How Does a High-Risk Pregnancy Impact Your Prenatal Care?

As more couples wait to start a family until they’re more established, women are having babies later in life. Unfortunately, age and other factors can increase the risk of pregnancy-related complications.

High-risk pregnancies are those situations in which the mother, the baby or both are at risk for health problems before, during or after pregnancy, explains Raminder Khangura, M.D., a maternal-fetal medicine specialist at Henry Ford Health.

There are many reasons high-risk pregnancy can occur that may be concerning for expectant parents, but Dr. Khangura stresses that high-risk pregnancies can be managed. “It’s important that you seek specialized prenatal care early. We work closely with our patients to develop a prenatal care and delivery plan tailored to meet both the mother’s and baby’s needs,” she says.

What Factors Can Cause A High-Risk Pregnancy?

While there are many reasons why a pregnancy is considered high-risk, it’s important to note that having one of these factors doesn’t guarantee that you will have a high-risk pregnancy.

Existing conditions that may increase your risk for pregnancy complications include:

• Young or advanced age: Under 17 or over 35 years old
• Lifestyle choices: Smoking, drinking alcohol or using illegal drugs
• Underlying health conditions: Autoimmune diseases, connective tissue disorders, diabetes, heart disease, high blood pressure, kidney disease, obesity, thyroid disease and uncontrolled asthma can all make pregnancy riskier for mom and baby
• Multiple pregnancy: Carrying two or more babies
• Previous pregnancy complications: A history of stillbirths or recurrent miscarriages

A pregnancy can also become high-risk if a mother or baby develops a health condition during pregnancy. Examples of these complications include:

• Fetal growth restriction: Occurs when the baby’s weight or the measurement around baby’s abdomen is less than the 10th percentile. If your baby develops this condition, your physician will monitor your baby’s growth and well-being throughout your pregnancy.
• Gestational diabetes: Women who have not had diabetes in the past can develop elevated blood sugar levels during pregnancy. Gestational diabetes can cause a baby to grow too large, making delivery more difficult. After birth, some babies may require follow-up care if they develop elevated blood sugar. Mothers can often control gestational diabetes with diet and exercise. In some cases, a mother may need to take insulin to control blood sugar levels.
• Placenta previa: During pregnancy, the placenta develops in the mother’s uterus to carry food and oxygen to the baby and remove waste. Placenta previa occurs when the placenta moves over the cervix, which is the opening of the uterus. For most women, placenta previa corrects itself. In some cases, though, it causes heavy bleeding. If the condition persists or bleeding doesn’t stop, your doctor may recommend delivery before you reach full term (40 weeks).
• Preeclampsia: A condition in which an expectant mother develops high blood pressure and has protein in her urine. If you have preeclampsia, your doctor may recommend bed rest at home or in the hospital and treatment with blood pressure medications.

Steps To Reduce Your Risk For Pregnancy Complications

Some high-risk pregnancy complications can’t be avoided, but lifestyle choices and prenatal care can reduce your risk. To promote a healthy pregnancy, Dr. Khangura recommends scheduling a preconception appointment with your doctor. By taking this step, your doctor can:

• Review your medical history to determine if any health issues, such as high blood pressure or diabetes, need to be controlled before you get pregnant.
• Identify medications that need to be stopped or adjusted if they pose a potential risk for your baby.
• Determine if you’re up to date on vaccinations (including the COVID-19 vaccination) to protect you and your baby from viruses during pregnancy.

Dr. Khangura recommends making lifestyle changes that support healthy pregnancy before you get pregnant. These practices include:

• Avoid alcohol and stop smoking. Both alcohol and smoking can pose risks to your health and your baby’s growth and development.
• Maintain a healthy weight. Gaining too much weight can increase your risk of developing high blood pressure or gestational diabetes. If you don’t gain enough weight, your baby is at risk for conditions like low birth weight or nutrient deficiencies.
• Stay active. Choose low-impact exercises, avoid overexertion and stay hydrated before, during and after your workouts.
• Begin taking prenatal vitamins at least one month prior to conception. This can decrease the risk of neural tube defects. Prenatal vitamins also help reduce the severity of nausea and vomiting during pregnancy.

Prenatal Care For A High-Risk Pregnancy

Regular prenatal care is important for everyone, but if you have a high-risk pregnancy, you need more frequent prenatal care from an obstetrician or maternal-fetal specialist. Your doctor may also recommend you see a specialist for underlying health conditions like heart disease or diabetes.

Your doctor will likely recommend screening tests to keep tabs on your and your baby’s health. These tests can identify any changes in your health, such as elevated blood pressure and blood sugar levels. Other screening tests, such as specialized ultrasounds, help monitor your baby’s development. If you have a family history or a risk factor for a genetic condition, your doctor may recommend genetic testing.

As part of your prenatal care, your doctor will also discuss your options for delivery. Many women with a high-risk pregnancy assume they will need a cesarean section (C-section). But a C-section isn’t a given for all high-risk pregnancies.

“We perform vaginal deliveries for many high-risk pregnancies. Depending upon your situation, you may be able to deliver vaginally even if you previously had a C-section,” says Dr. Khangura. “Your doctor will discuss the best delivery option to ensure your health and the health of your baby.”

Pregnancy Complications Can Be A Window Into Future Health

If you have experienced complications during pregnancy, it’s important to seek follow-up care after delivery. Complications like gestational diabetes or preeclampsia can put women at risk for conditions including diabetes and heart disease in the future.

“By sharing your pregnancy history with your physician, you can be proactive for future pregnancies as well as your long-term health,” says Dr. Khangura. “Your physician can recommend appropriate screening and steps you can take to reduce your risk for future complications.”

To find an obstetrician or maternal-fetal specialist at Henry Ford, visit henryford.com or call 1-800-436-7936. 

Dr. Raminder Khangura is an OB/GYN and a maternal-fetal medicine specialist who sees patients at Henry Ford West Bloomfield Hospital and Henry Ford Medical Centers - Ford Road and New Center One.