June 22, 2020

Dr. Matt Grace explains what maternal-fetal medicine specialists do in high-risk pregnancies, and why a pregnant woman may need this extra care.

If your obstetrician or midwife refers you to a maternal-fetal medicine specialist, you may feel fearful or anxious about what this may mean for you, your pregnancy and your baby. Dr. Matt Grace with the Fetal Center at Vanderbilt answers some common questions about what to expect during a visit with a maternal-fetal medicine specialist.

What is a maternal-fetal medicine specialist?

A maternal-fetal medicine physician is an obstetrician-gynecologist who has completed additional education, research and training in medical, surgical, obstetrical, fetal and genetic complications of pregnancy.  We are often called “high-risk pregnancy” specialists.

What kinds of pregnancy problems or complications does a maternal-fetal medicine specialist treat?

We care for women who have experienced complicated pregnancies in the past, have chronic medical conditions, or have developed unexpected or fetal complications during their pregnancy. Some examples of the conditions we help treat include:

Maternal chronic conditions, including:

  • Heart disease
  • High blood pressure
  • Lupus or other rheumatologic diseases
  • Thyroid disease
  • Asthma or other lung diseases
  • Diabetes
  • Obesity
  • Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
  • Bleeding or clotting disorders
  • Kidney disease
  • Seizure disorders
  • Chronic infections, such as hepatitis or HIV
  • Cancer

Complications in prior pregnancies, such as:

  • Pregnancy loss (miscarriage)
  • Preterm (premature) delivery
  • Stillbirth

Unexpected complications, such as:

  • An abnormal result on a genetic test
  • New diagnosis of a genetic syndrome or birth defect
  • Infections that may affect the pregnancy or fetus

Fetal complications, including:

  • Twins, triples, quadruplets, or more multiple fetuses
  • Fetal growth problems (fetal growth restriction)
  • Certain fetal conditions for which fetal treatment or surgery can be performed inside the uterus, before delivery

Why was I referred to a maternal-fetal medicine doctor?

Your prenatal provider may have referred you for one of the following reasons:

  • A preconception consultation: We meet with women before they become pregnant to discuss any medical conditions they have or complications they had in prior pregnancies. This is an opportunity to review any possible risks in a future pregnancy and to outline a plan for how those risks can be minimized in a future pregnancy.
  • Ultrasound: Maternal-fetal medicine specialists perform detailed ultrasounds to screen the fetus for birth defects or genetic syndromes. You may be referred if your provider saw something concerning during an ultrasound in their office or if they want a detailed evaluation of your baby’s anatomy.
  • Genetic screening or testing: We often work with genetic counselors to help you understand whether your pregnancy is at increased risk for being affected by a genetic condition (Down syndrome, for example). We can discuss the different testing options and, if you decide that you want testing, we can perform those tests and help you understand the results.
  • Consultation: Patients are often referred to maternal-fetal medicine for consultation due to a medical condition that may complicate their pregnancy. Often, patients referred for consultation continue their prenatal care with their doctor or midwife. The maternal-fetal medicine specialist provides a detailed list of recommendations to your doctor for how to manage that condition during the pregnancy and at the time of delivery. You may return for one or two follow-up visits with the specialist during your pregnancy but will continue prenatal care and have your baby delivered by your doctor or midwife.
  • Co-management: Your doctor or midwife may ask maternal-fetal medicine to co-manage a medical condition during your pregnancy. Diabetes, high blood pressure, thyroid disease or a history of premature delivery in prior pregnancies are common conditions that a maternal-fetal medicine specialist is asked to co-manage during pregnancy. You will continue to see your doctor or midwife for prenatal care but will see the specialist regularly to check bloodwork or adjust medication to keep you and your pregnancy healthy.
  • Transfer of care: Sometimes pregnancies are so complicated or high-risk that your prenatal care and delivery are all performed by a maternal-fetal medicine expert. If needed, the maternal-fetal medicine specialists work with other medical specialists to keep you and your pregnancy as healthy as possible.

Does a referral to a maternal-fetal medicine doctor mean my pregnancy is “high-risk?”

Being referred to a maternal-fetal medicine specialist does not necessarily mean that your pregnancy is “high-risk.” In many cases, we can provide guidance and recommendations to you and your prenatal care provider but you can continue your care with your provider and they can deliver your baby.  Our goal is to work with you and your provider to help you understand if your pregnancy is at an increased risk of complications and, if so, outline a plan to minimize those risks so that you and your baby are as healthy as possible.

What can I expect during my visit?

Your visit experience will depend on why you were referred.  It is common to have an ultrasound in our office before you meet with the maternal-fetal medicine specialist.  During your visit, the specialist will ask detailed questions about your medical history, family history and any complications in prior pregnancies. The doctor may recommend follow-up visits, additional ultrasounds, additional testing or visits with other medical specialists.


The Vanderbilt High-Risk Pregnancy team includes maternal fetal specialists, geneticists and pediatric subspecialists. We treat many conditions that may create challenges for mom or baby during pregnancy or birth. With many locations across Middle Tennessee and convenient clinic-to-clinic and genetic counseling telehealth services, we help you deliver your baby safely and with confidence. Our newest location, the Center for Women’s Health Murfreesboro, is open. Learn more here.