diagnosing Risk

Good prenatal care will help to identify your potential for a high-risk pregnancy. See your doctor as soon as you know you’re pregnant. You will talk through your medical history, and you will have tests to determine whether you are likely to experience a high-risk pregnancy. 

Even if your risks are low, your doctor will continue to ask about, and monitor, your health and personal habits to avoid problems that can develop in the middle and later stages of pregnancy. 

Treating High-Risk Pregnancies

Treatment of high-risk pregnancies varies, depending on your risk factors, as well as your condition and that of your baby.

If you are at-risk or high-risk, your medical team might include a specialist in your particular risk area, in addition to your OB/GYN and a maternal-fetal specialist. For example, you would continue working with the endocrinologist who has been treating your thyroid condition prior to pregnancy, or your OB/GYN may recommend a cardiologist to manage heart problems that arise. 

How often you see medical specialists also depends on your condition. “For example, if you have diabetes, the visits or communication with us (the maternal-fetal specialist) may be more regular, maybe a few times a week,” says Dr. McKenna. “Or, if you have a stable thyroid condition, we may only see you two to three times during the pregnancy.”

Depending on your particular medical condition, and the degree of risk, you might be able to continue with your daily activities. Or, your doctors could recommend a more relaxed schedule in certain situations. 

Giving birth may result in additional complications. But, while Cesarean sections occur more frequently in women who have complicated pregnancies, many high-risk mothers can safely deliver vaginally, according to Dr. McKenna.

Preventing a High-Risk Pregnancy

Not all risks can be avoided. However, experts agree that developing healthy habits before pregnancy, and maintaining them through delivery, are the best way to prevent many complications. 

This includes:

• Taking at least 400 micrograms of folic acid (a type of vitamin B) every day before and during pregnancy
• Making sure your immunizations are up-to-date
• Practicing healthy habits. Maintain a healthy weight, eat a nutritious diet, exercise regularly and avoid smoking, alcohol or drug use. 
• Starting prenatal visits early during pregnancy, and seeing your health provider regularly throughout the pregnancy

Getting and staying healthy, and seeing your doctor early for planning, are the keys to reducing pregnancy risk. “I’ve seen some really tragic things over the years,” Dr. McKenna says. “The healthier you are, and the sooner you can get in to start planning, the better.”

Source: American Pregnancy Association; National Institute for Child Health and Human Development, National Institutes of Health; whattoexpect.com; David McKenna, MD, Perinatal Partners