An Overview of High-Risk Pregnancy

A high-risk pregnancy is a pregnancy that has a greater chance of encountering problems before, during, or after delivery. It requires more careful monitoring than a typical pregnancy.

However, even though there is the potential for complications, with early and regular prenatal care a high-risk pregnancy can lead to a safe delivery and healthy baby. Here’s what you need to know about the diagnosis, care, and monitoring of a high-risk pregnancy.

Screening for High-Risk Pregnancy

Early in your pregnancy, your doctor will start gathering information to see if you are high risk for pregnancy complications, including preeclampsia or eclampsia (dangerously high blood pressure during pregnancy or childbirth), premature birth, uterine growth restriction (when a baby is very tiny), or certain birth defects (like spina bifida or fetal alcohol syndrome).

Screening tests do not give a diagnosis, but they can help healthcare providers recognize who may have an issue or develop one. Doctors will ask about your family history, your health history, your history of pregnancies, and your lifestyle choices. They will also monitor your weight, blood pressure, and heart rate.

What Makes You High-Risk?

Most pregnancies in the U.S. are not considered high risk. However, several conditions that raise the risk of complications are on the rise, including older age during pregnancy and certain health issues. Here are some risk factors that doctors will be on the lookout for.

Being a Teenager or Over 35

Pregnancy is typically healthiest in your 20’s. You are more likely to encounter problems if you are a teenager or over age 35. Teens have a higher risk of endometriosis, postpartum bleeding, and mild preeclampsia. If you are older than 35, doctors will watch out for signs of preeclampsia and problems with your baby's health, including restricted growth.

Medical Issues

If you already have a known health condition before pregnancy, doctors will follow you carefully to try to prevent it from getting worse or having an effect on your pregnancy. These major health issues are on the rise and indicate a high-risk pregnancy:

• Diabetes
• High blood pressure
• Obesity

Be sure to tell your doctor about any other aspects of your medical history, too. Heart issues, certain cancers, kidney disease, autoimmune disorders, certain infections (like HIV or HPV), and uterine fibroids are linked to pregnancy and childbirth complications as well.

Certain Lifestyle Choices

How you live your life has a big impact on your pregnancy. You are more likely to encounter complications during pregnancy if you smoke, drink alcohol, or use drugs. Substance use is linked to premature birth, low birthweight, fetal alcohol syndrome, miscarriage, stillbirth, and placental abruption.

Previous Pregnancy Complications

It's important for doctors to know if you've had trouble getting pregnant, staying pregnant, or giving birth in the past. The following issues are red flags that merit closer prenatal monitoring:

• Multiple miscarriages
• A long history of infertility
• Premature labor in a previous pregnancy
• Another pregnancy that ended in an early delivery
• A previous stillbirth or the loss of a newborn
• Other pregnancies that resulted in a c-section
• Five or more pregnancies

Early Pregnancy Complications

Doctors will look at what’s going on with you and your baby in early prenatal appointments to decide how closely to monitor the rest of your pregnancy. There is a higher risk for complications if:

• You are carrying multiples
• Your baby is not growing as expected
• You have gestational diabetes
• You have preeclampsia
• You are Rh negative (a blood-cell protein that can cause problems for your baby if they have it and you do not)
• You've had a pre-term birth previously
• Your baby shows signs of birth defects (like spina bifida and certain heart problems)

Specialists Who Can Help

When you have a high-risk pregnancy, you go to the doctor more often than other pregnant people. You may also see more doctors or a specialist who can help out with a specific concern. Doctors who treat high-risk pregnancies include:

• Obstetricians (OBs): Depending on your specific situation and where you live, your OB may take care of you throughout your high-risk pregnancy.
• Perinatologists: A perinatologist is an obstetrician who specializes in maternal-fetal medicine. They care for mothers and babies during high-risk pregnancies. You may meet with a perinatologist as part of your care and still see your OB, or your obstetrician may turn over your entire care to the perinatologist.
• Other specialists: Your OB or perinatologist may refer you to other doctors. You may see a cardiologist who can help keep your blood pressure under control or monitor a heart condition, or an endocrinologist to keep blood sugar in check or monitor a thyroid condition. You may also see doctors specializing in other areas of medicine depending on what you need. 

