- High-risk pregnancies are those that pose a higher-than-normal-risk to the unborn baby or parent.
- They occur because of pre-existing medical conditions, maternal age, and other factors outside of human control.
- Pregnancies are immediately considered high risk for anyone over 35 years of age, or those with diabetes or high blood pressure.
A high-risk pregnancy is a pregnancy that may impact the health or even the life of the birthing parent or the fetus. But the first thing to know is that "high-risk pregnancy" is a general term, covering a wide range of pregnancy health concerns.
"By definition, a high-risk pregnancy is a pregnancy with higher risk than the average healthy woman has, so this is very broad," Dr. Greg J. Marchand, a gynecological surgeon at the Marchand Institute, told Insider. "Some pregnancies are affected by very serious medical conditions and are extremely high-risk, such as a pregnant woman who has previously received a heart transplant. Other high-risk pregnancies may not be quite as dangerous but still require additional monitoring, such as mothers affected by diabetes or high blood pressure."
Some pregnancies are automatically considered high-risk if the pregnant person has certain risk factors, like pre-existing medical conditions or being younger than 17 or older than 35. However, these risk factors don't necessarily mean the pregnancy will develop complications. Likewise, some people without specific risk factors like age or pre-existing health conditions can develop complications during their pregnancy that may lead it to be considered high-risk.
According to the Cleveland Clinic, about 50,000 people in the U.S. experience severe pregnancy complications annually, which is relatively rare given there are between 3 and 4 million births in the U.S. each year. Additionally, factors that make a pregnancy high-risk can be as common as obesity, which affects over 40% of the population.
Ideally, any pregnant person will receive regular medical care so that their physician, or midwife, can monitor their health and that of their fetus throughout and keep an eye out for complications before they arise.
But if you experience any of the following symptoms, seek medical care immediately as it could signify a serious issue:
- Vaginal bleeding
- Stopped or slowed fetal movement
- Dizziness
- Fainting
- Shortness of breath
- Extreme fatigue
- Fever
- Persistent abdominal or chest pain
- Swelling or redness of the face and/or limbs
- Severe, persistent headache
- Heart palpitations (heart racing)
- Severe nausea or vomiting (worse than normal morning sickness)
- Thoughts of harming yourself or your baby
Ruptured membranes (more commonly called "water breaking") and contractions are normal parts of labor and don't necessarily signify a problem. If you experience these at any point, seek medical care as you could be preparing to deliver, even if it's well before your due date.
With some premature rupture of membranes, attempts to delay delivery may occur. This is to allow the baby to mature while also affording a health care team more time to maximize the situation for the birth.
How do I know if my pregnancy may be high-risk?
Ultimately, it's up to your OB/GYN to determine if a pregnancy should be considered routine or high-risk. But even before you get pregnant, be aware there are a number of factors that may lead to a pregnancy being considered high-risk. These include:
- Maternal age (under 17 or over 35)
- Lifestyle factors like smoking (and vaping), substance use disorder, and alcohol use
- Obesity
- Diabetes
- High blood pressure
- Autoimmune diseases (i.e. lupus, Crohn's disease, ulcerative colitis)
- Kidney disease
- HIV/AIDS
- Polycystic ovarian syndrome (PCOS)
- Thyroid disease
- Fibroids
- Blood clotting disorders like hemophilia
- Low body weight (a BMI under 18.5)
- Mental health conditions
Virtually any pre-existing condition can be exacerbated by or cause risk to a pregnancy. Additionally, pregnant people with or without any of the preceding factors can develop complications such as gestational diabetes, preeclampsia or eclampsia, birth defects, poor growth, or genetic conditions in the fetus. Even multiple gestation – carrying twins, triplets, or more fetuses at once – can be considered a high-risk condition.
Regarding maternal age, Dr. Monte Swarup, an OB/GYN at New Horizons Women's Care, explained that "age alone is a factor, but [it] also increases risk for hypertension, diabetes, blood clots and other complications." Additionally, the risk of trisomy 21 (also know as Down syndrom) increases exponentially after age 35. Conversely, there are specific risks related to teenage pregnancy as well, such as anemia and a lower rate of access to prenatal care.
