What does it mean to have a high risk pregnancy

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 factors

You 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:

• Blood disorders. When you have a condition like sickle cell disease or thalassemia, the strain of pregnancy can worsen your illness. There are also potential dangers for your baby during pregnancy and after delivery if your condition is passed down.
• Chronic kidney disease (CKD). Pregnancy can place extra stress on your kidneys. Having CKD increases your risk of miscarriage, high blood pressure, preeclampsia and delivering early.
• Depression. Left untreated, depression is also linked to some health risks for the baby. And while certain depression meds are associated with issues, as well, don’t stop taking them without first speaking to a provider. Stopping carries risks, too. It's important to know that some women experience increased symptoms of anxiety and depression during pregnancy, but your doctor can help you manage your condition with treatments that are safe for both you and your baby.
• High blood pressure. Many people with high blood pressure have perfectly normal pregnancies. However, if left untreated, your baby may grow more slowly than usual or be delivered early. Other complications related to high blood pressure include preeclampsia and placental abruption, a serious condition in which the placenta partially or completely separates from the uterus before a baby is born.
• HIV or AIDS. Your baby can become infected with either condition before birth, during delivery, or when you breastfeed. Fortunately, medication can dramatically reduce this risk.
• Lupus. Preterm delivery, preeclampsia, and low birth weight are risks connected to lupus, an autoimmune disease that often causes fatigue and joint swelling. Pregnancy may also increase the likelihood of your disease flaring up or worsening. Multiple sclerosis is another immune-related disorder that can lead to complications.
• Obesity. Having a body mass index (BMI) of 30 or higher prior to becoming pregnant puts you at greater risk for developing gestational diabetes, type 2 diabetes, and high blood pressure during your pregnancy. When it’s time to give birth, you're more likely to need your labor induced or have a cesarean delivery.
• Polycystic ovary syndrome (PCOS) or uterine fibroids. These conditions cause growths to form in your reproductive system. With PCOS, cysts form in your ovaries. If you have fibroids, benign tumors form in and around the uterus. Either can increase the risk of c-section. People with PCOS may be more prone to preeclampsia and gestational diabetes, as well.
• Thyroid disease. Having either an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) during pregnancy can cause problems for you and your baby if the condition isn't controlled. These issues can include miscarriage, preeclampsia, low birth weight, and having your baby early.
• Type 1 or type 2 diabetes. If your diabetes isn't managed well, you are at higher risk of complications including high blood pressure or preterm labor, and delivering a significantly bigger-than-average baby (macrosomia). Your baby may have problems with breathing, low glucose levels, and jaundice. Their chance of developing birth defects is also greater.

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:

• Birth defects. About 3 percent of babies have a birth defect, a health problem present at birth that develops during pregnancy. Some can be detected by ultrasound or by genetic testing before delivery. If a birth defect is suspected or diagnosed, you and your baby will be monitored more closely during pregnancy. You may need to give birth at a hospital with pediatric specialists available to care for your baby immediately.
• Genetic conditions. Sometimes, gene changes can result in your baby having disorders like cystic fibrosis or spina bifida, or chromosomal conditions such as Down Syndrome. Depending on the issue, your baby may need extra care in the womb or right after delivery. A genetic counselor can help you understand these conditions and how they might affect your family.
• Gestational diabetes. This is diabetes that develops during pregnancy. Gestational diabetes can usually be controlled by eating a healthy diet and following your treatment plan, which may include taking medication, such as insulin. Uncontrolled gestational diabetes can raise your risk of preterm birth, high blood pressure, and preeclampsia.
• Growth problems. Your provider will track your baby's growth by measuring your belly at each visit. If your baby's growth is too slow, you may need extra monitoring, and you may need to have your baby early.
• Infections. Becoming ill with certain diseases while you’re pregnant can raise the chances of birth defects. These include syphilis, hepatitis and chickenpox.
• Multiples. Carrying more than one baby at a time strains your body. So, if you become pregnant with twins or higher-order multiples (three or more babies), you'll receive extra care during your pregnancy. Preterm labor and birth are very common complications of having multiples.
• Abnormal placenta position. In most pregnancies, the placenta is located in the upper or side part of the uterus. When you have a condition called placenta previa, it’s positioned towards the bottom, blocking all or part of the cervix. With placental abruption, it prematurely splits from the uterine wall altogether. Either can cause severe bleeding and preterm labor.
• Preeclampsia. A serious condition that typically begins during the second half of pregnancy, preeclampsia occurs when you develop high blood pressure and protein leaks into your urine. It can slow the rate of your baby's growth and negatively affect your health. Giving birth is the only cure. If you develop preeclampsia, you may need to have your baby early.

Tobacco, alcohol and drugs

Smoking 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.

• Tobacco. Smoking can damage your baby’s lungs and brain. It also boosts the chances of low birth weight, premature birth and stillbirth.
• Alcohol. Drinking during pregnancy increases the risk of miscarriage, stillbirth and fetal alcohol spectrum disorders (FASDs). There is no good time or safe amount of alcohol to drink when you’re pregnant.
• Drugs. Regular substance use can have serious consequences. Some drugs are linked to birth defects and low birth weight, which can cause health problems in the long term. Your baby may also suffer from withdrawal symptoms after birth, such as sleep problems, vomiting, and seizures.

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 testing

There 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:

• A maternal blood pressure reading screens you for preeclampsia.
• A fetal ultrasound can be used as either a screening or a diagnostic test. It is used to check your baby’s growth, for example, or to look for birth defects.
• An amniocentesis is a diagnostic test that involves drawing amniotic fluid from the area around your fetus. It can detect some genetic conditions or brain abnormalities.

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 complications

When 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:

• Think ahead. If you’re not yet pregnant and believe you may have a high-risk pregnancy, schedule a preconception visit with your healthcare provider. Aim to do this at least a few months before you start trying to conceive. This will give you time to make any recommended lifestyle changes.
• Be open and honest with your provider about your health status. At your first prenatal visit, tell your healthcare provider about past and current medical problems, medications you're taking, and difficulties you had in previous pregnancies. Keep the lines of communication open throughout your pregnancy and alert a provider right away if you experience new, unusual or severe symptoms.
• Attend all prenatal visits. Listen to your provider's advice and make sure you stick to any treatment plans.
• Make healthy choices. Follow your provider's nutritional guidance and stay active if you're able. Keep an eye on weight gain, to ensure you gain a healthy amount. Don't smoke, drink alcohol, or use illegal drugs.
• Take steps to prevent infections. Wash your hands frequently. Beware of raw meats and unpasteurized dairy products. Ask someone else to change the cat litter for awhile. Make sure you’re up to date on immunizations before you start trying to conceive and speak with a healthcare provider about receiving vaccinations once you’re pregnant. Vaccinations recommended in pregnancy include:
  • The flu (influenza) vaccine
  • The COVID-19 vaccine
  • The Tdap (tetanus-diphtheria-acellular pertussis) vaccine
• Take medications as prescribed. If you have a prescription, you may need to change it while you’re pregnant to safeguard your health or your baby’s health. Never stop or start new meds without your provider’s OK.
• Protect your mental health. This may be a stressful time, so relax and reduce your stress levels where you can. Ask your partner, family, and friends for support. Speak with your provider about feelings of sadness, anxiety, or anger, especially if they begin to interfere with your day-to-day life.