Finding out you are pregnant can be considered a wonderful gift and a blessing but there are certain situations where pregnancy can come with a list of complications that can put both mom and baby at risk. In these special situations, doctors will determine pregnancy to be what is called “high-risk”, meaning mom and/or baby have an increased chance of complications during pregnancy. This usually requires a larger number of doctor visits, the potential for more ultrasounds than what is standard and weekly or even daily monitoring, when mom and baby reach the second half of the third trimester.
Although the majority pregnancies that happen around the world are not considered to be high risk, there are certain situations and factors that can contribute to complications during pregnancy and childbirth that lead for a high-risk diagnosis including illnesses, environmental factors, and unhealthy life choices. While some of these factors can be pretty rare, there are some that are more common than you might think and might even be within your control!
To help further understand the risks that are associated with pregnancy, here are 15 reasons why mom could be in for a high-risk pregnancy and how these pregnancies are treated differently by the medical community.
15 Carrying Multiples
Surprise! You’re having twins! Although this is a wonderful surprise when it happens, it can also come with a list of potential complications and thus can make you automatically be considered high-risk by doctors. This means more appointments, more monitoring and that you no longer have the option to be cared for by a midwife.
The biggest risk with caring multiples is that you will have to deliver the babies prematurely and this means that there could also be a higher risk for health problems as well. Although most babies end up being healthy in the end, 60 percent of twins and 90 percent of triplets were born before they are considered to be full-term, which is considered to be 37 weeks gestation.
Although this risk exists, it is good to know that the majority of multiple births eventually result and healthy babies with careful monitoring and close attention by doctors.
14 Have PCOS
Women with PCOS (Polycystic Ovarian Syndrome), a chronic hormonal medical condition are at an increased risk of developing complications during pregnancy and therefore may be considered high-risk by doctors.
Although we often hear of women with PCOS struggling to get pregnant, we don’t hear as much about pregnant women who suffer from the disease. PCOS can increase your risk of miscarriage, but also high blood pressure and gestational diabetes, which can lead to premature birth. Pregnant women who have PCOS are also more likely to need a C-section because their babies are often on the bigger side for their gestational age. If you have PCOS, it is possible to have a healthy pregnancy but expect your pregnancy and PCOS symptoms to be monitored closely by doctors.
13 Teen Pregnancy
Although it may not be too difficult to get pregnant as a teen, it is true that being a teenager can mean your pregnancy is considered high-risk. The largest risk with teen pregnancy is getting pregnancy induced hypertension (also called high blood pressure) and teens have a bigger chance of getting hypertension than pregnant women who are in their 20s or 30s.
High blood pressure can also lead to preeclampsia, a dangerous condition that can be fatal. Medication can be given to control the symptoms but there’s also a risk to the babies growth and development and this can lead to premature birth and a higher risk for low birth weight babies (3.3–5.5 LBS). Babies who have a lower birth weight may require a ventilator, close monitoring and time in the NICU. It is because of these risks that pregnant teens will be closely monitored by doctors.
12 Over 35
If you’re over 35 and pregnant, you may be considered high-risk by your doctor, especially if this is your first pregnancy. This is true for a number of reasons including an increased risk of miscarriage, ectopic pregnancy, hypertension, and gestational diabetes. If you do manage to successfully get through the first trimester, you then have an increased risk of having a baby with chromosome all abnormalities and this risk just keeps increasing every year at age 25, your risk of conceiving a baby with Down’s Syndrome is one in 1,250 but once you hit age 40, that number goes up to one in 100.
If you’re pregnant and over 35, be prepared to be offered genetic counselling and be closely monitored for genetic problems. Although more and more women are having children later in life and the majority of babies are born healthy, it is important to take these things into consideration when having a baby in your late 30s.
11 A Smoker
It is no secret that pregnant women are advised not to smoke at all at any point during their pregnancy. But how smoking can affect the baby and why pregnant smokers are considered high-risk is less explained by the media.
Although some women may find quitting difficult, most OBs advise women to stop smoking as doing so while pregnant can cause a whole slew of complications including: premature babies, babies with a low birth rate and babies who die before birth is even possible.
Cigarette smoke contains over 4000 chemicals. “When you smoke during pregnancy, that toxic brew gets into your bloodstream, which is your baby’s only source of oxygen and nutrients“. Out of all the harmful chemicals, nicotine and carbon monoxide are the two big ones and they cause the vast majority of complications in pregnant smokers – the biggest complications being stillbirth, premature birth and low birth rate. The sooner you quit, the better it is for you and your baby, so pregnant women are advised to quit smoking at any point during their pregnancy and will receive some benefits from quitting regardless of when they’re able to do so.
