Pregnant woman with her doctor

What Is a High-Risk Pregnancy?

There’s no such thing as a zero-risk pregnancy. All pregnancies come with some risk to both mother and baby. 

A low-risk pregnancy has been defined as a singleton pregnancy carried to term in which the baby is in the head-down position, and there are no other medical or surgical conditions with the mother or baby. On the opposite end of the spectrum is a high-risk pregnancy. 

A high-risk pregnancy is one in which the mother or baby is at an added risk of complications due to one or more of the following: the mother’s age or pre-existing health conditions (maternal risk factors), concerns about baby’s growth and development (fetal risk factors), or issues that arise during pregnancy (pregnancy-related risk factors).

Women who are labeled as high-risk will likely need more specialized medical care and treatment. This can look like more doctor visits, more frequent ultrasounds, bed rest or, in some cases, even hospitalization. The goal of specialized treatment during high-risk pregnancy is to reduce the risk of complications for mother and baby as much as possible. 

What Does High-Risk Pregnancy Mean? 

The term high-risk pregnancy does not describe a specific diagnosis or syndrome. Instead, it covers a wide variety of circumstances and conditions that may put the mother or baby at increased risk of complications before, during or after delivery. 

A pregnancy may be deemed high-risk at any time during the pregnancy. Some pregnancies become high-risk as they progress, while others could be considered high-risk before the woman even becomes pregnant. 

Who Is at Risk for a High-Risk Pregnancy? 

No one specific factor determines whether you will or will not experience a high-risk pregnancy. Healthy women may experience complications that lead to a high-risk label. Women with health complications going into a pregnancy may experience a typical pregnancy and birth — though often, they will be monitored as high-risk during the pregnancy. 

3 Factors That May Lead to High-Risk Pregnancy

There are many factors that can lead to a high-risk pregnancy. Broadly, they can be broken into three main categories: Maternal risk factors that exist before pregnancy, fetal risk factors that arise during pregnancy and pregnancy complications. 

1. Maternal Risk Factors

A woman’s health, age and medical history all play a part in the type of pregnancy she will have. Common maternal risk factors for high-risk pregnancy include: 

Age. Women who become pregnant over the age of 35 are often considered high-risk. That’s because as women age, the likelihood of developing complications — like high blood pressure, diabetes or heart disease — during pregnancy increases. 

There are also increased risks to babies of older mothers. Women over 35 are more likely to have a baby with chromosomal abnormalities. There is about a 1 in 1,000 chance at age 25 that a baby will be born with Down syndrome. At age 35, the risk is about 1 in 294. Older women — especially those over 40 — may also experience miscarriage at a higher rate than younger women. 

Pre-existing medical conditions. Diabetes, obesity, chronic high blood pressure, heart disease and other health conditions can increase the risk of pregnancy complications. Autoimmune conditions like Hashimotos, Graves disease or lupus can also cause complications in pregnancy that can lead to miscarriage or symptom flare-ups. 

Physical characteristics. Every person is different, and women of all sizes and statures are able to have successful, healthy pregnancies. Women who are obese or those who are severely underweight may be at higher risk when it comes to carrying and delivering a baby. Some aspects of your internal anatomy, like a double uterus, fibroids or a weak (incompetent) cervix, can also complicate your pregnancy journey. 

2. Fetal Risk Factors

Fetal risk factors include any complications with your developing baby that arise during the pregnancy. You may learn of complications from genetic testing, amniocentesis or ultrasound. Pregnancies can become high-risk due to issues like fetal growth, abnormal placental position or fetal heart problems. 

If fetal risk factors are detected at any point during your pregnancy, you’ll likely be referred to a maternal-fetal medicine specialist for more specialized care. Your doctor will monitor your condition and make recommendations for treatment or interventions as needed. 

3. Pregnancy-Related Risk Factors

Sometimes complications arise with your health during the pregnancy that will lead to a high-risk classification. These can include: 

  • Pregnancy history. If you have had complications or high-risk pregnancies in the past, you might be more susceptible to another one. This includes a history of multiple miscarriages or pregnancy losses, including stillbirth. 
  • Gestational diabetes. If you develop diabetes as a result of pregnancy, it can put you at higher risk for preterm labor and delivery. 
  • Preeclampsia. The sudden increase in blood pressure after 20 weeks can pose a significant risk to mother and baby. 
  • Premature rupture of membranes (PPROM). If your amniotic sac breaks before 37 weeks, you’re at greater risk of infection and preterm labor. 
  • Multiples. Women who are carrying more than one fetus are at higher risk of gestational diabetes and preterm birth. According to the National Institutes of Health, more than half of all twins and 93% of triplets are born at less than 37 weeks gestation. 

Managing Your High-Risk Pregnancy

Hearing the high-risk pregnancy label can be unsettling. The best thing you can do is ask your care team, including your OB-GYN and maternal-fetal medicine specialists, questions to understand the complications and risk factors that led them to a high-risk pregnancy diagnosis. 

Learn More: How to Advocate for Yourself During Your High-Risk Pregnancy

Get to know your high-risk pregnancy team. Your high-risk pregnancy doctors and team will be made up of a wide variety of specialists and supporters, but the most important thing is that they are united in ensuring you have the best possible experience and outcome

Follow your doctor’s recommendations. Make sure to attend all your scheduled appointments and follow through with recommended tests and medications. 

Take care of yourself. Eat well, stay hydrated and get plenty of rest. Depending on your diagnosis, your care team may recommend a specific diet, advise for or against exercise or place you on bed rest. It’s also important to care for your mental well-being. Tell your doctor if you’re struggling with mental health issues. 

Reduce stress. Stress can take an added toll on your body. Find stress-relieving practices that work for you, whether mediation, relaxation techniques, therapy or family support. 

Play an active role in your own care. Don’t hesitate to bring up changes in your body, emotions or new symptoms that arise. Whether it’s physical or emotional — even if you’re not sure if it’s a big deal — tell your team so they can determine if any action is needed. 

Learn more: Who’s on Your High-Risk Pregnancy Team?

There are many unknowns about high-risk pregnancy, but arming yourself with knowledge and working with your team to develop a treatment plan can make a big difference. By understanding risk factors, staying engaged with your own care, and choosing a high-risk pregnancy team you trust, you can move forward with confidence.

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