High-Risk Pregnancy: Causes, Signs, and Management

High-Risk Pregnancy: Causes, Signs, and Management

 

Every expecting mother hopes for a smooth and healthy pregnancy. While this is true for many, some women may face complications that make their pregnancy high-risk. A high-risk pregnancy can bring emotional and physical challenges, but with the right care, most women still go on to deliver healthy babies.

What is a High-Risk Pregnancy?

All pregnancies carry some level of risk, but a high-risk pregnancy is one where the health or life of the mother, baby, or both may be at increased risk due to specific medical or obstetric conditions. It requires closer monitoring and specialized care.

Approximately 6–8% of pregnancies are classified as high-risk. While this number may seem small, the complications can be significant. However, with proper management, many women with high-risk pregnancies can still achieve positive outcomes.

When is it Diagnosed?

A high-risk pregnancy may be identified:

Before conception, if pre-existing conditions are known.

During early pregnancy, based on medical history and routine screening.

Later in pregnancy, if complications arise.

Routine tests and assessments in the first and second trimesters (10–20 weeks) can help identify many risk factors early.

Common Causes of High-Risk Pregnancy

1. Pregnancy-Related Factors

History of Recurrent Miscarriages:

Women with two or more miscarriages are at increased risk. Causes may include hormonal imbalances, autoimmune issues, or uterine anomalies.

Abnormal Amniotic Fluid Levels:

Oligohydramnios (too little fluid) may restrict fetal growth or complicate delivery.

Polyhydramnios (too much fluid) can lead to preterm labor and pressure on maternal organs.

Placental Abnormalities:

Placenta accreta spectrum: Abnormally deep attachment of the placenta to the uterine wall.

Placental abruption: Premature separation of the placenta, causing bleeding and risk to the fetus.

HELLP Syndrome:

A severe form of preeclampsia involving Hemolysis, Elevated Liver enzymes, and Low Platelets. It can be life-threatening for both mother and baby if not promptly treated.

2. Fetal-Related Factors

Chromosomal Abnormalities:

Conditions like Down syndrome or trisomy 18 can be detected via prenatal screening. Nearly 86% of first-trimester miscarriages are linked to chromosomal errors.

Genetic Syndromes:

Inherited conditions like Fragile X syndrome, thalassemia, or sickle cell disease can affect fetal development.

Fetal Growth Restriction (FGR/IUGR):

When the baby doesn’t grow at the expected rate, often due to placental insufficiency or maternal conditions.

3. Maternal Health Conditions

Hypertension:

Chronic high blood pressure increases the risk of preeclampsia, stroke, placental abruption, and low birth weight.

Diabetes (Pre-existing or Gestational):

Can increase the risk of congenital malformations, macrosomia (large baby), preterm labor, and stillbirth.

Blood Clotting Disorders:

Conditions like thrombophilia can lead to placental blood flow issues, increasing the risk of miscarriage or preeclampsia.

Autoimmune or Rheumatologic Diseases:

Diseases like lupus or rheumatoid arthritis may cause pregnancy loss, preterm birth, or fetal heart block.

Infections:

HIV, cytomegalovirus, toxoplasmosis, and hepatitis B/C can be passed to the baby. Proper treatment (e.g., ART for HIV) reduces transmission risks significantly.

Substance Use (Smoking, Alcohol):

Can cause miscarriage, stillbirth, fetal alcohol syndrome, and premature birth.

Other Chronic Conditions:

Kidney disease, heart disease, cancer, or uterine fibroids can also complicate pregnancy and may need specialized care.

Maternal Age:

Advanced maternal age (≥35 years) is linked with higher risk of chromosomal anomalies and pregnancy complications.

Very young mothers (<17 years) are also at higher risk of anemia, preterm birth, and poor fetal outcomes.

Warning Signs of a High-Risk Pregnancy

Seek immediate medical attention if you experience:

Persistent or severe abdominal pain

Decreased or no fetal movement

Excessive swelling (face, hands, or legs)

Vaginal bleeding or unusual discharge

Fever above 100.4°F (38°C)

Blurred vision, severe headache, or chest pain

Painful urination

Pelvic pain or cramps

Shortness of breath or fainting

High blood pressure readings

Redness in limbs or unexplained fatigue

How is a High-Risk Pregnancy Diagnosed?

Evaluation includes:

– Blood & Urine Tests:

Detect infections (e.g., HIV, hepatitis B), anemia, gestational diabetes, thyroid issues, and kidney function.

– Ultrasound Scans:

Assess fetal growth, amniotic fluid, placental health, and structural anomalies.

– Biophysical Profile (BPP):

Combines ultrasound and fetal heart rate monitoring to evaluate the baby’s well-being.

– Non-Stress Test (NST):

Measures fetal heart rate in response to movements, often used after 28 weeks.

– Genetic Screening & Diagnostic Tests:

May be recommended based on family history or previous outcomes.

Management of High-Risk Pregnancy

1. Frequent Prenatal Visits

Regular checkups help monitor maternal and fetal well-being, detect complications early, and modify treatment plans when needed.

2. Medical Management

Control of conditions like diabetes, hypertension, or thyroid disorders with medications deemed safe in pregnancy.

Timely interventions like steroid administration for lung maturity in preterm risk cases

3. Lifestyle Modifications

Balanced, nutritious diet

Appropriate physical activity (as advised by your doctor)

Avoidance of smoking, alcohol, or unprescribed drugs

Managing stress through mindfulness, yoga, or counseling

4. Delivery Planning

Depending on your condition, your doctor will guide you on:

Timing of delivery (preterm or full term)

Mode of delivery (vaginal or cesarean)

Ensuring access to NICU if required

A planned delivery helps manage risks like postpartum hemorrhage, fetal distress, or preterm labor.

Conclusion

Being labeled “high-risk” can feel overwhelming, but it does not necessarily mean your pregnancy will be complicated. With timely medical care, lifestyle adjustments, and close monitoring, the vast majority of high-risk pregnancies result in healthy outcomes.

At Aveya Fertility Center, our team is committed to walking beside you at every step—providing expert care, emotional support, and personalized management to ensure the best possible experience for you and your baby.

 

FAQs

– What makes a pregnancy high-risk?

Factors like age, chronic health conditions, multiple pregnancies, or previous complications can increase risks to the mother or baby.

– Can I still have a normal delivery?

Yes, many high-risk pregnancies result in normal vaginal deliveries with proper care and monitoring.

– Will my baby need the NICU?

Not necessarily. Only if the baby needs special care (e.g., preterm birth, breathing issues), NICU admission may be required.

– Does a high-risk pregnancy mean future ones will be too?

Not always. Each pregnancy is different, and many women have uncomplicated pregnancies after a high-risk one.

– When should I seek medical help?

Immediately consult your doctor if you notice warning signs like severe pain, bleeding, or reduced fetal movement—early intervention can save lives.

Reviewed by Dr. Arzoo Chadha

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