High-risk pregnancy: Know what to expect

If your pregnancy is considered high-risk, it means that you or your baby might be more likely than usual to develop health problems before, during or after delivery.

Due to that risk, you may need extra medical appointments or tests during your pregnancy. At those appointments, your healthcare team checks to see if you may be developing any health problems and treats them quickly if they happen.

Learn about what it means to have a high-risk pregnancy. And find out what you can do to take care of yourself and your baby.

What makes a pregnancy high-risk?

Sometimes a high-risk pregnancy can happen due to a medical condition you have before pregnancy. Or a medical condition may develop during pregnancy that raises the risk of problems. The following factors could lead to a high-risk pregnancy.

Age

Pregnancy risks tend to be higher for pregnant people who are younger than 20 or who are older than 35.

Lifestyle choices

A variety of lifestyle choices can put a pregnancy at risk. Examples include:

• Drinking alcohol.
• Smoking cigarettes, vaping or using other tobacco products.
• Using illegal drugs.

Health problems

Some medical conditions in a pregnant person can raise pregnancy risks, including:

• High blood pressure.
• Obesity.
• Diabetes.
• Epilepsy.
• Thyroid disease.
• Heart or blood disorders.
• Poorly controlled asthma.
• Infections.

Pregnancy complications

Some health problems that develop during pregnancy can cause problems. Examples include:

• Unusual location of the placenta.
• Very low fetal growth. Usually, overall fetal growth or a fetal abdomen size that's less than the 10th percentile for gestational age is cause for concern. This condition is called fetal growth restriction.
• Rh sensitization. This happens when a pregnant person's blood group is Rh negative and the fetus's blood group is Rh positive.

Pregnancy with multiples

Risks to both a pregnant person and the fetuses are higher when a pregnancy includes more than one fetus.

The likelihood of having more than one fetus is higher in people who have gone through infertility treatments to get pregnant. Those treatments also are called assisted reproductive technologies (ART). One common type of ART is in vitro fertilization. The use of ART may raise the risk of some medical concerns during pregnancy, such as diabetes or high blood pressure.

Pregnancy history

Medical problems that happened during a previous pregnancy may raise the risk of having the same problems again. Examples include:

• Conditions during pregnancy related to high blood pressure, such as preeclampsia.
• Giving birth early. This is called preterm delivery.
• Having a baby born with a genetic condition.
• Having a miscarriage or stillbirth.

It's important to tell your healthcare professional about any medical problems that you had during other pregnancies.

What steps can I take for a healthy pregnancy?

You may know ahead of time that you'll have a high-risk pregnancy. Or you might want to do what you can to prevent a high-risk pregnancy. Either way, take the following steps.

Schedule an appointment before you get pregnant

If you're thinking about becoming pregnant, make an appointment to see your healthcare professional. During that appointment, you'll likely talk about:

• Taking a daily prenatal vitamin with folic acid.
• How to best manage any medical conditions you may have.
• All medicines you take, including those without a prescription.
• Vaccinations you may need.
• Your family and personal medical history.
• Your risk of having a baby with a genetic condition.
• Your partner's health.
• How you can prepare for a healthy pregnancy. For example, quitting smoking and being at a healthy weight before you become pregnant can lower some risks.

Get the care you need during pregnancy

Appointments with your healthcare team on a regular basis during pregnancy allows the team to follow your health and your baby's health. You might be referred to a specialist. Depending on your situation, you may see a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.

Avoid risky substances

If you use any form of tobacco or e-cigarettes, quit. Don't drink alcohol or take illegal drugs during pregnancy. Tell your healthcare professional about any medicines or supplements you take.

Do I need special tests?

Depending on the circumstances, your healthcare professional might suggest certain tests. The following are examples of tests that may be part of care during a high-risk pregnancy. The decision to get these tests is up to you. Talk about the risks and benefits with your healthcare professional.

Specialized ultrasounds

An ultrasound is an imaging test that uses high-frequency sound waves to make images of a fetus on a screen. Ultrasound is safe for both pregnant people and fetuses.

The following kinds of ultrasound may be helpful during a high-risk pregnancy:

• Three-dimensional (3D) or 4-dimensional (4D) ultrasounds can be used to pinpoint a suspected problem, such as fetal development that's not typical.
• Ultrasound to measure the length of the cervix can help determine if you're at risk for going into labor early.
• A biophysical profile is an ultrasound that can be used to check a fetus's health. Depending on the ultrasound results, your team also may check a fetus's heart rate. That procedure is called a nonstress test.

Cell-free DNA screening

This test sometimes is called cfDNA. It uses a blood sample from you to provide the healthcare team with your DNA and the fetus's DNA. A small amount of DNA from the fetus goes into a pregnant person's blood stream during pregnancy. Through the blood sample, the fetus's DNA is checked to see if there's a higher chance of certain chromosome problems. If so, those problems could signal a genetic condition.

Other genetic tests

Your healthcare professional might suggest amniocentesis or chorionic villus sampling (CVS). These tests can help find genetic conditions. They also can be used to confirm results from cell-free DNA screening.

• Amniocentesis. During amniocentesis, a sample of the fluid that surrounds and protects a fetus during pregnancy is taken from the uterus. The medical term for that fluid is amniotic fluid. Usually done after week 15 of pregnancy, the test can identify some genetic conditions. It also can find serious problems of the brain or spinal cord. Those conditions are called neural tube defects.
• CVS. During CVS, a sample of cells is taken from the placenta. It's usually done between weeks 10 and 13 of pregnancy.

Lab tests

Your healthcare team can run lab tests on a blood or urine sample from you to check for infections, anemia and diabetes. The tests also can be used to identify a higher risk of genetic conditions.

What else do I need to know about high-risk pregnancy?

Talk to your healthcare professional about how to manage any medical conditions you have during pregnancy. Ask how those conditions could affect labor and delivery.

Contact a member of your healthcare team right away if you have:

• Vaginal bleeding.
• Watery vaginal discharge.
• Pain or cramping in your abdomen or pelvis area.
• Less fetal activity than usual.
• Severe headaches.
• Pain or burning when you urinate.
• Changes in vision, including blurred vision.
• Sudden or severe swelling in the face, hands or fingers.
• Fever or chills.
• Vomiting or frequent nausea.
• Chest pain or shortness of breath.
• Dizziness.
• Weakness.
• Extreme tiredness.
• Nervousness or worry that makes it hard for you to do your daily activities.
• Overwhelming feelings of sadness or sadness that lasts.
• Thoughts of harming yourself or your baby.

Having a high-risk pregnancy may be stressful and cause you to worry about your baby's health. Try to do what you can to ensure a healthy pregnancy. Throughout your pregnancy, talk to a member of your healthcare team if you have questions or need support. After pregnancy, discuss with your healthcare professional how medical conditions during pregnancy might affect your long-term health.