High-Risk Pregnancy

A high-risk pregnancy is a pregnancy in which the risk of complications (to both the fetus and the mother) is greater than for a normal pregnancy. Before a woman becomes pregnant, it is important to have good nutrition and a healthy lifestyle. Several factors, present before pregnancy, can cause a high-risk pregnancy. Risk factors for a high-risk pregnancy include:

• Young or old maternal age
• Being overweight or underweight
• Having had problems in previous pregnancies
• Pre-existing health conditions, such as high blood pressure, diabetes, or HIV/AIDS

Health problems can also develop during a pregnancy that can make it high-risk. Such problems may occur even in a woman who was previously healthy.

Good nutrition, prenatal care, and a healthy lifestyle are all important to preventing pregnancy complications. Source: CDC

Causes

Depending on the risk factors, there are many pre-existing medical conditions that can affect pregnancy or be affected by pregnancy. These factors often compound; for example, women over 35 who are overweight and have had complications in a previous pregnancy are at higher risk that someone with only one risk factor. ^[1] Some medical conditions that can place women at higher-risk during pregnancy are:

• Obesity
• Alcohol abuse
• Chronic Hypertension
• Heart Disease
• Diabetes
• Asthma
• Thyroid Conditions
• Neurologic Conditions

Promoting a Healthy Pregnancy

Fetus of about eight weeks, enclosed in the amnion. Source: Gray's Anatomy of the Human Body

Many health care providers recommend that a woman who is thinking about becoming pregnant see a health care provider to ensure she is in good health.

If a woman has any chronic medical conditions, especially a problem that requires daily medication, it would be prudent to see a Maternal-Fetal Medicine specialist prior to pregnancy. While most medications tend to be safe during pregnancy, some are very dangerous, and should be discontinued prior to conception.

During pregnancy, there are also steps a woman can take to reduce the risk of certain problems:

1. Getting at least 400 micrograms of folic acid every day if she thinks she could become pregnant, and continuing folic acid when she does get pregnant
2. Getting proper immunizations
3. Maintaining a healthy weight and diet, getting regular physical activity, and avoiding smoking, alcohol, or drug use
4. Starting prenatal care appointments early in pregnancy

Prenatal Care

Prenatal care is the care a woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby. According to the Centers for Disease Control and Prevention, 83.9% of women receive prenatal care in their first trimester.^[2] In addition, health care providers are now recommending that women see health care providers for preconception care before even trying to get pregnant in order to plan and prepare for any future pregnancies.

Below are some steps women can take to provide a healthy environment for the baby:

• Getting at least 400 micrograms of folic acid every day to help prevent many types of neural tube defects. Health care providers recommend taking folic acid both before and during pregnancy.
• Maintaining a nutritious diet and a healthy weight.
• Getting regular physical activity before, during, and after pregnancy.
• Avoiding smoking, alcohol, or drug use before, during, and after pregnancy.

Complications

In a high-risk pregnancy, the likelihood of complications is higher than in a normal pregnancy. The severity of the complications may also be increased.

Miscarriage, also known as spontaneous abortion, is the loss of a pregnancy before the 20th week of pregnancy. Miscarriage occurs in as many as 10%-25% of all pregnancies.

Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mother’s kidneys, liver, and brain. With treatment, many women will have healthy babies. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems. Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother.

Gestational diabetes is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes. Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.

The HIV virus damages the body's immune system, progressively destroying the body's ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection. Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding. But, there are effective ways to prevent the spread of mother-to-infant transmission of HIV.

Preterm Labor is labor that begins before 37 weeks of pregnancy. Because the baby is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time. Although there is no way to know which women will experience preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth.

Anemia is a deficiency in the ability of blood to carry oxygen or iron. Tissue enzymes dependent on iron can affect cell function in nerves and muscles. The fetus is dependent on the mother's blood and anemia can cause poor fetal growth, preterm birth, and low birthweight. Women with anemia of pregnancy may not have obvious symptoms unless the cell counts are very low.

Premature rupture of membranes occurs when the amniotic sac begins to leak fluid ("the water breaks") before the 37th week of pregnancy. This can happen for many reasons, including infections or anatomic problems with the sac or uterus. The mother may require treatment to avoid an infection of the membranes and to prevent preterm labor.

Morning sickness occurs in most pregnant women. About one in four only has very mild nausea. Nausea is most common in the first trimester, and usually begins around the 8th to 10th week of pregnancy.

Back pain is very common during pregnancy. Many women can find relief with a variety of postures and strengthening exercises.

Other medical conditions like high blood pressure, diabetes, or heart, breathing, or kidney problems can become more serious during a woman’s pregnancy. Regular prenatal care can help ensure a healthier pregnancy for a woman and her baby.

Recent News

Talk show host Ricki Lake recently produced a documentary on childbirth in the United States titled The Business of Being Born. This film examines the current maternity system and asks "Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?"

References

1. ↑ Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG. 2008 May;115(6):720-5. Abstract | Full Text
2. ↑ Centers for Disease Control and Prevention. Prenatal Care.

External Links

Society for Maternal-Fetal Medicine

American College of Obstetricians and Gynecologists:

American College of Nurse Midwives

Doulas of North America

American Academy of Family Physicians

The National Women's Health Information Center

March of Dimes

American Pregnancy Association

International Childbirth Education Association