High Risk vs Low Risk Pregnancy
It goes without saying that all women want a healthy pregnancy and ultimately safe arrival of their babies. A woman is considered to have a low-risk pregnancy when it is free from complications or worry, and she is otherwise healthy. However, sometimes unforeseen circumstances can arise that warrant the label “high-risk pregnancy,” meaning there is an increased risk of complications. Being labeled “high risk” definitely doesn’t mean that there will be health problems with mother or baby. It simply means doctors will want to monitor her closely for specific concerns during the course of her pregnancy. Here we discuss what conditions indicate a high-risk pregnancy, what course of action to take afterward, and how to decrease the odds of a high-risk pregnancy from occurring.
What conditions constitute a high risk pregnancy?
Some pre-existing conditions that occur prior to pregnancy can automatically put someone on the track for high-risk pregnancy. These include:
Being underweight or overweight
Being underweight prior to conceiving can be dangerous to both a developing fetus and the mother. There is an increased risk for preterm birth, fetal distress during labor, and a low birth weight baby. Adequate nutrition is vital for both mother and baby. Achieve a healthy weight by eating large meals, adding good oils and fats to dishes, and drinking juices. Nutrient-dense foods are always preferable to junk food.
Being overweight prior to pregnancy also poses some risks for mother and baby. Mothers with a higher BMI have a greater chance for developing high blood pressure or preeclampsia and gestational diabetes. Likewise there is an increased risk for preterm birth, birth injury, c-section, and birth defects (specifically neural tube defects). Being overweight does not mean a woman will automatically experience these distressing complications. It is certainly possible to go on to have a healthy pregnancy. There are many ways for plus size women to take care of themselves prior to and during pregnancy. Find good support and education at Plus-Size Birth.
Infertility/History of miscarriage or preterm labor
Women who have used fertility drugs to achieve pregnancy have a higher chance of complications arising during pregnancy, specifically with the placenta and vaginal bleeding.
Repeated miscarriage or preterm labor puts a woman at high risk as the odds of recurrence are higher. A doctor will want to investigate the cause of recurring loss or premature birth to prevent complications in current and future pregnancies. At any rate, difficulty conceiving or previous loss can cause great anxiety for mother. Close monitoring for both mother and baby can put your mind at ease.
High blood pressure
If left unchecked or uncontrolled, high blood pressure during pregnancy can lead to kidney damage in the mother or pre-eclampsia, which is a very serious condition. High blood pressure, managed carefully can lead to a healthy delivery and baby.
Autoimmune diseases like Lupus and Multiple Sclerosis can cause complications during pregnancy. Lupus in particular puts a mother at higher risk for preterm labor and stillbirth. Some women’s conditions tend to improve during pregnancy while others worsen. It can be helpful to consult a doctor prior to conception to ensure conditions and factors are under control. Medication may need to be adjusted to a safe dosage or weaned off of completely, or doctors might recommend waiting until remission to conceive.
Advanced maternal age (over age 35)
First time mothers over the age of 35 have an increased risk for cesarean delivery plus a number of other potential complications. These include excessive bleeding during delivery, prolonged or stalled labor, high blood pressure, premature delivery, and increased risk of genetic disorders in the baby. Certainly women of advanced maternal age go on to have otherwise completely healthy pregnancies and deliveries—increase odds by practicing healthy lifestyle choices and seek out a care provider that doesn’t automatically classify you as high risk simply based on your age.
Family history of genetic disorders
A family history of certain conditions puts a woman at higher risk during pregnancy, specifically: pregnancy loss or death, chronic diseases like diabetes, high blood pressure, and mental illness. Pre-conception appointments can offer genetic counseling so you know the likelihood for potential complications
Smoking, drinking, or using harmful substances are very dangerous for a fetus as well as the mother. The Center for Disease Control (CDC) recommends women do not consume alcohol while pregnant or even while trying to conceive. Drinking during pregnancy increases the chance for miscarriage, stillbirth, and the baby developing Fetal Alcohol Spectrum Disorder (more about FASD here). There are varying viewpoints on this in terms of whether the occasional glass of wine is okay or not— consulting with your care provider will be your best course of action.
