What is a High-Risk Pregnancy?

High-risk complications occur in six to eight percent of all pregnancies, but many more are deemed high-risk because of underlying risk factors. This guide walks through the causes of a high-risk pregnancy and what to do if your doctor has told you your pregnancy is high risk. 

By Dr. Kenosha Gleaton

Doctors use the term “high-risk pregnancy” to describe a situation in which a mother, her fetus, or both are at higher risk for problems during pregnancy or delivery due to a known risk factor. This label is used to help the care team ensure a pregnant woman receives special monitoring and care. If your doctor tells you that your pregnancy is “high risk,” it doesn’t necessarily mean your pregnancy will have complications. In fact, most high-risk pregnancies go on to have uncomplicated births and healthy babies. 

What causes a high-risk pregnancy?

There is no exact definition of risk in pregnancy, as risk may be perceived in different ways by doctors and patients. But generally, there are a lot of factors that can make a pregnancy higher-risk, including (but not limited to):

• Age: under 17 years old or over 35 years old
• Weight: being underweight or overweight before becoming pregnant
• Multiples: twins, triplets, or other multiples
• Existing health conditions: high blood pressure, diabetes, PCOS, kidney disease, thyroid disease, HIV/AIDS, or other auto-immune disease, asthma
• Pregnancy conditions: gestational diabetes, preeclampsia, placental abnormalities, abnormal fetal growth
• Previous complication: premature labor or having a child with a genetic problem or birth defect, or prior cesarean section
• Lifestyle factors: alcohol, drug, or tobacco use

Why is age (35+) considered a high-risk pregnancy?  

More women are having their first child when they are over the age of 35. And most of these first-time mothers over 35 have normal pregnancies! But research shows that women over 35 are at higher risk for certain complications than younger women. For example, they are more likely to undergo Caesarean delivery (c-section) than are younger women, and more likely to develop diabetes and elevated blood pressure in pregnancy. 

If I have one high-risk pregnancy, will future pregnancies also be high risk?

Not necessarily. Obviously, you can’t reverse a risk factor like being over 35. Or, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy, so subsequent pregnancies would be considered high risk. But if you are high risk from a non-recurring factor such as having twins, and your next birth is a singleton, it will not necessarily be high risk. Furthermore, your existing health conditions may change over time. 

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So what happens if my doctor says I am high-risk?

It all depends! Sometimes, women who have a high-risk pregnancy will see a maternal-fetal medicine specialist and undergo more monitoring than someone with a low-risk pregnancy. Some common reasons for referral to a maternal-fetal medicine specialist before delivery include preterm labor, preeclampsia, vaginal bleeding, or any major health conditions such as diabetes or high blood pressure.

What should I do if I have a high-risk pregnancy?

Continue to take care of your mind and body. We recommend the following:

1. Make sure you’re taking a prenatal vitamin with the recommended nutrients. ACOG recommends you get enough folate, calcium, iron, and choline. Our Prenatal for her meets these guidelines.
2. Rethink your birth plan, or make one if you haven’t yet.  
3. Ask your doctor lots of questions. Remember, there are no dumb questions. Your doctor is there to help guide you throughout. (We outline questions you can ask him or her below). 
4. Try yoga. A randomized study of yoga in high-risk pregnancy showed that yoga can potentially be an effective therapy in reducing hypertensive related complications of pregnancy and improving fetal outcomes.

Questions to ask your doctor 

If your doctor has told you that your pregnancy is high risk, you may have some fears or concerns. The best next step would be to educate yourself on the situation, and take steps to ensure the health of you and your baby. Some questions to ask your doctor include:

• What factor(s) make this pregnancy high-risk?
• Will I need to see a specialist? 
• If I have to see a specialist, how will the two of you coordinate my care?
• Should I change my birth plan?
• What can I do to lower my risk of complications?
• What symptoms or signs should I look out for? Which ones mean I should seek emergency care? 
• Is it okay for me to have sex?

Should I tell my work I have a high risk pregnancy?

It’s hard to hide a pregnancy from coworkers, but you don’t necessarily have to tell them details of your pregnancy. It is important to know that no matter what, you are protected from pregnancy discrimination. By law, employers may not fire, refuse to promote, or otherwise retaliate against an employee because of pregnancy, breastfeeding, or pregnancy-related conditions. You are also protected from retaliation for requesting a reasonable accommodation, whether or not it is granted. Read more about Pregnancy Discrimination at Work.

Take-aways

About 20-30% of all pregnancies are categorized as high risk, but serious complications occur in only six to eight percent of all pregnancies. That means that most often what is categorized as high risk ends up as a healthy, uncomplicated pregnancy and birth.     

Hearing the news that your pregnancy is high-risk may make you feel nervous or anxious. Knowing your exact risks and empowering yourself with knowledge and a plan is a great way to gain control of the situation. But if the added stress of this news is significant, talk to your doctor.