12.NOV.2020 4 MIN READ | 4 MIN READ

There may be the potential for complications, but prenatal attention and tender loving self-care can help women with high-risk pregnancies go on to have healthy babies with an uncomplicated delivery.

Pregnancy is a joyful time for an expecting mother. However, whether it’s your first, second or third pregnancy, most mothers still worry about whether their little one is growing well inside their wombs.

Hearing your doctor say that you have a high-risk pregnancy amplifies these worries. But what exactly is a high-risk pregnancy and what can you do to take care of yourself and your baby?

A pregnancy is called “high-risk” if there are conditions that increase you or your baby’s risk of developing health problems. Some pregnancies are already considered high-risk from the start, while others become high-risk as the pregnancy progresses.

High-risk pregnancies should be managed by specialists so that the best possible outcome for the pregnant woman and the baby can be attained.

What are the causes of high-risk pregnancies?

High risk pregnancy causes
There are many different conditions that make a pregnancy high-risk. These may include:

Diseases that develop during pregnancy, such as preeclampsia and gestational diabetes mellitus

Preeclampsia refers to a condition where pregnant women develop high blood pressure, protein in the urine and swelling, usually of the feet. This condition, if not properly treated, can endanger the health of both the mother and the baby.

Gestational diabetes mellitus refers to diabetes that develops while a woman is pregnant. Aside from monitoring your glucose levels, your doctor will also carefully monitor your baby’s growth and weight since these women are at risk of having very large babies.

Women younger than 17 years, or older than 35 years

There is an increased risk of complications, particularly high blood pressure and preeclampsia, for women who become pregnant in these age groups. In addition, teens who become pregnant are at risk of preterm labour and underweight babies.

Being underweight or overweight

Women who are underweight are at risk of having underweight babies. Women who are overweight are at risk of high blood pressure, preeclampsia, gestational diabetes, and miscarriages or stillbirth. Their babies may also have birth defects, be underweight or be very large while still in the womb.

Carrying more than 1 baby (twins, triplets, quadruplets)

Women carrying more than 1 baby are more likely to develop preeclampsia and preterm birth.

Congenital defects in the baby

Problems in the structural development of the baby can develop unexpectedly and can sometimes be detected during the regular ultrasound scans. Specialists in the care of a newborn may have to be present when the baby is delivered.

Infections, particularly sexually transmitted diseases

Certain infections can affect the normal growth of your baby, especially if these occurred in the first trimester. Infections that develop in the third trimester can be transmitted to your baby during labour.

Pre-existing diseases, such as hypertension, diabetes mellitus, lung disease, kidney disease, heart problems, autoimmune diseases or other illnesses

Women with pre-existing diseases even before pregnancy are at risk of developing complications, especially if the disease was not controlled before becoming pregnant.

Previous miscarriage or preterm birth

Women who had previous miscarriages or preterm births are more likely to have a recurrent miscarriage or preterm birth.

Caring for mothers with high-risk pregnancies

Many women with high-risk pregnancies go on to have healthy pregnancies and deliver healthy babies. Here are some tips to help them manage the risks of developing complications.

  • Consult a doctor early when trying for a child. Have regular prenatal check-ups once pregnant

  • Do not smoke or drink alcohol

  • Eat a healthy, balanced, diet

  • Exercise regularly unless advised not to by the doctor

  • Maintain a healthy weight throughout pregnancy

  • Receive the appropriate vaccines through a doctor

  • Take daily folic acid supplements while trying for a baby, up until the first trimester

What care can be expected from a doctor?

High risk pregnancy care
If a pregnancy is classified as high-risk, the doctor will monitor the pregnancy more closely. Mothers-to-be may also be referred to a perinatologist, an obstetrician that specialises in high-risk pregnancy care.

Depending on the type of high-risk pregnancy, the doctor may request for the following tests:

  • Biophysical profile to evaluate the baby’s well-being. This is done through an ultrasound.

  • Detailed foetal ultrasound screening to evaluate for possible birth defects.

  • Foetal echocardiography to evaluate the baby’s heart.

  • Genetic screening through amniocentesis or chorionic villus sampling. In amniocentesis, a sample is taken from the fluid surrounding the baby (called the amniotic fluid). In chorionic villus sampling, a sample is taken from the placenta. These samples will be evaluated for certain genetic conditions. There is a small risk of pregnancy loss in amniocentesis and chorionic villus sampling which will be clearly explained by the doctor. Discussions should be made between the couple, and the doctor before making a decision on whether to proceed with these tests.

  • Routine laboratory tests, including urinalysis, complete blood count, oral glucose tolerance test, and tests for infectious diseases such as syphilis and human immunodeficiency virus (HIV).

Even if a pregnancy is classified as high-risk, it is still possible to have a healthy baby without any complications during delivery. Regular prenatal care and good self-care regimens can help increase your chances of having a safe and healthy pregnancy. Speak to a doctor should there be any doubts or concerns regarding pregnancy.

 

Article reviewed by Dr John Yam, obstetrician and gynaecologist at Gleneagles Hospital

References

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Artal-Mittelmark R. Risk Factors for High-Risk Pregnancy, retrieved on 29 September 2020 from https://www.msdmanuals.com/home/women-s-health-issues/high-risk-pregnancy/risk-factors-for-high-risk-pregnancy. (September 2020)

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Fuentes A. What's a "High-Risk" Pregnancy?, retrieved on 29 September 2020 from https://kidshealth.org/en/parents/high-risk.html. (October 2018)

7 Tips for Managing a High-Risk Pregnancy, retrieved on 29 September 2020 from https://www.signatureperinatal.com/blog/7-tips-for-managing-a-high-risk-pregnancy. (n.d.)

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12.NOV.2020
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Yam Pei Yuan John
Obstetrician and Gynaecologist
Gleneagles Hospital