Smoking can lead to birth defects as well, and there is a strong link to SIDS (sudden infant death syndrome). Even second hand smoke while pregnant can increase risk for health problems.
Your own medical history
Previous c-sections, low birth weight babies or preterm delivery can all put a woman at greater risk for repeat occurrences. Doctors will want to monitor closely to prevent any further complications.
Conditions that may arise during pregnancy that constitute high-risk
Some complications can develop during pregnancy that could project a woman into the high risk category. These include:
Problems with uterus, cervix or placenta might arise. These could include a heart shaped uterus, or bicornuate uterus (divided in two halves); placenta previa (when the placenta is covering the cervix); or cervical insufficiency. Likewise, structural complications in the fetus discovered during anatomy scans might warrant further testing and very close monitoring.
Abnormal amniotic fluid levels
During pregnancy, too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid can develop. Doctors will usually notice these anomalies during routine exams. A uterus might measure too big or two small, there might be excessive swelling in hands and feet, or fluid might be leaking from the vagina.
Restricted fetal growth
A baby can begin to exhibit signs of restricted growth during the course of pregnancy. Doctors will schedule continuous monitoring and possibly even an early induction (if the baby is post 34 weeks).
Rh factor issues
The Rh factor is a protein that can be present on the surface of red blood cells. Just as a person has a blood type (A, B, O, AB) they also either have the Rh protein (positive Rh factor) or they do not (negative Rh factor). A mother is only at risk if the she is negative and the father is positive, potentially resulting in an Rh positive baby. When the mother’s blood comes in contact with the baby’s, it will cause the mother to produce Rh antibodies to attack the fetus’s blood as if it were a foreign substance, which can cause severe anemia in the baby. Mother and baby would need close monitoring—a blood transfusion may be given through the umbilical cord if need be, or the baby may need a transfusion after delivery. Rh factor issues can be prevented through early screenings. If a mother is Rh negative, and the baby is positive, she can receive a shot to prevent her from developing Rh antibodies. Read more about Rh factor here.
A mother is at greater risk of complications if she is carrying twins or more. You will come up with a care plan to address multiples early on in your pregnancy.
Ways to promote a healthy pregnancy
Although many conditions cannot be helped, there are many ways to decrease your chances of becoming labeled “high risk.” Here’s some things you can control.
It is wise to meet with a healthcare provider prior to becoming pregnant. Your doctor can do a complete physical, review your personal and family medical histories, and provide council on any potential problems. They can help you adjust any current medications to a safe level, or help wean you off of them. They can discuss the things to do to ensure a healthy lifestyle and help you provide the best physical environment in which the baby can grow.
Keep all pregnancy appointments
It’s wise to have regular appointments with your practitioner while pregnant, not only to make sure things are going well with the baby, but with you as well. A good doctor or midwife will spend adequate time listening to any concerns you may have, answering questions, offering counsel, and making sure you are doing okay mentally and emotionally as well.
Practice good nutrition habits
It’s more important than ever to be conscious of what you are eating. The developing baby gets all his nutrients from you, and it’s important to make sure what he is receiving is high quality. Focus on eating large amounts of fruits and vegetables in a variety of colors, and good fats like nuts and avocados. Eat food close to its natural form and cook things from scratch rather than reaching for processed packaged items. Get enough protein from high quality sources, and eat a variety of leafy greens for iron. Remember water as your beverage of choice. Staying hydrated is essential for you and baby.
Keep weight in check: Eating right and good nutrition will help to ensure a proper amount of weight gain during pregnancy. A good rule of thumb to follow is to listen to your body. Eat when you are hungry, and stop just before you are full, when you are satisfied. This can be more effective than following “rules” of eating three square meals a day at certain times. Ensure you have healthy food on hand for when hunger strikes, and let your body communicate with you. You might find you are starving only an hour after breakfast, or that you are satisfied well beyond. You can’t go wrong when you listen to physical cues. Keep in mind that all women gain weight differently during pregnancy and as long as you are eating healthy food and visiting your care provider regularly you shouldn’t worry too much about the number on the scale.
