High-risk pregnancy
Pregnancy with increased risk of adverse outcomes for carrier or fetus.
A high-risk pregnancy is one in which the gestational carrier or fetus faces an elevated likelihood of adverse outcomes relative to uncomplicated pregnancies. No concrete guidelines exist for distinguishing high-risk from low-risk pregnancies, but certain studied conditions have been shown to increase risk. These conditions fall into three categories: pre-existing health problems in the gestational carrier, health problems arising during pregnancy, and fetal health conditions.
Quick Facts
- Specialty
- Obstetrics, midwifery
- Diagnosis
- Based on symptoms
- imaging
- screening
Facts from the source article.
Causes
Pregnancies may be considered high-risk if the gestational parent has certain pre-existing health conditions, including age, chronic high blood pressure, pre-existing diabetes, cardiac or heart diseases, and autoimmune disease. Gestational parents over age 35 are considered of advanced age; first-time pregnant parents in this group may have normal pregnancies, but research indicates increased risks of first-trimester miscarriage, fetal chromosomal abnormalities such as Down Syndrome (Trisomy 21) and Trisomy 13, and fetal growth restriction (FGR). The mechanism linking older age to FGR is not well understood but may involve placental dysfunction. Younger age also poses risks: pregnant teenagers are more likely to develop anemia, have preterm births, and have low birth weight babies. Chronic hypertension is a risk factor because it increases the likelihood of pre-eclampsia, restricted fetal growth, and preterm birth. It is thought that hypertension reduces blood flow to the placenta, which may restrict fetal growth and trigger changes that raise the risk of these outcomes.
Management
Management of high-risk pregnancy depends on the specific etiology and situation of each pregnancy. For diabetes, self-monitoring via finger stick blood glucose monitoring is recommended, along with medical nutritional therapy, insulin therapy, and anti-hyperglycemic oral medications. Births should occur at healthcare centers with trained medical staff, including those trained in advanced life support. After birth, the gestational parent's blood glucose levels should be consistently monitored, with other tests deferred until signs of complications appear. For chronic hypertension, anti-hypertensive agents safe during pregnancy should be used; the American College of Obstetricians and Gynecologists also recommends low-dose aspirin for those with chronic hypertension and other pre-eclampsia risk factors. Management of fetal congenital defects depends on the specific condition—for example, certain cardiac anomalies may require fetal cardiac catheterization to correct pulmonary atresia with intact ventricular septum, while spina bifida can be repaired before birth. Other anomalies, such as hypoplastic left heart syndrome, can be monitored during pregnancy and treated with surgery soon after birth. For multiple gestations, conditions like preterm birth should be monitored, though evidence on specialized antenatal care improving outcomes is limited. Early and regular prenatal care helps prevent infections; options include medication prophylaxis, vaccines, antibiotics (e.g., for congenital syphilis), antifungals, or Caesarian delivery to prevent transmission.
High-Risk Pregnancy Specialists
Individuals with pre-existing medical conditions or those who develop complications during pregnancy may be referred to a physician trained in managing high-risk pregnancies. Such specialists include maternal-fetal medicine specialists (MFMs), also known as Perinatologists or High-Risk OBGYNs, and Complex Family Planning Specialists. Complex Family Planning Specialists are OBGYNs trained in managing pregnancy in individuals or fetuses with complex health conditions and are also specialists in contraception, unplanned pregnancies, and abortion care. These specialists provide support, advice, and organize medical appointments and hospital stays.
More in Pathology of Pregnancy, Childbirth and the Puerperium
Spotted an error? Know more?
Reader corrections go straight into our review queue. Suggest an edit · How this site is sourced