High-risk Pregnancy: Risk Factors & Complications

What is a high-risk pregnancy?

A high-risk pregnancy is one in which the health of the mother or the developing fetus is compromised, necessitating additional medical care and attention. Various factors contribute to the classification of pregnancy as high-risk, requiring close monitoring and specialised care.

What makes a pregnancy high-risk?

1. Advanced maternal age: 

   • Pregnancies in women over 35 are considered high risk due to an increased likelihood of complications such as gestational diabetes and chromosomal abnormalities.

2. Multiple gestation: 

   • Twins, triplets, or higher-order multiples pose higher risks, including premature birth and low birth weight.

3. Pre-existing medical conditions:

   • Conditions such as diabetes, hypertension, autoimmune disorders, and heart disease can elevate the risk during pregnancy.

4. Gestational diabetes: 

   • The onset of diabetes during pregnancy can lead to complications for both the mother and the baby.

5. Hypertensive disorders in pregnancy: 

   • Hypertensive disorders in pregnancy can compromise both the mother and the fetus.

6. Placenta previa:

   • Placenta previa, where the placenta partially or completely covers the cervix, can result in bleeding and complications during delivery.

7. Use of Assisted Reproductive Technologies (ART): 

   • Pregnancies resulting from fertility treatments, such as in vitro fertilisation (IVF), may be at a higher risk of certain complications.

8. Lifestyle factors: 

   • Smoking, substance abuse, or excessive alcohol consumption increase the risk of preterm birth, low birth weight, developmental issues, and other complications.

How to manage a high-risk pregnancy?

Management of high-risk pregnancy depends on the underlying condition of the mother and the risk factors. It involves a multidisciplinary approach.

1. Consultation with specialists: 

   • Collaboration with specialists such as maternal fetal medicine specialists, endocrinologists, and other relevant healthcare providers.

2. Specialised prenatal care: 

   • High-risk pregnancies require more frequent and specialised prenatal visits to monitor both maternal and fetal health.

3. Medical interventions: 

   • Medications may be prescribed to manage conditions such as gestational diabetes or hypertension.

4. Bed rest and activity restriction:

   • In some cases, bed rest or activity restriction may be recommended to prevent complications.

5. Fetal monitoring: 

   • Continuous monitoring of the fetus's growth and well-being through ultrasounds, non-stress tests, and other diagnostic tools.

FAQs

When should I go for antenatal booking if I have high-risk pregnancy?

It should be done as soon as you are confirmed pregnant. The recommended time is when you are less than 12 weeks pregnant.

What are the complications associated with high-risk pregnancy?

High-risk pregnancies are associated with an increased likelihood of complications that require careful monitoring and specialised medical attention. The specific complications can vary based on the underlying risk factors and health conditions. Here are some common complications associated with high-risk pregnancies:

1. Preterm birth: 

   • One of the most significant complications is the risk of preterm birth. Babies born before 37 weeks of gestation may face developmental challenges and health issues.

2. Low birth weight: 

   • Babies born from high-risk pregnancies are more likely to have low birth weight, which can lead to complications such as developmental delays, respiratory problems, and a higher risk of infections.

3. Hypertension and preeclampsia: 

   • Hypertension (high blood pressure) during pregnancy can lead to preeclampsia, a serious condition characterised by high blood pressure and damage to organs such as the liver and kidneys. Preeclampsia can result in premature birth and affect the health of both the mother and the baby.

4. Fetal growth restriction:

   • In high-risk pregnancies, inadequate fetal growth may occur, leading to fetal growth restriction. This condition can result in low birth weight and other health problems for the baby.

5. Caesarean Section (C-Section): 

   • High-risk pregnancies may have a higher likelihood of requiring a C-section, either as a planned intervention or due to complications during labor.

6. Neonatal Intensive Care Unit (NICU) admission:

   • Babies born from high-risk pregnancies may require admission to the NICU for specialised care and monitoring, especially if born prematurely or with health issues.

7. Chromosomal abnormalities:

   • High-risk pregnancies, especially in older mothers, may be associated with an increased risk of chromosomal abnormalities, such as Down syndrome.

8. Postpartum complications:

   • The risks associated with high-risk pregnancies can extend into the postpartum period, including an increased likelihood of maternal complications such as postpartum hemorrhage, infections, and challenges in breastfeeding.

9. Maternal health issues: 

   • The mother's health is also at risk in high-risk pregnancies, and complications may include exacerbation of pre-existing conditions, gestational hypertension, and postpartum depression.

I'm currently taking medications for a chronic medical condition and just found out I'm pregnant. Should I stop taking my medication?

Do not stop taking or alter the dose of a prescribed medicine without the knowledge and consent of your doctor. It can be dangerous to make the decision to stop taking a medication without guidance from a doctor as some illnesses or pregnancy complications may risk the health of the mother or baby, or both if untreated. Discuss any concerns you may have about medicines with your doctor. 

What can you do to prevent complications during a high-risk pregnancy?

1. Preconception planning: 

   • Planning pregnancies and optimising health before conception can reduce the risk of complications.

2. Regular prenatal check-ups:

   • Regular and early prenatal care allows for the timely identification and management of potential risk factors.

3. Lifestyle modifications: 

   • Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding harmful substances, can contribute to a lower risk of complications.

4. Management of pre-existing conditions: 

   • Managing chronic conditions before and during pregnancy can minimize associated risks.

5. Early detection and intervention: 

   • Early detection of risk factors and prompt medical intervention can prevent or mitigate complications.