Prenatal Tests

Since your doctor will follow and monitor you more closely during a high-risk pregnancy, there tends to be a lot of testing. You may have many of the following tests leading up to childbirth. Pregnant people with typical pregnancies may receive many of the same tests, though less frequently.

• Blood pressure tests help monitor potential or existing preeclampsia.
• Basic blood tests indicate certain infections, anemia (iron level), and your Rh factor.
• Urine tests check for a urinary tract infection (UTI) or protein in the urine
• Genetic testing, such as carrier screening (blood or saliva test), cell-free DNA tests (blood test), chorionic villus sampling (of your placental tissue), quad screen (blood test), or amniocentesis (of your amniotic fluid) check for birth defects or diseases
• Glucose tolerance test to check your blood sugar for gestational diabetes
• Ultrasounds of your uterus, your cervix, and the baby monitor growth and anatomical irregularities.
• Fetal heart rate checks
• Kick counts to monitor your baby's activity levels
• Group B strep cervical swab

Care Tips

There are things you should do to try to be as healthy as you can during any pregnancy, but it’s especially important during a high-risk pregnancy. If your pregnancy is high risk, here’s what you can do to help manage it and stay as healthy as possible.

1. Prepare for pregnancy: Make an appointment with your doctor when you begin thinking about starting your family, especially if you have a health condition such as diabetes or high blood pressure. Your doctor can gather information on your general health, advise you on how to stay healthy, and refer you to specialists you may need to see depending on your individual needs.
2. Take folic acid: Folic acid helps prevent low birth weight and congenital disabilities such as spina bifida which can cause a high-risk pregnancy and life-long issues for your child. Folic acid may also help reduce the risk of other high-risk pregnancy conditions such as gestational hypertension, preeclampsia, and heart disease. The recommendation is 400 micrograms of folic acid each day for all women of childbearing age but especially for women who are or wish to become pregnant.
3. Go to all your doctor appointments: High-risk pregnancies require more monitoring, care, and treatment than a pregnancy that isn’t high risk. So, it might take up a lot of your time, and you may feel like you are always going to an office or a lab, but make it a point to get to all your prenatal testing and checkups. It's really important.
4. Nourish your body: Eat well and drink plenty of fluids. If you have special dietary needs because you're on a special diet, you have diabetes, or you have an eating disorder, then your doctor may recommend you see a nutritionist or a dietician to be sure you're getting the proper nutrition you need during your pregnancy.
5. Make good decisions: Follow the advice and instructions of your doctor. Gain the appropriate amount of weight — not too little, not too much. If you smoke, try to quit and ask for help if you need it. Stay away from alcohol and recreational drugs. If you take prescription medication, use it the way your doctor directs you to use it, and make sure all of your doctors know that you are pregnant.

Signs of Complications

During any pregnancy, you should be on the lookout for signs that mean you need to seek medical care as soon as possible. This is even more the case when your pregnancy is high risk. So, be vigilant and contact your doctor quickly if you experience the following:

• Bleeding
• A change in type or odor of vaginal discharge
• A gush of fluid
• Cramps
• Contractions
• Headaches
• Blurry vision
• Feeling lightheaded
• A fever
• A change in the baby’s movements 

A Word From Verywell

Learning that your pregnancy is high risk and getting through it can be stressful. Feelings of anxiety, sadness, and even anger are normal, but the constant worry throughout your pregnancy isn’t good for your health.

Your partner, family, and friends can be an excellent source of support. However, if you need someone else to talk to about your fears, you can reach out to your doctor or get a referral for a health professional who can help you work through your emotions. Once you feel more in control, you’ll be able to focus on staying healthy and enjoying your pregnancy.

Remember, just because your pregnancy is labeled high risk doesn’t mean that something terrible is going to happen. It just means that you and your baby need a little extra care and monitoring. By going to all your appointments and following your doctor’s recommendations, you'll be doing all you can to deliver a healthy baby.