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Identifying a High-Risk Pregnancy
In all likelihood, you’ve heard the term “high-risk pregnancy.” However, you may not know why some pregnancies are so identified.

A pregnancy is likely to be termed “high risk” if the mother, the baby or both have a higher-than-average chance of developing complications. Pregnancies can be higher risk due to a maternal condition, such as chronic medical illness, or a fetal factor, such as exposure to an infectious disease. A prior complicated pregnancy or a history of pregnancy loss can also raise concern during a current pregnancy. Other times, pregnancies begin as low risk and become high risk when worrisome symptoms arise or prenatal tests uncover a problem.

While nobody wants to hear that her pregnancy is at increased risk, most of these pregnancies have successful outcomes with appropriate care.

Conditions that complicate pregnancies.

Maternal factors that increase the risk of complications include:
  • Being younger or older when you become pregnant—either younger than 18 or older than 35
  • Being significantly underweight or overweight
  • Having a shortened maternal height—less than 5 feet tall
  • A history of prior pregnancy complications. These include stillbirth, fetal loss, preterm labor, delivery of a small-for-gestational age or a large-for-gestational-age infant, gestational diabetes, pre-eclampsia or eclampsia.
  • A history of gynecologic conditions such as DES exposure or uterine or cervical surgery.
  • A preexisting illness such as asthma, autoimmune disease, cancer, Crohn’s disease, diabetes, heart disease, sickle cell anemia, thyroid disease or ulcerative colitis.
Conditions that may put a fetus at risk include:
  • Exposure to maternal infection such as herpes simplex, viral hepatitis, HIV, rubella, varicella (Chickenpox), syphilis, toxoplasmosis, Cytomegalovirus or Parvovirus 19.
  • Exposure to specific medications, including certain anticonvulsants, acne medication containing isotretinoin, lithium, methotrexate, streptomycin, thalidomide, tetracycline or warfarin.
  • Exposure to addictive substances such as cigarettes, alcohol, cocaine or heroine.
Symptoms and test results indicating a higher risk include:
  • Bleeding during pregnancy
  • Severe persistent nausea or vomiting
  • Placenta previa
  • A fetal anatomic or genetic disorder
  • Multiple gestation (twins, triplets or more)
  • Elevated maternal blood pressure
  • Elevated maternal blood sugar
Getting the care you need

If you have a high-risk pregnancy, you are likely to need extra medical attention. Establishing ongoing prenatal care with a competent provider is of utmost importance.

If you are not yet pregnant and know you have a medical condition that increases your risk, schedule a pre-pregnancy planning appointment. If you are already pregnant, contact your health provider to schedule a visit right away. Bring your medical records and a list of current and previous medications.

If your healthcare provider does not have expertise in providing prenatal care for someone with your condition, you may benefit from consultation with a perinatologist—an obstetrician who specializes in high-risk pregnancies. Sometimes, it’s advisable to utilize this specialist for ongoing care.

Treatment for high-risk pregnancies may involve closer monitoring, extra prenatal tests, a new medication or a specific medical procedure. In some cases, an induction of labor or a Caesarean section may be advisable to avoid further complications. All of these interventions are designed to maximize chances for a healthy outcome. This is one area where vigilant prenatal care can make a world of difference!

Laura E. Stachel M.D. Obstetrician & Gynecologist