10 Received Abnormal Test Results
I can speak to this particular risk from personal experience with my own pregnancy. At my 12 week blood test, two markers that monitor hormones in the placenta showed an abnormal result, which led me to be slightly higher risk than the average pregnant women for developing something called Placental Insufficiency.
Placental Insufficiency basically means the placenta could stop providing the baby with adequate nutrition later on in the third trimester. Pregnant women who are at risk for Placental Insufficiency require extensive monitoring, especially later on in the pregnancy to determine if the baby is growing at a normal rate. If the baby is not growing properly, the most common treatment is early delivery, so the baby can start getting adequate nutrition from breastmilk or formula. The placenta essentially stops working too early and babies typically weigh less when they are born. Regular weekly ultrasounds are used in the third trimester to track the baby’s size and growth. With proper monitoring most women with this condition go on to have healthy babies.
9 Have Diabetes
Whether you have been diagnosed with Gestational Diabetes (diabetes exclusive to pregnancy that goes away once you have the baby) or have a pre-existing condition of Diabetes, you are likely to be considered more high-risk during your pregnancy. Diabetes occurs when you have a buildup of glucose and your body can’t handle it. Normally your body produces enough insulin to properly digest the sugars, but diabetic people are unable to process the sugars properly. They usually need to control their blood sugar levels through low sugar diet and also possibly with insulin injections.
If you have Diabetes while pregnant, it can lead to several complications. The biggest complication doctors are worried about is that diabetic pregnant women are at risk for having very large babies. This means that the babies are bigger than they should be for their gestational age, which can lead to complications during birth like requiring C-section because your baby is too big to deliver naturally. The good thing is that science has made stunning progress when it comes to diabetes and pregnant women. With proper monitoring and a diabetes- friendly diet, most diabetic women go on to deliver healthy babies and have a normal delivery.
8 At Risk For Preeclampsia
Preeclampsia is very scary and another reason why you could be considered high-risk while pregnant. Anyone watch Downton Abby? Remember what Cybil died from during childbirth? Yes, that was Preeclampsia and if left untreated, it is fatal, even today. Preeclampsia occurs only to pregnant women and consists of symptoms like hypertension (high blood pressure), swelling and protein in the urine.
You are most at risk for Preeclampsia after 20 weeks of pregnancy. Doctors will keep a close eye on your blood pressure and want to treat you for rapid weight gain or swelling in the feet, limbs and or face. If you are diagnosed with Preeclampsia, the only real treatment is to deliver your baby otherwise you risk this illness leading to something called Eclampsia, a condition where you have violent seizures and oxygen is cut off to you and the baby. This can be fatal to mom and this is why doctors take Preeclampsia so seriously. If you are at risk for having Preeclampsia, be prepared to be monitored closely throughout the remainder of your pregnancy.
7 Have High Blood Pressure
If you have high blood pressure prior to being pregnant or they discover your blood pressure is high at any point during your pregnancy, be prepared for some extra attention as you may be considered high-risk. As we looked at before, high blood pressure, also known as hypertension, is one of the risk factors that can lead to Preeclampsia, a condition that occurs in pregnant women that can be fatal if left untreated. If your blood pressure continues to be high, you may be monitored closely and given medication to help keep it at a healthy level.
High blood pressure in pregnancy is less common in the beginning stages of pregnancy and is more of a concern during the third trimester. During pregnancy, women usually have blood pressure that’s on the lower side, but either way your doctor or midwife will be checking your blood pressure every appointment and monitor you for this risk.
6 Tested Positive For Down's Syndrome Or Other Chromosomal Conditions
If you have had abnormal test results in one of your scans that indicate you’re at an increased risk for Down’s Syndrome and other genetic abnormalities, you may be considered high-risk by doctors.
Down’s Syndrome and other chromosomal abnormalities are generally tested at your first trimester screening, which occurs around 12 weeks gestation. You have several options for testing, however the most common test is a combination of bloodwork and an ultrasound to measure the nuchal translucency (a small gap behind your baby’s neck, which is a good indicator for chromosomal abnormalities including Down’s Syndrome). If the screening comes back positive, you have several other options for tests to give you a more conclusive diagnosis. If it is determined that your baby has Down’s or another chromosomal condition, you will be monitored more closely, as this can lead to other complications during pregnancy. Some chromosomal issues can also be fatal to the baby either prior to birth or immediately after.
