What Is High-risk Pregnancy?

High-risk pregnancy is a term used when the health of the mother and fetus is threatened. Many different factors can endanger the health of the fetus and mother.

High-risk pregnancies are used for pregnant mothers who have many risk factors, so they need special care during pregnancy and after childbirth. Many factors can put the pregnancy at risk. The word high-risk may cause great fear for mothers, but it is used to indicate the importance of special attention and care for these mothers.
These people need to see a doctor more often and may need more tests and ultrasounds during pregnancy to monitor the health of the mother and fetus. This care will help the doctor to diagnose any medical problem and take the necessary measures quickly.

Risk Factors for High-Risk Pregnancy

Several factors can cause a high-risk pregnancy.

Maternal age

One of the most common risk factors for high-risk pregnancies is maternal age. Women who give birth under the age of 17 or over the age of 35 are more likely to have side effects than those between the late teens and early 30s. The risk of genetic defects and miscarriage increases after the age of 40.

Medical conditions that exist before pregnancy

Conditions that pose a risk to the mother or baby include:

•  High blood pressure
•  Lung, kidney, or heart problems
•  Diabetes
•  Depression
•  Obesity
•  Autoimmune disease
•  Sexually transmitted diseases (STDs)
•  Long-term infections such as the human immunodeficiency virus

Problems with previous pregnancies, a history of miscarriage, and a family history of genetic disorders are also risk factors for high-risk pregnancies. If women have the disease, it is important to consult the doctor before deciding to become pregnant. The doctor may perform tests, prescribe medications, or recommend things to keep the mother and baby healthy.

Medical conditions that occur during pregnancy

In some cases, the mother may be healthy before pregnancy, but problems may develop or be diagnosed during pregnancy, affecting both mother and baby. Three of the most common pregnancy problems are:

•  Preeclampsia: It is a syndrome that includes high blood pressure, high protein levels in the urine, and swelling. This condition can be dangerous for the mother or baby if left untreated. However, with proper management and regular doctor visits, most women with preeclampsia give birth to healthy babies. The exact cause of preeclampsia is not known, but if the mother is older, carrying more than one baby, the mother is overweight, or has high blood pressure or pre-gestational diabetes, preeclampsia is more likely to occur during pregnancy.
•  Gestational diabetes: Gestational diabetes is a type of diabetes that develops during pregnancy. Women with gestational diabetes may have a healthy pregnancy if they follow the treatment plan from their healthcare provider. Diabetes usually resolves after childbirth. However, women with gestational diabetes are at increased risk for type 2 diabetes and high blood pressure. In mothers with gestational diabetes, a cesarean section may be needed instead of a normal birth to prevent harm to the baby.
•  Depression: Between 14% and 23% of women experience depression during pregnancy. If the mother was depressed before pregnancy, she is more likely to develop the disease during pregnancy. Pregnancy may be associated with depression due to hormonal changes, fatigue, stress, and lack of support. Depression may be related to problems during pregnancy and childbirth, such as low birth weight and preterm birth. After the birth of a baby, a mother with depression has difficulty taking care of herself and the baby.

Pregnancy-related issues

Most pregnancies are classified as high-risk pregnancies because of issues that arise from the pregnancy itself and have little to do with the mother’s health.

 Premature labor

Premature labor occurs when regular contractions cause the cervix to open after 20 weeks and before 37 weeks of gestation. The earlier a preterm birth occurs, the greater the health risks to the baby. Many premature babies need intensive care in the neonatal intensive care unit. Premature babies can also have long-term mental and physical disabilities.
The specific cause of preterm labor is often unknown. Some risk factors may increase the chances of preterm birth, but preterm labor can also occur in pregnant women without known risk factors. Factors that put women at greater risk, such as certain infections, shortening of the cervix, or previous preterm birth.

 Multiple births

Multiple pregnancies are more common in cases where women use infertility treatments. These women increase the risk of preterm birth, gestational diabetes, and gestational hypertension. These babies are more prone to long-term health problems such as growth retardation or cerebral palsy. But keep in mind that most multiples are born healthy.

 Placenta previa

The placenta previa is a condition in which the placenta covers the cervix. The disease can cause bleeding, especially if a woman has a contraction. If the placenta still covers the cervix near delivery, the doctor may order a cesarean section to reduce the risk of bleeding for both mother and baby.

Fetal problems

Fetal problems, which are sometimes seen on ultrasound. Approximately 2 to 3 percent of all infants have a minor or major structural problem. Sometimes there may be a family history of fetal problems, but these problems are completely unexpected in other cases.