Physical activity also helps keep your weight in balance before, during, and after pregnancy. This is another opportunity to listen to your body. You do not have to be intensely pumping iron til exhaustion for 2 hours each day. In fact, quite the opposite. Ask yourself, “How would my body like to move today? What would feel good?” Use a variety of activities to keep your program well rounded. Some good exercises for pregnancy are: walking, swimming, elliptical machines, gentle strength training, yoga, stretching, hiking, low-impact aerobics, and pilates. Do what is enjoyable and what will help you stay motivated to move.
Avoid harmful substances: smoking, drinking, and illegal drugs are all very harmful while pregnant and have potentially damaging effects on a fetus. Stay away from them, and tell your doctor if you need help weaning off. There are good resources, so speak up.
One of the most empowering tools you can have as a new mother is the gift of education. Arm yourself with knowledge about pregnancy, birth, breastfeeding, mental/emotional health, and more. There are endless resources available. Start with what you are interested in, or the phase of pregnancy you are in. The more you know, the more options you will have available to you, and the better equipped you will be to handle the demands of a changing body, and the challenges up ahead.
What happens if I become high risk?
If you are seeing a midwife, depending on the nature of your conditions, you will potentially be passed to an OB’s care. There are certain circumstances where a midwife will continue seeing a patient, but it really rests on the midwife’s comfort level and the specific case of the patient. Homebirths are generally not recommended or in some cases aren’t legal for midwives to attend once you become high risk, but again, it depends on the individual case. No matter who your current care provider is, you may also be referred to an MFM (maternal fetal medicine) doctor.
Depending on what has developed during the pregnancy, your OB may suggest the following tests/screenings: specialized ultrasound, amniocentesis, chorionic villus sample, umbilical cord sample, lab tests, routine ultrasounds or stress tests. You may be asked to go on bed rest or pelvic rest, or to otherwise take it easy physically.
Continued monitoring will be important to doctors treating a pregnant woman at high risk. Even if nothing alarming is happening, he will want to continue regular appointments, stress tests, ultrasounds, and extra appointments to ensure optimal health up until delivery.
Ask your doctor about specific risks with your condition. What warning signs do you need to be aware of? Things like bleeding, sharp pains, early contractions, decreased fetal movement, headaches and vision changes can all be warning signs. When should you call? What constitutes an emergency? Educate yourself about situation.
A low-risk pregnancy is certainly preferable, but be aware of the possibility of high-risk conditions and complications. Pregnancy, and delivery, and motherhood for that matter, can all be unpredictable. Do your best to take care of yourself and stay informed, and try to be flexible with what comes your way. Never be afraid to speak up and follow your intuition!
- The American College of Gynecologists. September 27, 2013. The Rh Factor:How it can affect your pregnancy. American College of Gynecologists, Frequently Asked Questions (027). [September 27, 2013; January 17, 2017]. http://www.acog.org/Patients/FAQs/The-Rh-Factor-How-It-Can-Affect-Your-Pregnancy
- 2008. Understanding Pregnancy and Birth Issues. NIH Medline Plus (winter 2008). [winter 2008; January 17, 2017]. Volume 3 (issue 1): https://medlineplus.gov/magazine/issues/winter08/articles/winter08pg22-23.html
- The American College of Gynecologists. March 2015. Good Health Before Pregancny: Preconception Care, Frequently Asked Questions (056). [March 2015; January 17, 2017].http://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care#being
- Goldmuntz, Ellen and Penn, Audrey S. July 16, 2012. Autoimmune Diseases Fact Sheet. Office on Women’s Health (e-publications). [July 16, 2012; January 17, 2017]. https://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html
- Centers for Disease Control and Prevention. July 21, 2016. Atlanta, Georgia. [July 21, 2016; January 17, 2017]. https://www.cdc.gov/ncbddd/fasd/alcohol-use.html