High-Risk Pregnancy: What You Need to Know

Whether it's your first or your third pregnancy, hearing your obstetrician say that this is a high-risk pregnancy can be concerning.

However, the term "high-risk pregnancy" can refer to a wide variety of common conditions. Many of these are related to pre-existing conditions, that is, before becoming pregnant, or to conditions you may have developed during pregnancy or childbirth.

A high-risk pregnancy does not necessarily mean that your pregnancy will be more difficult than a low-risk one. However, you will need the help of a specialist in maternal-fetal medicine and undergo more intensive monitoring.

What is the difference between a maternal-fetal medicine specialist and an obstetrician?

A maternal-fetal medicine specialist (perinatologist) receives traditional training in obstetrics and gynecology, but with an additional three years to learn to manage medical complications related to pregnancy. Additionally, the Maternal-Fetal Medicine Specialist is trained to assess and treat fetal problems. Most perinatal ultrasounds are interpreted by maternal-fetal medicine specialists.

You may be referred to a maternal-fetal medicine specialist if you have a pre-pregnancy condition, or if you develop a disease during pregnancy, or if you have problems during childbirth.

Also, a maternal-fetal medicine specialist will be involved during the pregnancy if your baby has any abnormalities. In this case, the maternal-fetal medicine specialist will coordinate your care and your baby's during pregnancy and childbirth with the help of a pediatric care team.

Should I consult a maternal-fetal medicine specialist before pregnancy?

It may be beneficial to consult a maternal-fetal medicine specialist before pregnancy if you find yourself in one (or more) of the following situations:

• Pre-existing medical condition. There are many pre-existing conditions that may require monitoring during pregnancy, such as diabetes, lupus, kidney disease, and hypertension (high blood pressure). In some cases, a maternal-fetal medicine specialist may change the type of medication you take to maintain your health and prevent adverse effects in your future pregnancies. If you have diabetes, a maternal-fetal medicine specialist can help you optimize blood sugar control before conception to reduce the risk of fetal abnormalities. If you are obese, a maternal-fetal medicine specialist can review the benefits of losing weight before pregnancy. Losing weight healthily can reduce the risk of developing conditions such as hypertension and gestational diabetes during pregnancy.
• Genetic risks. Pre-conception genetic testing has become more common in recent years thanks to technological advances and the accessibility of testing. If family members have a certain disease or if you belong to an ethnic group that has a higher risk of developing specific conditions (such as sickle cell anemia or Tay-Sachs disease), genetic testing can be used to assess your risk and that of your partner of being a carrier. Likewise, common genetic diseases, such as cystic fibrosis or spinal muscular atrophy, can be detected through a blood test.

Additionally, if you have a child with a genetic condition, a maternal-fetal medicine specialist can advise you and help determine the impact this condition may have on your future pregnancies.

What conditions can lead to a high-risk pregnancy?

The following list represents the most common conditions that can lead to a high-risk pregnancy, but it is important to note that not all women with these conditions will have a high-risk pregnancy.

• Diabetes. If you had diabetes before becoming pregnant, you are likely to be referred to a maternal-fetal medicine specialist who will monitor your condition and determine the appropriate medications. Ideally, you should benefit from counseling before conception. The onset of diabetes during pregnancy (gestational diabetes) is very common, and your obstetrician may be able to treat you without the need for a maternal-fetal medicine specialist. Whether it's the maternal-fetal medicine specialist or your gynecologist, they will monitor your baby's growth and well-being and monitor your health by providing nutritional advice, checking your blood sugar level, and possibly prescribing medications.
• Preeclampsia. Preeclampsia is a pregnancy-specific condition characterized by high blood pressure associated with the presence of protein in the urine and edema (swelling of the skin). In some women with preeclampsia, liver or platelet abnormalities occur. The only treatment for preeclampsia is delivery, so it is a condition that requires very close monitoring to balance maternal complications and the risks of premature birth.
• Hypertension. If you have high blood pressure before pregnancy, a maternal-fetal medicine specialist will monitor your baby's growth and may consult you if any problems arise. Some medications commonly used outside of pregnancy to treat hypertension are contraindicated during pregnancy.
• Multiple pregnancies. Twin or multiple pregnancies have a higher risk of complications. Women with multiple pregnancies are more likely to develop preeclampsia or premature birth. Twin pregnancies have a higher risk of fetal abnormalities and growth problems, especially if the twins share the same placenta. In the case of a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend the mode and timing of delivery. If you stay healthy and the growth of your babies is normal and without complications, you can continue to see your obstetrician-gynecologist, or you may prefer to be cared for at a clinic specialized in multiple pregnancies.
• Sexually Transmitted Diseases (STDs). Generally, your obstetrician can treat you for sexually transmitted diseases that may occur during pregnancy or if you have a pre-existing STD, such as herpes. In some cases, consultation with a maternal-fetal medicine specialist will be necessary. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide additional care and management. HIV-positive women are generally followed by maternal-fetal medicine specialists because pharmacological treatments are complex.
• Obesity. Obese women have a higher risk of developing diabetes, hypertension, and preeclampsia during pregnancy. Obesity is one of the few health issues affecting pregnant women that can be corrected before pregnancy. That is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies.

Will all my future pregnancies be high risk?

Having a high-risk pregnancy does not mean that all your future pregnancies will also be considered high risk. A fetal complication may occur in one pregnancy but not in another, and some health conditions may change over time.

However, if you had a pregnancy that ended in premature birth, you are at a higher risk of delivering prematurely in your next pregnancy. In this case, your obstetrician will monitor your pregnancy with medications, and a maternal-fetal medicine specialist will monitor the length of your cervix through an ultrasound.

Ultimately, the most important thing to remember about a high-risk pregnancy is that your maternal-fetal medicine specialist and your obstetrician-gynecologist have the knowledge and experience needed to ensure that you and your baby are as healthy as possible.

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