April 26, 2024

There are lots of reasons for a high-risk pregnancy — the vast majority of which are manageable. Here’s what to expect.

Most pregnancies are mostly smooth sailing, or what medical professionals refer to as “low-risk.” But nearly everyone knows a mom who’s had a high-risk pregnancy, so you may be wondering what the chances are that yours will be too.

It’s difficult to estimate exactly what percentage of pregnancies are high-risk, considering that a standardized definition of a “high-risk pregnancy” is not available.

“It’s such a broad term and there are so many nuances,” said Dr. Amelie Pham, an obstetrician/gynecologist with the Vanderbilt Women’s High-Risk Pregnancy program. Pregnancy is never without some risk and “a pregnancy can be high-risk for many reasons that are often unpredictable.”

It is also worth noting that risk in pregnancy and risk at the time of delivery are separate issues. One can have pregnancy risk factors such as diabetes or hypertension and still have an uncomplicated labor and delivery, or vice versa.

“It’s such a broad term and there are so many nuances. A pregnancy can be high-risk for many reasons that are often unpredictable.”

Even within the high-risk pregnancy category, there’s a range of risk that dictates what type of care is needed throughout the pregnancy. Not all risk factors are equally significant. For some, having a high-risk pregnancy simply means an additional ultrasound or two. For others, it can mean having their care transferred over to a maternal-fetal medicine specialist for close monitoring for the entirety of the pregnancy and a modified birth plan.

Here’s a look at some of the most common reasons a pregnancy might be termed “high-risk” and what that means for you and baby.

Maternal risk factors

Certain health conditions present prior to conception are identified risk factors for perinatal complications. These include:

  • Autoimmune disease
  • Cardiovascular disease, including hypertension
  • Diabetes mellitus
  • Kidney disease
  • Lifestyle factors, such as alcohol, drug or tobacco use
  • Genetic syndromes
  • Hematologic disease, such as history of blood clots
  • Cancer history
  • Neurologic disease, such as multiple sclerosis
  • Respiratory complications, including asthma
  • Obesity

Prior pregnancy history, such as a history of miscarriages, stillbirth or being under 20 or over 35 at the time of a first pregnancy can put a person’s pregnancy in the high-risk category as well.

Then there are conditions that develop in the mother during pregnancy.

“For example, let’s say a mom develops preeclampsia or gestational diabetes,” Pham said. “Especially if it’s her first pregnancy, we’ll want to follow her a bit more closely.”

Fetal risk factors

Some high-risk pregnancies stem from abnormalities or birth defects detected in the growing fetus. These are typically discovered via early genetic screening test or during the anatomy scan, which usually takes place around the 20-week mark. They include:

  • Chromosomal abnormalities
  • Major birth defects, such as congenital heart defects
  • Fetal growth restriction (when a baby’s growth is much smaller than expected at a certain gestational age)

If any of the above are suspected, your provider will work with you to determine if additional testing is recommended. You’ll also be referred to a pediatric specialist who can help you develop a treatment plan for your baby after birth.

Pregnancy risk factors

Sometimes, the pregnancy itself poses a risk to both mom and baby. Placental problems, such as having a low-lying placenta or a placenta that pulls away from the uterine wall (called placental abruption), require additional monitoring and potentially a hospital admission.

Being pregnant with two or more babies greatly increases the risk of preterm birth, the need for a Cesarean section and having babies with low birth weights, which is why moms-to-be of twins and triplets will be followed more closely.

Don’t wait to see your OB

The good news is that the majority of pregnancies — even high-risk ones — result in the birth of a healthy baby. One way to ensure that outcome is to schedule a preconception visit and to get quality prenatal care from the beginning of pregnancy.

“Even if you think you’re low-risk, getting prenatal care as early as possible is important,” Pham said. “That can make a really big difference.”

Expert care for you and your baby

Each pregnancy and delivery is unique and yours should be too. Learn more about how Vanderbilt Health’s high-risk obstetrics team, known as maternal-fetal medicine specialists, can provide you and your baby unmatched expert care. With the region’s most advanced care, you and your baby have everything you need, all in one place.

To learn more, call 615-343-5700.

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