High-Risk Pregnancy: Causes, Tests, Risk Factors & Treatment

A high-risk pregnancy may pose a threat to maternal or fetal life due to possible complications these pregnancies carry. Therefore, experts recommend that high-risk pregnancies acquire specialized care from specially trained healthcare professionals (1).

The data suggests that approximately 6–8% of all pregnancies have a high risk. However, most of them culminate successfully with no complications for the mother and baby, provided the mother remains under continuous medical guidance.

Read on to learn more about the causes, risk factors, and ways to manage a high-risk pregnancy.

Causes And Risk Factors Of A High-Risk Pregnancy

The following are some maternal risk factors that may lead to a high-risk pregnancy

(1) (2) (3) (4).

1. Advanced or too young maternal age

Teenage pregnancies are at higher risk of high blood pressure, anaemia, low birth weight babies and postpartum depression. Pregnancies in women of age 35 or older are at an increased risk of miscarriages, preeclampsia, gestational high blood pressure, Down syndrome, fetal anomalies, small for gestational age babies, late preterm delivery and caesarean sections.

2. Lifestyle choices

Tobacco, alcohol, or drug abuse may cause complications in pregnancy.

3. Overweight and obesity

Obesity can increase the risk of high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery. Obesity in mothers can increase the risk of heart problems in infants by 15%.

4. Chronic health conditions

Health conditions such as the following could lead to complications in pregnancy, making it a high-risk pregnancy.

• Sickle cell disease
• Diabetes
• Heart disease
• High blood pressure
• Cystic fibrosis
• Multiple sclerosis
• Obesity
• HIV
• Uncontrolled asthma
• Chronic depression
• Chronic anxiety
• PCOS
• Lupus
• Thyroid problems
• Cancer
• Zika infection
• Blood clotting disorders 

5. Previous surgeries

A history of multiple C-sections, multiple abdominal surgeries, and surgeries of the uterus for fibroid removal may cause complications with conception, pregnancy, and childbirth.

6. Pregnancy complications

Abnormal position of the placenta, poor fetal growth, preterm labor or premature rupture of membranes may cause complications in the pregnancy.

7. Multiple pregnancies

Women carrying twins, triplets, or more babies might be at a higher risk of pregnancy-associated complications. 

8. Organ transplants

Pregnant women with a history of kidney or liver transplants may have problems with renal function during pregnancy and may be at an increased risk of developing preeclampsia, hypertension, and fetal growth restriction.

The following are some fetal risk factors that may lead to a high-risk pregnancy (4).

9. Birth defects

Congenital heart defects may lead to complications for the fetus and make the pregnancy a high-risk pregnancy.

10. Chromosomal abnormalities

Chromosomal conditions, such as Down syndrome, could lead to complications in pregnancy.

11. Genetic diseases

Genetic syndromes, such as Fragile X syndrome, may cause complications in the pregnancy.

12. Fetal growth restriction

For some women, the fetus grows more slowly than normal. It may happen due to maternal high blood pressure, kidney diseases, diabetes, heart diseases, respiratory conditions, anemia, infections, substance abuse, or smoking. Most often, the exact cause of growth restriction is unknown.

13. Fetal anemia

Anemia in the fetus may cause complications and intervention in the form of intrauterine blood transfusion. 

Special Tests For High-Risk Pregnancies

These tests may be advised for some women during pregnancy, depending on their overall health and other complications (5).

1. Chorionic villus sampling (CVS)

CVS is an invasive diagnostic procedure usually done in the first trimester between 10-12 weeks of pregnancy, where the doctor takes a sample of the placental tissue to detect conditions, such as Tay-Sachs disease, hemophilia, or Down syndrome.

2. Amniocentesis

Amniocentesis is a invasive prenatal diagnostic test of the amniotic fluid, which surrounds the fetus in the uterus. It is usually done between weeks 16 and 20. This test can detect certain neural tube defects and genetic abnormalities.

