High-Risk Pregnancy Care

More than 15 percent of pregnancies require some specialized maternal care. If this includes your pregnancy, your OB/Gyn may recommend partnering with an obstetrician with specialty expertise to address the unique concerns of high-risk pregnancies.

High-Risk Pregnancy Defined

The term high-risk pregnancy is generally applied to any pregnancy where there is a higher than normal chance of a condition requiring extra care. Although it can sound scary, most often, having a high-risk pregnancy means only that you will require some extra care and monitoring. In some high-risk pregnancies, however, there is risk to you or your baby and you will need advanced, coordinated care to have the best possible outcome.

The list of factors that can qualify a pregnancy as high-risk is extensive. It may include:

• Being over age 35, and sometimes under age 17.
• Having one or more risk factors for a birth defect, such as a family history of genetic disorder.
• Having had a previous premature birth or high-risk pregnancy.
• Having had several miscarriages.
• Carrying multiples (twins, triplets or more).
• Developing a pregnancy complication such as gestational diabetes, preeclampsia (pregnancy-related high blood pressure), or problems with the uterus, cervix or placenta.
• Having Rh sensitization — a potentially serious condition in mothers with Rh negative blood who are type carrying Rh positive babies.
• Having a chronic medical condition known to impact pregnancy, such as diabetes, high blood pressure, kidney disease or epilepsy.
• Having taken a drug during pregnancy known to impact fetal development. This could include illegal substances or drugs you may need to take to manage or treat a health condition.
• Having a viral or bacterial disease that could pose a risk to your baby, such as hepatitis C, rubella, HIV, cytomegalovirus, chickenpox, toxoplasmosis or syphilis.
• Going through cancer treatment during pregnancy.
• Carrying a baby with a known birth defect.

Testing and Special Care

Obstetricians are trained to offer both regular and high-risk pregnancy care. In addition, you may need to meet with a genetic counselor or see a specialist in maternal-fetal medicine. When there is a known issue with a specific problem, your pregnancy care team may also work with specialists in other fields such as endocrinology, cardiology, neurology, radiology or oncology.

In general, high-risk pregnancy means more testing during pregnancy and a higher level of care during labor and delivery. Advanced prenatal diagnostic tests you may need include amniocentesis, chorionic villus sampling, first-trimester nuchal screening, targeted ultrasound evaluation and various antepartum (before birth) tests. Your doctor may also teach you how to monitor your pregnancy at home by knowing the signs of preterm labor and how to track your baby’s movements.

Throughout your pregnancy, your doctor will use information from various tests to make the best possible care recommendations for you. Together, you may need to make some decisions about when you will deliver your baby and what types of interventions you may need to deliver as safely as possible.

Some of the advanced services and programs available for high-risk pregnancies include:

• Preconception planning and genetic testing
• In-utero fetal therapy, such as surgery on the fetus or placenta
• Dedicated high-risk maternity units
• Support programs for moms of multiples
• Support programs for parents of babies with birth defects
• Gestational diabetes care and nutrition counseling