High Risk Pregnancy

Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem. Many things can put you at high risk. Being called "high-risk" may sound scary. But it's just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early.

I have a high-risk pregnancy. What does that mean?

If your pregnancy is high-risk, it means you need extra care to help you have a healthy pregnancy and baby. If you're being treated for a lifelong (chronic) condition, you may have known for a long time that becoming pregnant carries additional risks. Or you may find out you have a high-risk pregnancy because of a problem that develops for the first time during pregnancy.

Either way, having a high-risk pregnancy means it's more likely that you or your baby will have health problems during pregnancy, birth, or after delivery. These could be very minor problems, but in some cases, a high-risk condition can be life threatening for a woman or her baby. That's why a high-risk pregnancy requires extra monitoring by a healthcare provider.

Being told that your pregnancy is high-risk can be a shock, and you're likely to feel a mix of emotions. You might find it difficult to enjoy your pregnancy because you're worried about your own health or your baby's health.

Ask your provider for information about your pregnancy and how to prevent or manage problems. Building a support network, talking to your partner, family and friends, or other women in a similar situation, can help you feel better informed and more in control.

It's likely you'll hear and read about many issues and complications that could affect your pregnancy. But having a high-risk pregnancy doesn't mean you won't have a healthy baby. So don't give up hope.

What causes a high-risk pregnancy?

Many factors can make a pregnancy high-risk.

You may be considered high risk if you had problems in a previous pregnancy – if you delivered a baby early, for example. This doesn't mean you'll definitely experience the same problems again, but your provider will want to keep a closer eye on you as your pregnancy progresses.

Some health conditions can make your pregnancy high-risk too. See a doctor before you start trying to get pregnant if you have a chronic condition, so you can be as healthy as possible before you conceive. There are many health conditions that affect pregnancy including:

1. Blood disorders. If you have a blood disorder, such as sickle cell disease or thalassemia, the additional strain pregnancy puts on your body can make your condition worse. There are also potential risks to your baby (both during pregnancy and after delivery) if she inherits your condition.
2. Chronic kidney disease. This condition increases your risk of miscarriage, developing high blood pressure and preeclampsia, and having your baby early. Pregnancy can also put an extra strain on your kidneys.
3. Depression.  Pregnancy and becoming a mom can make you more vulnerable to mental health problems, including anxiety and depression. Untreated depression and some medications for depression are linked with risks for your baby. (However, don't make changes to your medication without talking to your healthcare provider first. Stopping suddenly has risks too.)
4. High blood pressure. You can still have a normal pregnancy, even if you have high blood pressure. However, untreated high blood pressure can cause your baby to grow more slowly than usual or be born early. Other complications associated with 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.
5. HIV or AIDS. If you have HIV or AIDS, your baby can become infected before birth, during delivery, or when you breastfeed. Fortunately, medication can dramatically reduce this risk.
6. Lupus. Lupus and other autoimmune diseases can increase your risk of preterm delivery, preeclampsia, and having a small baby. Being pregnant may also increase the likelihood of your disease flaring up or getting worse.
7. Maternal age. Your age can affect how likely you are to have a high-risk pregnancy. Being an older mom (age 35 or older in your first pregnancy) or a younger one (in your teens) puts you at greater risk of some complications and health problems.
8. Obesity. Having a body mass index (BMI) of 30 or higher before pregnancy puts you at greater risk of gestational diabetes, type 2 diabetes, and high blood pressure during your pregnancy. When it comes to giving birth, you're more likely to need your labor induced or a cesarean delivery.
9. Thyroid disease. Both an underactive thyroid (hypothyroidism) and an overactive thyroid (hyperthyroidism) during pregnancy can cause problems for you and your baby if the condition isn't controlled. These problems can include miscarriage, preeclampsia, low birth weight, and having your baby early.
10. Type 1 or type 2 diabetes. If your diabetes isn't managed well, you could be at risk of complications including birth defects, high blood pressure, having your baby early, and having a very big baby (macrosomia). Your baby may have problems with breathing, low glucose levels, and jaundice.
11. Addiction to cigarettes, alcohol, or drugs will increase your risk of pregnancy problems. Try to be open and honest with your healthcare provider so she can help you access the support you need:
12. Alcohol. Heavy drinking during pregnancy exposes your baby to an increased risk of stillbirth and fetal alcohol spectrum disorder (FASD).
13. Smoking. If you smoke while you're pregnant, your baby is at risk of many complications including being born small and being born early.
14. Substance abuse. If you use illegal drugs or misuse prescription medication regularly your baby may suffer from withdrawal symptoms after birth. He may have birth defects, have a low birth weight, or be born early.
15. It's also possible to develop health problems for the first time during your pregnancy, even if you're usually fit and healthy. These sorts of problems include:
16. Birth defects. About 3 in 100 babies born will have a birth defect. Some birth defects can be detected by ultrasound or by genetic testing before birth. If a birth defect is suspected or diagnosed, you and your baby will be followed more closely during pregnancy. Depending on the defect, you may also need to give birth at a hospital with pediatric specialists available to care for your baby immediately.
17. Gestational diabetes. This is diabetes that develops during pregnancy. Gestational diabetes can be controlled by following a diet and treatment plan that may include medication, such as insulin. Uncontrolled gestational diabetes can put you at risk of a preterm birth, high blood pressure, and preeclampsia.
18. Growth problems. Your provider will track your baby's growth by measuring your belly at each visit. In some cases, a baby doesn't grow as well as it should. If your baby's growth is too slow, you may need extra monitoring, and you may need to have your baby early.
19. Multiples. If you're pregnant with twins or more, you'll have extra care during your pregnancy because carrying more than one baby puts a strain on your body. Your babies can be at risk of complications, especially being born early.
20. Preeclampsia. This is a serious condition that occurs during the second half of pregnancy, in which you develop high blood pressure and protein leaks into your urine. Preeclampsia can slow down the rate of your baby's growth and affect your health. Giving birth is the only cure for preeclampsia, so if you develop this condition you may need to have your baby early.

