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Whether it’s your first pregnancy or your third, hearing your obstetrician, nurse practitioner or midwife say that your pregnancy is high risk can feel concerning. High-risk pregnancy is a term that can denote a wide variety of common conditions. Many of them are related to pre-existing conditions you may have had before becoming pregnant or conditions you may have developed while pregnant or during delivery.
A high-risk pregnancy does not necessarily mean that your pregnancy will be more difficult or challenging than a low-risk pregnancy. However, it does sometimes mean that you will need to consult a maternal-fetal medicine specialist and undergo more monitoring than someone with a low-risk pregnancy. Learn more about high-risk pregnancy from Janice Henderson, M.D., a Johns Hopkins maternal-fetal medicine specialist and the coordinator of the Johns Hopkins Nutrition in Pregnancy Clinic . Q: What’s the difference between a maternal-fetal medicine specialist and an obstetrician?A: A maternal-fetal medicine specialist (perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to learn how to treat medical complications that are related to pregnancy. In addition, the maternal-fetal medicine specialist has extensive training in assessment and treatment of fetal problems. Most perinatal ultrasound is interpreted by maternal-fetal medicine specialists. You may be referred to a maternal-fetal medicine specialist if you have a pre-existing medical condition prior to pregnancy, develop a medical condition during pregnancy or have problems during delivery. Additionally, you will see a maternal-fetal medicine specialist during pregnancy if your baby has an anomaly. In this case, the maternal-fetal medicine specialist will coordinate your care as well as your baby’s care during pregnancy and at delivery with the help of a pediatric care team. Q: Should I see a maternal-fetal medicine specialist before pregnancy?A: It can be beneficial to consult with a maternal-fetal medicine specialist before pregnancy if you have one (or more) of the following:
Additionally, if you have a child affected by a genetic disorder or syndrome, a maternal-fetal medicine specialist can provide counseling and management to consider how the condition may impact your future pregnancies. Always speak with your health care provider to determine what’s best for you and your pregnancy. Q: What conditions may lead to a high-risk pregnancy?A: The following list represents the most common conditions that can lead to a high-risk pregnancy, but note that not all women with these conditions will have a high-risk pregnancy.
Q: Will all my future pregnancies be high risk?A: Having one high-risk pregnancy does not mean that all your future pregnancies will be deemed high risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time. However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance. Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.
Approved by the Society for Maternal-Fetal Medicine If your pregnancy is high-risk, it means you and your baby have a greater-than-normal chance of health problems that affect your pregnancy, labor, and delivery. Many times, these issues are temporary or treatable. But some can be dangerous or even life-threatening. Either way, you’ll need extra care and will likely see your medical team more often for visits and monitoring. Here’s what you should know. What defines a high-risk pregnancy?Some pregnancies are high-risk because of a problem that develops during the pregnancy. Others are deemed high-risk because of an existing health issue. If you have a chronic condition, you may be aware that becoming pregnant carries additional risks. Being told your pregnancy is high-risk can be a shock, and you may have many different feelings about it. You might find it tough to enjoy being pregnant because you read or hear about things that could potentially go wrong. But don’t let it discourage you. Being high-risk does not guarantee a hard time. If you are concerned about a high-risk pregnancy, ask your provider about how to deal with your feelings. Build a support network and talk to your partner, family, friends, or other people going through a similar experience. Maintaining open lines of communication can keep you informed and help you manage your emotions. High-risk pregnancy risk factorsYou may be considered high-risk if you had difficulties during a previous pregnancy – if you delivered early, for example. While this doesn't mean you’ll have the same experience again, your provider will want to keep a close eye on your progress. Many different factors can make a pregnancy high-risk, however. These include the following. Maternal age. Becoming pregnant for the first time at age 35 or older increases your changes of some complications and health problems. Age 17 and younger is considered to be a high-risk pregnancy age, as well. Medical conditions present prior to pregnancy. If you are trying to get pregnant and have a chronic illness, see a healthcare provider so you can be as healthy as possible before you conceive. These pre-existing conditions include:
Medical conditions that occur during pregnancy. It's also possible for problems to develop after conception, even if you're usually fit and healthy. These issues include:
Tobacco, alcohol and drugsSmoking tobacco or drinking alcohol raises your risk of pregnancy problems. So does using marijuana, taking illegal drugs or misusing prescription drugs. That’s because these substances can easily make it into the placenta.
It’s crucial to be open and honest with your healthcare provider about smoking, drinking, and drug use. They can help you get the support you need. High-risk pregnancy testingThere isn’t a single test that can tell you if your pregnancy is high-risk. Instead, your provider will take into account your age, previous pregnancies, health history and current health status. You’ll also undergo many tests to monitor the health of you and your baby, and to check for potential troubles. Some of these tests are screenings performed routinely for all pregnancies. Others are diagnostic tests, done to identify a specific health problem if a provider suspects something is wrong. There are many different kinds of screenings and diagnostic tests. For example:
How does being high-risk affect my care?Having a high-risk pregnancy often means going to more prenatal appointments and getting extra provider attention. You may even see a maternal-fetal medicine (MFM) doctor, a physician specially trained for these cases. Your situation will determine the exact care you and your baby receive. You might see your MFM doctor just once, or regularly throughout your pregnancy, in which case they will work with your medical team as the months roll on. Will a high-risk pregnancy affect my labor?It's worth preparing yourself for the idea that the birth experience you have may not be the one you'd choose. If your pregnancy is high-risk, you won't have the option of a home birth or going to a birthing center. You'll need to have your baby in a hospital, where you can both be monitored and where specialist care is available during and after delivery. To avoid or minimize potential troubles, you may have your labor induced. Sometimes, a vaginal birth may not be possible. If this is the case, you will have a c-section. If your baby does experience problems after delivery, such as breathing issues or an infection, extra support will be necessary. This may involve spending time in the neonatal intensive care unit (NICU), a special area of the hospital that provides medical support for newborns. Talk to your provider about what to expect during labor, so you can prepare yourself in the best way possible. How to manage a high-risk pregnancy and lower the risk of complicationsWhen you have a high-risk pregnancy, you may worry about your baby experiencing complications. This is common and completely normal. Fortunately, you can take steps to reduce the chances of pregnancy complications – beginning with getting good prenatal care. Here’s how to give your baby the best possible start:
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