What happens if I have a high-risk pregnancy?
Once your doctor determines your pregnancy as high-risk, they will decide if the care you need is within the scope of their practice or if you need additional care from a specialist in Maternal Fetal Medicine. Marchand explained that after four years of undergrad, four years of medical school, and a four-year residency in obstetrics and gynecology, MFM specialists undergo an additional three years of training in order to treat pregnancies with serious medical conditions. Your regular OB/GYN may involve a MFM specialist depending upon their own expertise and comfort level with treating your specific condition.
Because high-risk pregnancies can include a diverse array of conditions, the treatment plan is going to depend heavily on the specifics of a pregnant person and their fetus' health status. Generally speaking, healthcare providers will likely want you to check in frequently so they can closely monitor your pregnancy and any health markers that may be affected by it, such as blood pressure or blood sugar.
One such possibility for care is antenatal testing, which means "monitoring the pregnancy to check for fetal oxygenation," Dr. Marchand explained. Antenatal testing, he said, "usually includes testing once or twice weekly after 24 weeks, but usually starting between 28 and 32 weeks. This is common in high-risk pregnancies affected by diabetes, high blood pressure, or advanced maternal age."
Swarup added that it's not uncommon for physicians to recommend inducing labor, even before the due date, if they determine it to be in the best interest of both parent and child.
Pregnant people with more severe conditions like heart failure, or pregnancy diseases like preeclampsia, may need to be hospitalized for extended periods of time to closely monitor the health of both the parent and the fetus.
A doctor may also recommend a particular setting for a birth in some cases. This is because not all birthing facilities are equipped to handle all high-risk situations. Any recommendation of a setting will be discussed prior a birth to assure the pregnant person, and the baby, get the best care available.
How can I prevent a high-risk pregnancy?
"There are very few cases when a high risk pregnancy can be prevented," Marchand said. Most high-risk pregnancy situations are due to factors beyond your control, like pre-existing or pregnancy-related medical conditions, or age.
That said, there are several things you can do to maximize your chances of a healthy pregnancy, including avoiding alcohol, smoking, and other drugs, maintaining a healthy weight, and managing any pre-existing conditions as best as you can. Even routine medical conditions can pose additional risks during pregnancy, so if you're in need of any procedures or treatments, try to pursue those before trying to become pregnant.
Having a pre-conception health visit is highly recommended. Doing so allows a doctor to advise any changes in medicine (and to begin a prenatal vitamin with folic acid) and provides the opportunity to be up to date on any vaccinations. It's also a way to learn about certain conditions that may impact the pregnancy.
Thoughtful family planning is something both Swarup and Marchand encouraged. This includes regularly communicating with your physicians about your personal and family health history before conceiving; it can also include planning pregnancy between the ages of 18 and 34, especially if you have a pre-existing condition that may pose additional risk to a pregnancy.
Some doctors also recommend a standard spacing between pregnancies of no sooner than six months after a prior pregnancy, with the ideal length being 18 months or longer.
Regardless of whether or not you have any factors for a high-risk pregnancy, any pregnant person can do their best to maintain their own health, and that of their fetus, by seeing a medical provider for thorough and regular prenatal care, staying hydrated, eating well, being active, and taking prenatal vitamins.
Insider's takeaway
A "high-risk" pregnancy is any pregnancy that poses a higher-than-normal risk to the health of the parent or unborn baby and can be due to pre-existing medical conditions, maternal age, and a number of other factors. Most high-risk pregnancy situations are beyond human control, and if you're diagnosed with a high-risk pregnancy, it's likely not because of anything you did or didn't do.
Not all parents with risk factors develop pregnancy complications, and if complications do occur, they can often be managed with the help of a healthcare professional to result in healthy outcomes for both parent and child.
If you're pregnant or trying to get pregnant, maintaining your own health is the best way to optimize your chances for a healthy pregnancy and birth. Work closely with a trusted physician to ensure you and your unborn baby are in the best shape possible throughout your pregnancy.