High-Risk Pregnancy: Your Go-To Guide for Understanding and Managing Your Maternal Health 

A high-risk pregnancy can be challenging for expectant mothers and their healthcare teams, as it comes with an elevated probability of complications that can impact both the mother and the developing foetus. 

This article will discuss what constitutes a high-risk pregnancy and the factors behind it. From maternal age and multiple pregnancies to pre-existing medical conditions, gestational complications, and a history of previous issues, we'll explore the various elements that healthcare professionals consider when assessing pregnancy risk. 

What is a high-risk pregnancy? 

A high-risk pregnancy, also known as a high-risk gestation or high-risk obstetric pregnancy, is a pregnancy that has a higher likelihood of complications for the mother, the foetus, or both compared to a typical pregnancy. 

What causes high-risk pregnancy? 

Various factors can contribute to a pregnancy being categorised as high-risk, including:

• Maternal age: pregnant women who are of advanced maternal age are at higher risk of having babies with chromosomal abnormalities such as Down syndrome, developing gestational diabetes, pregnancy-induced hypertension/pre-eclampsia, preterm labour, etc [1]. 
• Multiple pregnancies: multiple pregnancies, such as twins or triplets, have a higher likelihood of foetal anomalies, intrauterine growth restriction/low birth weight and growth discordance [2]. They are also more likely to end up with premature birth. These factors can lead to complications such as respiratory distress syndrome, jaundice, etc, requiring admission to neonatal intensive care units. Women who are carrying multiple pregnancies also have a higher chance of developing anaemia, gestational diabetes, pregnancy-induced hypertension/pre-eclampsia and needing caesarean sections as their mode of delivery [3]. They are also at a higher risk of experiencing postpartum haemorrhage (afterbirth bleeding) as well as postpartum depression [4,5]. 
• Pre-existing medical conditions: women with pre-existing medical conditions such as diabetes mellitus [6], hypertension [7], heart disease [8], kidney disease [9], autoimmune conditions (such as lupus) [10], epilepsy [11], thyroid or blood disorders [12], neurological conditions [13], etc. who become pregnant will be considered as high-risk pregnancies. 
• Gestational conditions: certain antenatal conditions/complications can change a low-risk pregnancy to a high-risk one. These include poorly controlled gestational diabetes [14], pregnancy-induced hypertension/pre-eclampsia [15], antepartum haemorrhage [16], placenta previa/abnormally adherent placenta [17], etc. 
• Lifestyle factors: lifestyle factors such as smoking, alcohol/substance abuse, poor nutrition, extremes of body mass index (underweight and obesity), high caffeine consumption, high stress levels, presence of domestic violence, and lack of social support can result in a high-risk pregnancy [18].
• Obesity: pregnant women who are obese are at higher risk of various pregnancy complications [19]. Their babies are also at increased risk of congenital disabilities and macrosomia (large birth weight). 
• History of preterm birth/cervical surgeries: women with a history of preterm birth or history of cervical surgeries (e.g. cervical cone for cervical dysplasia) are at higher risk of having another preterm delivery [20]. Preterm babies are at increased risk of respiratory distress syndrome, intraventricular haemorrhage (bleeding into the brain), necrotising enterocolitis (gut inflammation/tissue death), retinopathy of prematurity (which can lead to visual impairment/blindness), jaundice, temperature dysregulation, feeding difficulties, infections, growth/development delays, cerebral palsy, and downstream long-term health issues. 
• Rh incompatibility: Rh incompatibility occurs when mothers who are rhesus-negative have a baby with a partner who is rhesus-positive; there are situations where the mother's immune system produces antibodies against rhesus-positive blood cells, which can then cross the placenta and attack the rhesus-positive blood cells of the developing foetus. This immune response can cause haemolysis (breakdown of red blood cells) and result in a condition known as haemolytic disease of the newborn (HDN). HDN can lead to severe anaemia, jaundice, and, in more severe cases, hydrops fetalis, which is characterised by severe swelling and fluid accumulation in the foetus’ body. In severe cases, HDN can be life-threatening for the baby.
• Genetic disorders: genetic disorders that can result in a pregnancy being high risk, such as chromosomal abnormalities, e.g. Down Syndrome (Trisomy 21), Trisomy 18 (Edwards Syndrome), Trisomy 13 (Patau Syndrome), Turner’s syndrome, neural tube defects (such as spina bifida and anencephaly), cystic fibrosis, sickle cell disease, thalassaemia major, inborn errors of metabolism can all contribute to a high-risk pregnancy.  

If you have a high-risk pregnancy, it is crucial for you to consult a highly professional obstetrician and gynaecologist and to ensure regular monitoring throughout your pregnancy. This approach greatly enhances the likelihood of a healthy pregnancy and safe delivery for you and your baby.

What is the significance of prenatal care in high-risk pregnancies?

Prenatal care is essential for the health and well-being of expectant mothers and their developing babies. Regular prenatal care involves a series of medical check-ups, screenings, and guidance throughout the pregnancy. Here's why prenatal care is so important:

• Early detection and prevention: early and consistent prenatal care is crucial in identifying, accessing, and managing risk factors and complications. Experienced obstetricians can tailor care plans to address specific needs and risks associated with high-risk pregnancies.
• Optimising maternal health: this is typically achieved through a multidisciplinary approach. 
• Monitor baby’s growth to prepare for labour and delivery: you will likely require more frequent foetal ultrasounds to monitor your baby’s development and well-being; depending on the findings, your obstetrician can then plan the next steps and advise on the timing/mode of delivery to reduce possible complications.
• Emotional and psychological support: high-risk pregnancies can be physically, emotionally, and financially straining. It is essential to provide expectant mothers with the utmost support and care. 

