When Is a Pregnancy Considered High Risk?

You’ve probably heard that some pregnancies are high risk and some are not, usually called low risk, but what do these phrases mean? Here we’ll take a look at the issues that can arise that cause care providers to classify your pregnancy as one or the other and discuss what it means if you have a high-risk pregnancy.

Factors that could make a pregnancy high risk

There are several medical conditions that when they’re present in people who get pregnant can make the pregnancy more complex. They include:

High blood pressure can present risks for the pregnant person and the fetus because high blood pressure makes the heart work harder to get blood to necessary organs and tissues. Plus, because blood volume increases during pregnancy, there’s already strain on the heart. If you have high blood pressure going into pregnancy, it’s important to work with your doctor or midwife to get it under control as early pre-conception or prenatally as you can. In some cases, uncontrolled high blood pressure turns into preeclampsia, which can be dangerous for mom and baby.

Polycystic Ovarian Syndrome (PCOS) can predispose pregnant people to pregnancy loss, gestational diabetes, and preeclampsia.

Uncontrolled diabetes presents a situation where the fetus is used to getting more sugar in the bloodstream than is appropriate, so babies born to mothers with uncontrolled diabetes often have problems regulating their blood sugar. Diabetes where blood sugar is not well managed also usually makes babies grow bigger, which may present more complications during birth.

Pregnant people with preexisting kidney disease may have trouble with preterm delivery, preeclampsia, and babies with birthweights low for their gestational age. If you have kidney disease, you should manage your disease carefully with your providers and a nutritionist during pregnancy.

Autoimmune diseases, such as multiple sclerosis and lupus, can all complicate a pregnancy. While sometimes autoimmune disease manifestations improve during pregnancy, other times flare-ups become more common or severe. Autoimmune disease is another situation that requires close monitoring from healthcare providers during pregnancy.

Infections, including Herpes Simplex Virus, HIV/AIDS, Zika virus, and COVID-19—even if they’re experienced before pregnancy—can all create complications during pregnancy. For instance, HIV can be passed to the fetus, so the pregnant person should work with their doctors to take antiviral medications throughout pregnancy. Zika virus can lead to complications in the fetus, including microcephaly, and COVID-19 can have effects on the cardiovascular system that affect the placenta.

History of preterm birth, depending upon the reason, may mean subsequent pregnancies are also at risk for the baby being born too early. Cervical insufficiency, for instance, is a cause of preterm birth and second-trimester loss that can recur and should be treated.

In addition to the complicating factors discussed above, a pregnancy may also be considered high risk in both pregnancy teenagers and people who experience their first pregnancy after age 35 (also known as advanced maternal age). Alcohol, tobacco, and drug use can also complicate a pregnancy and have adverse effects on the fetus.

Finally, there are conditions that can arise during pregnancy that make the pregnancy high risk. These are:

Multiple gestation (being pregnant with more than one fetus at a time) increases the risk of premature birth and babies who are small for their gestational age.

Preeclampsia, eclampsia, and HELLP syndrome are all related pregnancy disorders that usually come with high blood pressure and protein in the urine, as well as a suite of other possible signs and symptoms. As discussed above, high blood pressure is dangerous to the fetus because it can mean that the placenta gets less blood than it needs, and high blood pressure can also increase the risk for seizures in the pregnant person and the fetus.

Mental health issues can also make a pregnancy high risk. Anxiety, for instance, has been shown to increase the risk of preterm birth, and untreated perinatal mental illness can mean poor health outcomes for both mother and baby. Just as you would with a physical complaint, talk to your care provider about your mental health during pregnancy.

So what do I do if my pregnancy is high risk?

First, control what you can. Find care providers that you trust and who listen to you. If you don’t feel as though you’re being heard and have concerns about your pregnancy, it’s okay to seek a second opinion. Next, get support. Find friends, loved ones, and professionals who will let you vent, reassure you, hear your concerns, and carry you through the rough spots of a high-risk pregnancy. Finally, work as closely with your care team as you can to get your complications under control.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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