3. Fetal blood sampling and intrauterine transfusion

The doctor might extract a small amount of blood from the fetus’ umbilical cord to check for signs of fetal anemia. If the test results confirm anemia in the baby, the doctor may perform fetal intrauterine transfusion to replace destroyed blood cells.

4. Fetal echocardiogram

This test is done to check for the development of the unborn baby’s heart. If the test results point to a heart defect, pediatric cardiologists will closely monitor the fetus throughout the pregnancy to ensure safe delivery and prompt care in case of need.

5. Genetic testing

The doctor might recommend genetic testing for you if your child is at risk of developing cystic fibrosis or muscular dystrophy. If the results of genetic testing reveal some problem, the doctor might recommend amniocentesis or CVS.

6. Fetal magnetic resonance imaging (MRI)

It is a noninvasive procedure that uses a magnetic field to get detailed information about the unborn baby’s organs and other tissues. It might be recommended during the second or the third trimester if any abnormalities are suspected based on an earlier genetic test or ultrasound.

7. Biophysical profile (BPP)

A biophysical profile (BPP) test is used to assess the developing fetus’ health during pregnancy. A BPP profile includes a non-stress test with electronic fetal heart monitoring and fetal ultrasound. The test measures the baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around the baby.

The test is recommended between 32 and 34 weeks or earlier of pregnancy for women with high-risk pregnancies. Some women with more complications are asked to go for a BPP test every week or twice a week in the third trimester (6) 7. 

What To Do If You Are At A Risk Of High-Risk Pregnancy? 

If your doctor suspects you to have a high-risk pregnancy, the doctor may recommend the following tips for you.

• Additional prenatal vitamins, tests, and scans than those for a normal pregnancy
• An appointment with a genetic counselor and the neonatologist
• Reference to a physician who specializes in high-risk pregnancies
• A healthy balanced diet plan
• Minimal safe exercise or no exercise
• Cessation of smoking
• Bed rest at home or hospital in some extreme cases

You must stay alert to the following symptoms if you are suspected of having a high-risk pregnancy.

• Vaginal bleeding
• Abnormal vaginal discharge
• Leaking of fluid from vagina
• Abdominal pain (either lower abdominal or at the stomach area)
• Contractions
• Severe headaches
• Blurred or changed vision
• Decreased fetal movement
• Pair or burning during urination
• Swollen face, hands, or fingers
• Fever
• Chills
• Vomiting or persistent nausea
• Dizziness

Steps To Promote A Healthy Pregnancy 

The following steps may help you have a healthy pregnancy (3) (7).

• Schedule a preconception visit to the doctor with your partner
• If you (and your partner) have any pre-existing medical condition, check with your doctor whether it is safe for you to conceive, and if there are any medications that need to be changed to pregnancy-safe choices
• Do not skip any prenatal appointment
• Take folic acid three months before you try for pregnancy and throughout your first trimester
• Take your prenatal supplements prescribed by your doctor regularly
• Avoid using alcohol, tobacco, or narcotics
• Inform your healthcare provider about any medicines that you might be consuming daily
• Avoid exposure to dangerous substances such as lead, radiation, pesticides, some metals, certain chemicals, and solvents
• Eat a balanced diet
• Avoid consuming raw fish, undercooked meat, deli meat, and unpasteurized cheese
• Limit the total caffeine intake to 200 milligrams per day
• Avoid alcohol
• Maintain your body weight in the healthy BMI range for your pregnancy week or month
• Talk to your healthcare provider about the safe intensity and frequency of workout for you
• Ask your doctor if you need vitamin B12 or iron supplements
• Be careful of your emotional well-being and consult a counselor if needed 

Treatment For High-Risk Pregnancy

The treatment for a high-risk pregnancy depends on the underlying cause. The doctor will work along with the expectant mother in managing the underlying factor to avoid any complications. In a high-risk pregnancy, the expectant mother will be closely monitored by a team of specialists. They will try and detect any potential problems as early as possible and start the treatment at the earliest to avoid any complications to the mother and the fetus. If necessary, the doctor might recommend hospitalization to provide better care (8).

References

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