I get this question from many of my patients. As a maternal–fetal medicine (MFM) specialist, I provide care for women with complicated pregnancies. In my experience, they are usually looking for more than a “yes” or “no” answer. My patients are understandably nervous about the term “high-risk,” and they want my reassurance that their pregnancy will be OK.
More women are having high-risk pregnancies than ever before, due to the rise in health conditions like obesity that can affect pregnancy. Also, more people are having babies later in life, and age itself is a risk factor in pregnancy.
Here’s what I want patients to know about high-risk pregnancies and what it means for your prenatal care, labor, and birth.
You and your fetus need extra attention.
Let me tell you about two sisters, “Sara” and “Tania.” I took care of their high-risk pregnancies under very different circumstances.
The older sister, Sara, had just turned 40 when she got pregnant. She experienced a blood clot when she was in her 20s and now had high blood pressure. Those three factors combined meant her pregnancy was at high risk, and she knew this going in.
A few years later, her younger sister was pregnant at 34. Tania had no history of health conditions and looked forward to a low-risk pregnancy. But, a routine ultrasound showed her fetus was smaller than normal and had a birth defect called clubfoot. At that point, Tania’s pregnancy became high-risk.
The sisters’ stories illustrate the two ways a pregnancy can be high-risk. Sometimes it’s due to health complications, like in Sara’s case. Diabetes, high blood pressure, heart problems, and being over 35 are among the most common reasons.
Other times, the issue is detected in the fetus. We may notice the fetus has a birth defect or isn’t growing normally, like Tania’s. An abnormal amount of amniotic fluid is another common reason for concern. Often, risks to you or your fetus go hand in hand.
It may help to think of high-risk pregnancies as a spectrum. For some patients, being pregnant is dangerous for their health. Other patients simply have greater chances of pregnancy complications due to factors like their age. Even in the world of complicated pregnancies, you can be low-risk, very high-risk, or somewhere in between.
You will get a lot of care from a lot of people.
If a pregnancy is high-risk, you can count on more frequent health care visits. You might need more ultrasounds to track the growth of your fetus. The most high-risk pregnancies will need regular fetal monitoring to check that the fetus is doing well.
You’ll probably visit multiple doctors too. In addition to your regular ob-gyn, you’ll see an MFM specialist like me throughout your pregnancy. Or your care might transfer from your ob-gyn to an MFM early on. If another specialist cared for your preexisting condition before you got pregnant, they should weigh in on your prenatal care too. That could be a cardiologist, pulmonologist, rheumatologist, endocrinologist, or other medical specialist.
If the high-risk problem is with your fetus, we might consult with a pediatric surgeon, pediatric cardiologist, or other expert. Your hospital’s neonatal intensive care unit (NICU) will likely be involved as well. Together your health care team can plan for any necessary interventions once your baby is born.
Sara and Tania both needed close monitoring throughout their pregnancies, including extra growth ultrasounds. Sara took medication for her high blood pressure too. All those appointments and tests can feel stressful and time-consuming. But they serve an important purpose: to keep a close eye on you and your fetus.
You may need to deliver a little earlier than your due date.
Because a high-risk pregnancy poses risks to a woman and her fetus, it’s very common to give birth before 39 weeks. We want to deliver the fetus safely and before a maternal health condition has a chance to develop or get worse. For example, we don’t want a woman’s chronic high blood pressure to become preeclampsia, which can be very dangerous.
If you have a high-risk pregnancy, your ob-gyn may recommend inducing labor. This gives you and your doctors more control over the situation. Both of my patients agreed to induction at or before 39 weeks.
You may need to adjust your plan for labor and birth.
A high-risk pregnancy could have implications for your birth plan as well. If you have a serious underlying heart condition, for instance, the physical stress of labor could be risky for you. Your ob-gyn or MFM may recommend scheduling a cesarean birth instead.
You may need special care immediately after delivery, too. Women with preexisting diabetes typically need higher doses of insulin during pregnancy, as one example. Once you give birth, your ob-gyn or MFM should work with you to lower your insulin dosage and get your blood sugar under control, while supporting any plans to breastfeed. (Breastfeeding burns a lot of calories, which can cause your blood sugar to go too low if you’re not careful.)
You likely will not need bed rest.
Many people associate high-risk pregnancies with bed rest. And, indeed, bed rest was once widely recommended for women with high-risk pregnancies.
But bed rest has not been shown to reduce the risk of any pregnancy complications. Preterm labor was usually the greatest concern, but bed rest does not prevent a woman from going into labor. Perhaps more importantly, lying in bed all the time increases your risk for blood clots—and it isn’t great for your mental health either.
So, here’s some good news: ACOG no longer recommends bed rest or activity restriction during pregnancy. In fact, physical activity is an important part of a healthy pregnancy. Talk with your ob-gyn about exercise and whether you need to avoid any specific activities, based on your situation.
Having a high-risk pregnancy may impact future pregnancies.
Once you have a high-risk pregnancy, any future pregnancies you have may be high-risk, too. Your ob-gyn should watch you and your fetus closely to see whether the same condition develops again. If it does, they’ll know what to do to ensure everything goes as smoothly as possible.
High-risk and healthy
You can still have a successful pregnancy and birth if your pregnancy is high-risk. I’m pleased to report that both Sara and Tania had healthy babies, and the whole family’s doing great.
I know it’s hard hearing that your pregnancy is high-risk. But as I remind my patients, it’s important we know about pregnancy risks so we can prevent and treat complications. No matter what happens, you should count on your doctors to take good care of you and your fetus. With any pregnancy, we all want the best possible outcome for you and your baby.
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