High-risk
Pregnancy

What are High-Risk Pregnancies?

A pregnancy is called “high-risk” if there are conditions that increase your or your baby’s risk of developing health problems. Some pregnancies are already considered high-risk from the start, while others become high-risk as the pregnancy progresses.

O&G specialists should manage high-risk pregnancies to ensure the pregnancy goes smoothly and the mother and baby stay healthy. O&G specialists with a clinical interest in high-risk pregnancies are often well-equipped to manage complications that may arise during pregnancy and delivery (such as ectopic pregnancies, fetal distress or preeclampsia).

What Are Some Symptoms Ladies Should Look Out For?

You should talk to your doctor immediately if you have any of these symptoms during pregnancy:

• Abdominal or chest pain
• Nausea or dizziness
• Extreme fatigue or headache
• High fever
• Heart palpitations or breathing difficulties
• Swelling, redness or pain in your face or limbs
• Vaginal bleeding or discharge

What Are Some Causes of High-risk Pregnancies?

1. Preeclampsia

Preeclampsia is a severe condition that typically develops after the 20th week of pregnancy. It raises your blood pressure to above 140/90 mmHg (hypertension) and elevates the protein levels in your urine (proteinuria). It can also affect the blood supply to your placenta, impair liver and kidney function or cause fluid to build up in your lungs. As preeclampsia is dangerous to you and your unborn baby, you should seek treatment from your doctor as soon as possible.

2. Gestational diabetes

Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation), causing high blood sugar that can affect your pregnancy and your baby’s health. You should manage your blood sugar levels by eating healthily, exercising and even taking medication to remain healthy and prevent a difficult delivery.
You will also be at higher risk of type 2 diabetes after your pregnancy, so you will need to continue monitoring your blood sugar levels closely.

4. Being underweight or overweight

Being underweight or overweight is associated with several complications, including higher risks of miscarriage, high blood pressure, preeclampsia, gestational diabetes, caesarean birth and stillbirth. Moreover, your baby is more likely to struggle with weight management and other long-term health problems during childhood and adult life.

The closer you are to the healthy weight range, with a body mass index of between 18.5 and 24.9, the more likely you will have a smooth delivery and a healthy baby.

5. Carrying more than one baby (twins, triplets, quadruplets)

Multiple births or pregnancies mean you carry more than one baby (twins, triplets, quadruplets, etc.). Such pregnancies have higher risks of premature labour, gestational diabetes, and high blood pressure. Your babies are also more likely to have long-term health problems such as delayed development or cerebral palsy, but you do not have to worry too much because most multiples are born healthy.

6. Congenital disabilities in the baby

Congenital disabilities are structural or functional anomalies which can contribute to long-term disability. The most common ones are the heart and neural tube defects and Down syndrome.

You can prevent specific congenital disabilities by:

• Being up to date on all your vaccinations
• Adequate intake of folic acid or iodine supplements
• Proper care before and during pregnancy

7. Infections, mainly sexually transmitted diseases

Chylamia is a common STD caused by bacteria which may cause abnormal vaginal discharge, bleeding after sex or painful urination. If left untreated, you may experience pregnancy issues such as preterm labour, premature rupture of membranes and low birth weight. Your newborns may also develop eye and lung infections as they pass through the birth canal during delivery.

Human immunodeficiency virus is the virus that causes acquired immune deficiency syndrome (AIDS), resulting in severe health conditions. HIV can be passed from you to your child during pregnancy, childbirth, or breastfeeding. However, if your HIV is diagnosed and treated in early pregnancy, like using C-section delivery, the risk of mother-to-child transmission can be less than 1%.

8. Pre-existing diseases

Certain health conditions can become further complicated by pregnancy and endanger you and your unborn child. Some pre-existing diseases include hypertension, diabetes, lung disease, kidney disease, heart problems or autoimmune diseases.

Autoimmune diseases, such as multiple sclerosis and active Crohn’s disease, can raise your chances of miscarriage or make carrying a pregnancy to term physically tricky. Likewise, unmanaged thyroid or kidney disease can cause issues with fertility and lead to congenital disabilities, low birth weights, and fetal heart failure.

9. Previous miscarriage or preterm birth

If you have had a miscarriage or another problem in a previous pregnancy, you are more likely to go into labour prematurely or experience other pregnancy difficulties. Research has proven that women with one or more miscarriages are twice as likely to give birth prematurely in their subsequent pregnancy. In comparison, those with three or more miscarriages are at even greater risk. Terminating a previous pregnancy for any reason also raises your chances of premature birth in a subsequent pregnancy.

10. Lifestyle factors

Consumption of alcohol, tobacco products, or recreational drugs will pose serious health risks to yourself and your unborn baby, including congenital disabilities, developmental delays, and low birth weights.

What Happens When I Have a High-risk Pregnancy?

Such pregnancies are dangerous for both the mother and the unborn baby. Serious complications can include:

• Preeclampsia (high blood pressure from pregnancy)
• Eclampsia (seizure from pregnancy)
• Preterm delivery
• Cesarean delivery (C-section)
• Excessive bleeding during labour, delivery or after birth
• Too low or high birth weight
• Congenital disabilities
• Brain development issues
• Miscarriage or stillbirth

How is a High-Risk Pregnancy Diagnosed?

Early prenatal care is critical to detecting high-risk pregnancies. If you are at high risk, you may need special monitoring throughout your pregnancy.

Tests to monitor your health and your unborn child’s health include:

• Blood and urine test: To check for specific genetic conditions or congenital disabilities.
• Ultrasonography: Creates images of the baby in the womb using sound waves to screen for congenital disabilities.
• Biophysical profile: Monitors your unborn baby’s breathing, movements and amniotic fluid using ultrasound
• Non-stress test: Monitors your unborn baby’s heart rate to ensure it has sufficient oxygen.

How is a High-risk Pregnancy Managed?

Don’t be too disappointed if you have been diagnosed with a high-risk pregnancy. Many women with high-risk pregnancies go on to deliver healthy babies.

You should, however, manage the pregnancy well to reduce the risks of developing complications:

Consult a doctor for a pre-conception appointment and have regular prenatal check-ups

• Do not smoke or drink alcohol
• Eat a healthy and balanced diet
• Exercise regularly and maintain a healthy weight throughout pregnancy
• Receive the appropriate vaccines through a doctor
• Take daily folic acid supplements as advised

Depending on the type of high-risk pregnancy, the doctor may order the following tests:

1. Biophysical profile
Such profiles are done via ultrasound to evaluate the baby’s well-being.

2. Detailed foetal ultrasound screening
Your doctor will perform this screening to check for possible congenital disabilities.

3. Foetal echocardiography
This test evaluates your baby’s heart for any abnormalities.

4. Genetic screening
Genetic screening consists of amniocentesis or chorionic villus sampling.

Your doctor will take samples from the amniotic fluid surrounding your baby in amniocentesis or take samples from your placenta in chorionic villus sampling. Next, he will analyse the samples for specific genetic conditions. Your doctor will clearly explain a small risk of pregnancy loss in amniocentesis and chorionic villus sampling. You should discuss this with your doctor before deciding whether to proceed with these tests.

5. Routine laboratory tests
These include urine analysis, complete blood count, oral glucose tolerance test, and tests for infectious diseases such as syphilis and human immunodeficiency virus (HIV).