Prevention

Even if the mother does not have a health problem before pregnancy, it is recommended to see a doctor before getting pregnant to ensure her health. In this case, the doctor may recommend measures that the woman can take to reduce the risk of some problems. This includes:

•  Getting at least 400 micrograms of folic acid daily, starting before and continuing through pregnancy
•  Eating a healthy diet and maintaining proper weight
•  Getting regular physical activity
•  Getting recommended immunizations
•  Avoiding cigarettes, alcohol, and drugs
•  Taking only the over-the-counter and prescription medicines
•  Seeing your doctor regularly
•  Working with a doctor to manage problems such as diabetes, depression, high blood pressure, or infection

Special tests

Depending on the condition, the doctor will perform a series of tests to make sure the mother and fetus are healthy.

Specialized or targeted ultrasound

This type of ultrasound shows problems such as abnormal fetal growth. This imaging technique uses high-frequency sound waves to view the fetus inside the mother’s womb.

Prenatal cell-free DNA screening

Prenatal cell-free DNA (cfDNA) screening, also known as non-invasive prenatal screening, is a screening method for certain chromosomal abnormalities in the fetus. During prenatal cell-free DNA screening, maternal and fetal DNA is taken from the mother’s blood sample and screened to increase the risk of some chromosomal issues, such as Down syndrome, trisomy 13, and trisomy 18. The minimum gestational age for this test is ten weeks. The sex of the fetus will be determined during this test.

Genetic screening

The doctor may recommend amniocentesis or chorionic villus sampling, but these tests are different. Amniocentesis is a diagnostic test in which a sample is taken from the uterine amniotic fluid, which surrounds and protects the baby, and is tested, usually at 16 to 22 weeks gestation.

Amniocentesis can identify specific genetic conditions and serious abnormalities in the brain or spinal cord. If placental villus sampling (CVS) is performed between the tenth and twelfth weeks of pregnancy, this test is also one of the diagnostic tests recommended by a doctor if there is a suspicion on ultrasound to solve problems such as chromosomal abnormalities, thalassemia, etc.

Ultrasound for cervical length

Cervical ultrasound is performed so that the doctor can check the length of the cervix and take the necessary measures if he notices changes such as shortening of the cervix. Short cervix increases the risk of preterm birth many times over. If the results of the ultrasound show that the cervix is short, your doctor can prevent preterm labor by taking measures such as prescribing progesterone to loosen the uterus or using cerclage sutures to sew the cervix.

Lab tests

Lab tests include:

•  The amount of sugar in the urine: One of the things that the doctor examines after seeing the test result is the sugar in the urine. It is normal to have a small amount of sugar in your urine during pregnancy, but if the test results show a large amount of sugar, it could be a sign of gestational diabetes. Therefore, your doctor may recommend a GCT glucose challenge test to confirm this.
•  Protein levels in the urine: High protein levels in the urine may indicate kidney problems or the presence of urinary tract infections and other conditions. Normally, the kidneys excrete some protein, but during pregnancy, because the pressure on the kidneys doubles and more blood enters them, they may not function properly and excrete too much protein. Protein excretion may also be a problem with urinary tract infections.
•  Leukocyte counts or bacteria: The presence of white blood cells in the urine can indicate a urinary tract infection. During pregnancy, due to hormonal changes that occur, urination is difficult, and some urine remains in the bladder, which causes infection. In addition, the doctor will usually order a urine culture test early in your pregnancy to make sure there are no bacteria that indicate a urinary tract infection.

Biophysical profile test

A biophysical profile is a simple, painless test performed during pregnancy to assess the fetus’s health, especially to make sure the fetus is getting enough oxygen from the uterus. This test is often done after the due date. This test can also be done in the third trimester if you have a high-risk pregnancy.

See a doctor immediately

Contact your doctor if you have any of the following:

•  Vaginal bleeding or watery vaginal discharge
•  Severe headaches
•  Pain or cramping in the lower abdomen
•  Decreased fetal activity
•  Sudden or severe swelling in the face, hands, or fingers
•  Fever or chills
•  Pain or burning with urination
•  Changes in vision, including blurred vision
•  Vomiting or persistent nausea
•  Dizziness

The bottom line

Pregnancy is considered high-risk when a doctor determines the possibility of a complication that could affect the mother, baby, or both. In such cases, the mother and fetus must be under medical care so that they are completely under control in case of any problems.

Expectant mothers with high-risk pregnancy conditions need special care to ensure the health of themselves and the fetus. These people need to see a doctor more often and may need more tests and ultrasounds during pregnancy to monitor the health of the mother and fetus. These cares will help the doctor to diagnose any medical problem and take the necessary measures quickly. A high-risk pregnancy does not mean that the mother or baby will have a problem, but more care is needed to reduce any risk.

Arjang Naim MD minimizes the risk of problems for pregnant women at higher risk with more care and checkups during pregnancy.

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