If reading this has freaked you out a little, keep in mind that the chances of this happening are generally rare and most moms go on to have a healthy pregnancy with no chromosomal issues.
5 Subchorionic Bleeding
Although any kind of severe bleeding may raise a red flag for doctors, subchorionic bleeding is a condition that can lead to a high-risk pregnancy. Subchorionic bleeding generally happens because the placenta detaches from the uterine wall. Although this sounds pretty scary, generally the parts of the placenta that detached are small and the bleeding is not severe, making subchorionic bleeding not harmful in the long term. In rare cases, however, this bleeding can lead to miscarriage and even stillbirth later on in the pregnancy.
The only way subchorionic bleeding can be diagnosed is with an ultrasound and often women with this condition won’t have any other symptoms other than bleeding. Once it is deemed that you have this condition, you’ll be monitored closely throughout your pregnancy or until the bleeding has been resolved and haemorrhage is no longer visible.
4 Have A History Of Miscarriage
A miscarriage on its own it’s not enough to deem a pregnant woman high-risk, however, multiple miscarriages in a row can lead to increased monitoring and a high-risk pregnancy. The majority of women who have miscarriages will only have one in their life. Only 1% of women go on to having two or more miscarriages. Once you have had one miscarriage, your chances of having a second one is around 14%. If you have had two miscarriages, your risk of having a third goes up to 26% and then your risk of having a fourth miscarriage would be approximately 28%.
While most women who have miscarriages go on to have successful pregnancies, these pregnancies maybe monitored with greater care. You may be in for a lot more ultrasounds, bloodwork to test hormone levels and constant fetal monitoring. This can be seen as both a blessing and a curse as this constant monitoring can make many women anxious but it can also be comforting to know that doctors are taking pregnancy after miscarriage so seriously.
3 Have An Autoimmune Disease
Although not all autoimmune diseases can lead to high-risk pregnancies, there are quite a few that exist that can cause extra concern for doctors. Autoimmune diseases may improve or worsen during pregnancy depending on the disease itself and the way the body reacts to the pregnancy. Some diseases like Multiple Sclerosis and Rheumatoid Arthritis actually tend to improve during pregnancy. But this is not the case for the majority of autoimmune diseases, however, as the bulk of them tend to cause pregnancy complications, which means increase monitoring and being declared high-risk. Some of these complications can include the auto immune disease symptoms being unpredictable during pregnancy, the body reacting poorly to the baby because it considers the baby to be a foreign entity, and mom’s autoimmune responses being transferred to the fetus.
Thankfully science has made some progress in helping women tackle these issues to help them have a safer and more comfortable pregnancy. Many women with autoimmune diseases go onto having healthy babies. The caveat, however, is that these women are likely to be monitored very closely during pregnancy and be declared high-risk by doctors.
2 Have An STI
If you have a pre-existing sexually transmitted infection or come to catch one during pregnancy, there’s a good chance you’ll have more monitoring and be considered high-risk if the infection cannot be treated with normal course of antibiotics. A lot of different STIs can lead to different complications during pregnancy including preterm birth, physical conditions like fetal blindness and the baby potentially catching the STI during delivery, if it is an STI like genital herpes, Hepatitis B or HIV.
The good news is that most doctors will test pregnant women for STIs when they initially find out they are expecting. This will help health care professionals be more informed about the level of care the pregnant woman needs. In situations where the pregnant woman has a certain STI like Gonorrhoea or Chlamydia, usually standard any antibiotics are prescribed and infections are treated and are no longer an issue. But with other infections that cannot be cured such as HIV, Hep B and other viral sexually transmitted diseases, the only thing that can be done is to monitor the pregnancy closely and to intervene if necessary, to ensure mom and baby have a safe and successful delivery, to help the baby avoid catching the infection.
1 Had Previous High-Risk Pregnancies
If you have a history of having one or more previous high-risk pregnancies, chances are any subsequent pregnancies will be considered high risk. The reasons most women are deemed high-risk often do not subside with time and are usually present in future pregnancies as well. Although there are some cases where this isn’t always true, a lot of doctors will air on the side of caution when it comes to monitoring pregnant women.
If something came up during the past pregnancy and doctors are concerned there’s a risk that it could happen again, they will generally recommend increased monitoring to be on the safe side. Although this may be troublesome for some women, it’s important to know that medical community generally has their best interest at heart and it should bring some comfort that they only hope this closer monitoring will ensure that the pregnancy goes smoothly.
Sources: WedMD; Mayo Clinic; Baby Center; Pregnancy, Birth & Baby