How does being high risk affect my care?

If you have a high-risk pregnancy, you may need more frequent prenatal appointments and will be monitored closely by your providers. You may also be referred to a maternal-fetal medicine (MFM) doctor. This is a physician who is specially trained to care for women who have a high-risk pregnancy.

The exact care you and your baby need depends on your particular circumstances and on the reasons your pregnancy is high-risk. You might see your MFM doctor just once or regularly throughout your pregnancy. Your MFM doctor will work with your ob-gyn and other providers to keep you and your baby healthy as your pregnancy progresses.

How does being high-risk affect my labor?

It's worth preparing yourself for the idea that the birth you have may not be the birth you'd choose. If your pregnancy is high-risk, you won't have the option of a home birth or attending a birth center. You'll need to give birth in a hospital where you and your baby can be monitored closely and specialist care is available during the birth and afterward.

If you're having multiples, you're more likely to go into labor early. Preterm labor is also more likely if you have a high-risk pregnancy for other reasons, such as having too much amniotic fluid around the baby or having certain medical conditions.

You may also need to have your labor induced to prevent or reduce health problems for you and your baby. Or there may be reasons why a vaginal birth isn't possible and you need to have a c-section.

Talk to your provider about what you can expect during labor, so you can prepare yourself in the best way possible.

Will my baby be okay if I'm high-risk?

If you have a high-risk pregnancy, one of your biggest worries will probably be whether any harm will come to your baby. It's natural to be concerned.

However, with good prenatal care it's possible to have a healthy baby. Healthy moms grow healthy babies: That's why it's so important to talk to your provider to find out how best to keep you and your baby safe.

Some conditions, as well as the drugs that are usually prescribed to manage them, pose a risk to your baby's health. But stopping medications that you take for a condition can also be very dangerous.

You may be asked to change the drugs you take for a health condition, such as high blood pressure, to another medication that's safer during pregnancy. This can help to reduce the risk of problems that the side effects of your medication might cause for your baby while he's developing in the uterus. Note: Don't stop taking any medication without consulting your provider first.

If your baby is born early, he could have difficulty breathing or feeding, or develop infections or other complications. If this happens, he needs extra care and support, which means staying in the hospital for several weeks, probably in a neonatal intensive care unit (NICU).

How can I reduce the risk of pregnancy complications?

There are a few things you can do to reduce the risk of pregnancy complications when you're high risk:

1. If you're not yet pregnant, schedule a preconception visit with your healthcare provider. Aim to do this at least a few months (or more, depending on your condition) before you start trying to conceive. This gives you time to make any changes your provider recommends before you become pregnant.
2. Find out all you can about your condition and what you can do to stay healthy. Ask your provider for information.
3. At your first prenatal visit, tell your provider about any current health problems you have, any medication you're taking, and any difficulties you had in previous pregnancies.
4. Go to all your prenatal appointments and follow your healthcare provider's advice.
5. Have a healthy lifestyle: Follow your provider's nutritional guidance, gain the right amount of weight, and stay active if you're able. Don't smoke or drink alcohol.
6. Ask your partner, family, and friends for support – this is likely to be a stressful time.
7. Look after your emotional well-being. Take time out for yourself and reduce your stress levels where you can.