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High-risk pregnancy: Know what to expect

If you have a high-risk pregnancy you or your baby might be at increased risk of health problems before, during or after delivery. Typically, special monitoring or care throughout pregnancy is needed. Understand the risk factors for a high-risk pregnancy, and what you can do to take care of yourself and your baby.

What are the risk factors for a high-risk pregnancy?

Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age. Pregnancy risks are higher for mothers older than age 35.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
  • Medical history. A history of chronic hypertension, diabetes, heart disorders, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.
  • Surgical history. A history of surgery on your uterus, including multiple C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an abnormal placenta position, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby's blood group is Rh positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.

What steps can I take to promote a healthy pregnancy?

Whether you know ahead of time that you'll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, stick to the basics. For example:

  • Schedule a preconception appointment. If you're thinking about becoming pregnant, consult your health care provider. He or she might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby with a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby's health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you'll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps. Talk to your health care provider if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby's health — and make it easier to shed the extra pounds after delivery. Work with your health care provider to determine what's right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider's OK before you start — or stop — taking any medications or supplements.

Do I need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your health care provider might recommend:

  • Specialized or targeted ultrasound. This type of fetal ultrasound — an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus — targets a suspected problem, such as abnormal development.
  • Amniocentesis. During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 15 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS). During this procedure, a sample of cells is removed from the placenta. Typically done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Cordocentesis. Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby's blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders, blood conditions and infections.
  • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you're at risk of preterm labor.
  • Lab tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
  • Biophysical profile. This prenatal test is used to check on a baby's well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your health care provider.

Can I have a planned home birth?

It's often difficult to predict which pregnancies will become high risk or when a high-risk condition might occur. That's why planned home births typically aren't recommended.

What can I do to ease my anxiety?

If you have a high-risk pregnancy, you might feel reluctant to think about the future and nervous about prenatal visits — for fear that you'll hear bad news.

Unfortunately, anxiety can affect your health and your baby's health. Consult your health care provider about healthy ways to relax and stay calm. Some studies suggest that techniques such as imagining pleasant objects or experiences or listening to music can reduce anxiety during pregnancy.

What else do I need to know about high-risk pregnancy?

Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

  • Vaginal bleeding
  • Severe headaches
  • Pain or cramping in the lower abdomen
  • Watery vaginal discharge — in a gush or a trickle
  • Regular or frequent contractions — a tightening sensation in the abdomen
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision

Find out which signs or symptoms should prompt you to contact your health care provider and when to seek emergency care.

A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.

Last updated: February 21st, 2018

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