How do I manage a high-risk pregnancy? 

Managing a high-risk pregnancy requires close collaboration between you, your healthcare team, and, sometimes, specialists. Here are some key steps to help manage a high-risk pregnancy:

• Choose a skilled healthcare provider: high-risk pregnancies typically benefit from multidisciplinary care and may require the involvement of a high-risk maternal-foetal specialist throughout the pre-conception, antenatal, and postnatal stages. 
• Regular prenatal care: high-risk pregnancies require closer monitoring, and this, in turn, translates to frequent appointments with your obstetrician, particularly in the run-up to your estimated due date. 
• Follow medical advice: the management of a low-risk pregnancy differs from a high-risk one, so if you have a high-risk pregnancy, your friends’ experiences may not apply to you – follow your obstetrician’s medical advice closely to ensure optimal outcomes for you and your baby. 
• Manage pre-existing conditions: poorly controlled pre-existing conditions, such as diabetes, lupus, etc., can adversely impact your pregnancy. It is vital to keep them under control whilst you are trying to conceive and throughout your pregnancy – this may require you to see multiple specialists during this journey. 
• Lifestyle modifications: having a healthy lifestyle has never been so important – eat healthy foods, engage in physical exercise (as advised by your obstetrician), avoid smoking/alcohol/excessive caffeine intake, and modulate your stress levels. 
• Medications: make sure all the medicines you take during pregnancy are pregnancy-safe. If you are obtaining any medications from doctors other than your obstetrician, be sure to inform them that you are currently pregnant so that the appropriate ones can be prescribed. 
• Specialised testing: certain specialised tests are required during pregnancy, including Down syndrome screening (if one opts for it), detailed foetal anomaly scans, growth ultrasound scans, etc., and these are typically time-sensitive, i.e. to be done at certain weeks of the pregnancy. Keep to your scheduled appointments to attend all necessary testing. 
• Stay informed: don’t be shy to ask your obstetrician questions, particularly if you have any concerns or are unclear about anything. This is a learning process for you and your partner, and it is important to gain as much information as possible to make the journey smoother. 
• Emergency plan: know what red flag symptoms you should look out for, e.g. contractions or leaking of water bag before you hit 37 weeks of pregnancy, vaginal bleeding, reduced foetal movements, etc. Keep the emergency contacts of your obstetrician and nearby hospitals with you at all times. It would also be good to keep a file containing all your antenatal information and investigations for easy reference and access.  
• Foetal movement monitoring: most women will start to feel foetal movements from about 20 weeks. However, this varies between individuals – some may feel foetal movements earlier (particularly if they have prior experience and are more sensitive to baby movements). Foetal movements may also be perceived later, especially if the placenta position is anterior (i.e. front of the uterus). 
• Postpartum care: pregnancy care does not end at childbirth; the “fourth” trimester involves postpartum care and consists of both mother and newborn care. Care of the mother involves assessment of vaginal bleeding (lochia), pain management, healing of incisions (e.g. episiotomy, caesarean section wound), breastfeeding support (if applicable), emotional well-being, discussion of exercise, sexual health, and contraception. Care for the newborn involves checking for congenital conditions, feeding,  jaundice, overall development, vaccinations, etc. 

Remember that each high-risk pregnancy is unique, and the management plan will be tailored to your circumstances. Always consult with your doctor for guidance and support throughout the pregnancy. The goal is to optimise the health and safety of both you and your baby.

What preparations should be made for delivery in high-risk pregnancies?

In high-risk pregnancies, some essential preparations should be made for the delivery to ensure the safety and well-being of both the mother and the baby. These preparations include:

• Birth plans and preferences: discuss and create a birth plan with your healthcare provider, outlining your preferences and any specific requirements or concerns related to labour and delivery. This is particularly important if you have a high-risk pregnancy, as some common birth plans may interfere with the care your baby needs. 
• Emergency preparedness: be prepared for potential emergencies during labour, such as premature birth or complications. Know when and how to seek immediate medical attention.
• Cesarean sections vs vaginal births: be informed about the implications of both delivery methods and which one is more suitable for your situation 

What should be considered in postnatal care and beyond in high-risk pregnancies?

• Neonatal Intensive Care Units (NICU): be aware of the potential need for neonatal intensive care if the baby is born prematurely or with health complications. This can be particularly costly if the stay is projected to be extended. 
• Long-term monitoring and follow-up: recognise the importance of ongoing healthcare and follow-up appointments for mother and child after delivery, as high-risk pregnancies may have a lasting impact.
• Contraception and family planning: discuss contraception and family planning options with your healthcare provider to make informed choices about future pregnancies. 

Conclusion

The goal of managing high-risk pregnancies is mitigating risks by optimising maternal and foetal health. This is done through medical interventions, lifestyle modifications, or both. In conclusion, it is safe to say that the management of high-risk pregnancies requires a team approach, personalised care, and a focus on early detection and intervention.

Work closely with your obstetrician and follow their advice and guidance. This way, you can increase your likelihood of a healthy pregnancy and the birth of a healthy baby.

References

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