Most pregnancies are routine, but for some women, medical complications and other factors result in what is known as a high-risk pregnancy. SheKnows spoke to Dr. Joanie Y. Hare, maternal and fetal medicine specialist at The Woman’s Hospital of Texas- HCA Houston Healthcare, about what makes a pregnancy high-risk and what expectant moms can do to minimize complications and ensure they achieve the healthiest pregnancy possible.
It can be really daunting to go through a high-risk pregnancy, but it’s key to seek care early — even before getting pregnant. In Hare’s experience, many moms are scared to be considered high-risk, but they shouldn’t let that stop them from getting help. With the right interventions and treatments, risk factors can be managed and minimized. “Most babies are still delivered by the mom’s own OB-GYN,” adds Hare. “The high-risk doctor is simply part of the care team, and they’re there to ensure the best possible outcome for Mom and Baby.”
1. Maternal age
Maternal age can cause pregnancy complications at both ends of the scale. A teen mom may not even know she is pregnant or share that information with her parents or caregivers, says Hare. This could result in missed prenatal appointments, which are crucial for monitoring the pregnancy and identifying and treating any risk factors. Additionally, teenage pregnancy is more likely to lead to pregnancy-related high blood pressure, anemia (a shortage of healthy red blood cells) and preterm labor and delivery.
Most first-time moms over 35 years old have risk-free pregnancies, but according to Hare, this age group is at a higher risk for certain issues than younger women, including pregnancy loss, ectopic pregnancy (when the embryo attaches itself outside the uterus) and pregnancy-related high blood pressure (gestational hypertension) or diabetes (gestational diabetes). First-time pregnancy after age 35 also comes with a higher risk for C-section delivery, prolonged labor and chromosome abnormalities (such as Down syndrome).
2. Lifestyle choices
If a mom consumes alcohol or uses tobacco products during pregnancy, she automatically puts herself in the high-risk category, says Hare. Drinking alcohol can increase the risk of fetal alcohol spectrum disorders, sudden infant death syndrome, miscarriage and stillbirth. Smoking also puts the fetus at risk for sudden infant death syndrome as well as preterm birth and certain birth defects.
While many studies, including one published in the journal Frontiers in Behavioral Neuroscience, show the risks of alcohol and tobacco use during pregnancy, there’s a lack of substantive research on the risks of marijuana use. “Some moms may use marijuana during pregnancy to reduce nausea,” says Hare. “But we don’t encourage that because we don’t know for sure what the risks to the fetus are.”
3. High blood pressure
“Women who have high blood pressure should automatically be seen by a doctor specializing in high-risk pregnancy care,” Hare tells SheKnows. Additionally, she recommends those patients check their blood pressure once or twice per day and take one aspirin per day to help keep it within a normal range.
While slightly high blood pressure can be controlled before pregnancy to avoid risks to the mom and the fetus, uncontrolled high blood pressure can cause maternal kidney damage and increase the risk for preterm delivery, low birth weight and preeclampsia (high blood pressure in women who haven’t had high blood pressure before, characterized by high level of protein in their urine and swelling in the feet, legs and hands).
It’s crucial for women with diabetes to manage their blood sugar levels both before getting pregnant and throughout pregnancy, says Hare. During the first few weeks of pregnancy, at which point a woman may not even know she is pregnant, high blood sugar levels can cause fetal abnormalities. Even women who have their diabetes under control may experience metabolic changes during pregnancy that require extra care or treatment to minimize risks. Babies born to moms with diabetes are typically larger than average and likely to have low blood sugar.
5. Kidney disease
Women with kidney disease can have healthy pregnancies, says Hare, but it’s important to manage the disease to reduce the risks, which include preterm delivery, low birth weight and preeclampsia. Pregnant women with kidney disease should be followed closely by their health care provider and may require additional treatments and changes in diet and medication.
6. Polycystic ovary syndrome
Women with PCOS, a hormone disorder that interferes with ovulation, often experience fertility issues. During pregnancy, they have a higher risk for high blood pressure, gestational diabetes and preeclampsia, and their babies are more likely to be born preterm and spend time in a neonatal intensive care unit. Additionally, women with PCOS are three times more likely to miscarry in the early months of pregnancy than women without PCOS.
7. Autoimmune disease
Autoimmune conditions such as lupus and multiple sclerosis can increase a women’s risk for problems during pregnancy and delivery. For example, women with lupus are at increased risk for preterm delivery, stillbirth and low birth weight. While some women find that their symptoms improve during pregnancy, others experience flare-ups. Lupus can affect the kidneys, heart and brain, so taking control of the disease is really important, says Hare. Certain medicines to treat autoimmune diseases may be harmful to the fetus, meaning a woman with an autoimmune disease must work closely with her health care provider throughout pregnancy.
8. Sickle cell disease
Hemoglobin disorders like sickle cell disease, which prevents red blood cells moving easily through the blood vessels, may cause serious complications — such as infections in the kidneys, lungs and urinary tract; gallstones; heart enlargement; and miscarriage — during pregnancy. Preterm birth, low birth weight and stillbirth are risks for the baby.
Moms with sickle cell disease may be in a lot of pain, which can be difficult to manage during pregnancy because some medications are not recommended while pregnant. Some women need blood transfusions to replace the sickle cells with fresh blood, which may be done several times during pregnancy. If the baby’s father also carried the sickle cell trait, an amniocentesis or other tests may be required to find out if the baby has it too.
If a mom-to-be is HIV-positive or has AIDS but is being treated, the rate of transmission to the fetus is very low, but when she is untreated or doesn’t take her meds, there is a high risk the fetus will be HIV-positive too, says Hare. According to WHO, HIV transmission rates range from 15 percent to 45 percent without intervention, but the rate can be reduced to less than 5 percent with effective interventions during pregnancy, labor, delivery and breastfeeding.
It’s important the mom is seen by an infectious-disease doctor to minimize the transmission rate and is treated to reduce and prevent the spread of HIV to the fetus or baby. Treatment is primarily antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby.
Obesity is the No. 1 thing that can affect diabetes, says Hare, so it’s imperative that overweight or obese moms try to lose weight through exercise and a controlled diet before pregnancy. Obesity before pregnancy is associated with an increased risk of structural problems with the baby’s heart and other anomalies, which may go undetected because it’s harder to get a clearer picture of the baby on the ultrasound.
The most recent guidelines from the Institute of Medicine recommend that overweight women should gain no more than 15 to 25 pounds during pregnancy and that women with obesity gain no more than 11 to 20 pounds.
11. Multiple births
Multiple gestation — pregnancy with twins, triplets, quadruplets or more fetuses — carries a 50 percent chance of preterm birth, says Hare. Other complications include anomalies and low birth weight. Many moms find multiple gestation difficult for several reasons. “A mom expecting twins needs to gain 40 to 50 pounds during pregnancy, and even more if she is expecting triplets or quads,” explains Hare. “This can be hard to do. Some moms may need to be on bed rest, and there’s also the increased risk of high blood pressure, preeclampsia and gestational diabetes.” Good prenatal care and close monitoring are crucial if a mom is expecting multiple babies.
12. Previous preterm birth
Moms who went into labor or delivered their baby early (before 37 weeks of pregnancy) with a previous pregnancy are at a higher risk for preterm labor and birth with their current pregnancy, says Hare. For these moms, a progesterone injection every week from the 16th week of pregnancy or vaginal suppositories can help to minimize those risks.
This post was created by SheKnows for The Woman’s Hospital of Texas- HCA Houston Healthcare.