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High-Risk Pregnancy: What You Need to Know

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Many conditions affecting a mother or her baby before, during or after pregnancy can designate a pregnancy as high risk. Learn what causes a high-risk pregnancy and how maternal-fetal medicine specialists can help.

Pregnant woman looking out window.

Whether it’s your first pregnancy or your third, hearing your obstetrician, nurse practitioner or midwife say that your pregnancy is high risk can feel concerning. High-risk pregnancy is a term that can denote a wide variety of common conditions. Many of them are related to pre-existing conditions you may have had before becoming pregnant or conditions you may have developed while pregnant or during delivery.

A high-risk pregnancy does not necessarily mean that your pregnancy will be more difficult or challenging than a low-risk pregnancy. However, it does sometimes mean that you will need to consult a maternal-fetal medicine specialist and undergo more monitoring than someone with a low-risk pregnancy.

Learn more about high-risk pregnancy from Janice Henderson, M.D., a Johns Hopkins maternal-fetal medicine specialist and the coordinator of the Johns Hopkins Nutrition in Pregnancy Clinic.

Q: What’s the difference between a maternal-fetal medicine specialist and an obstetrician?

A: A maternal-fetal medicine specialist (perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to learn how to treat medical complications that are related to pregnancy. In addition, the maternal-fetal medicine specialist has extensive training in assessment and treatment of fetal problems. Most perinatal ultrasound is interpreted by maternal-fetal medicine specialists.

You may be referred to a maternal-fetal medicine specialist if you have a pre-existing medical condition prior to pregnancy, develop a medical condition during pregnancy or have problems during delivery. Additionally, you will see a maternal-fetal medicine specialist during pregnancy if your baby has an anomaly. In this case, the maternal-fetal medicine specialist will coordinate your care as well as your baby’s care during pregnancy and at delivery with the help of a pediatric care team.

Q: Should I see a maternal-fetal medicine specialist before pregnancy?

A: It can be beneficial to consult with a maternal-fetal medicine specialist before pregnancy if you have one (or more) of the following:

  • Pre-existing medical condition. There are many pre-existing medical conditions that may need to be monitored in relation to pregnancy, e.g., diabetes, lupus, renal disease and hypertension (high blood pressure). In some instances, a maternal-fetal medicine specialist may alter the type of medication you’re taking to maintain your health and prevent any adverse effects to your future pregnancies. If you have diabetes, a maternal-fetal medicine specialist can help you optimize your blood sugar control prior to conception to help reduce the risk of fetal anomalies. If you struggle with obesity, a maternal-fetal medicine specialist can review the benefits of weight loss before pregnancy. According to Henderson, “Losing weight in a healthy manner can reduce your risk of developing conditions such as hypertension and gestational diabetes during pregnancy.”
  • Genetic risks. Preconception genetic screening has become more common in recent years as technology has advanced and testing has become more accessible. If you have family members with a certain disease or if you belong to an ethnicity that has a greater risk of developing specific conditions (such as sickle cell disease or Tay-Sachs disease), genetic screening can be used to assess your and your partner’s risk of being a carrier. Also, common genetic conditions, such as cystic fibrosis or spinal muscular atrophy, can be screened for with a blood test. 

    Additionally, if you have a child affected by a genetic disorder or syndrome, a maternal-fetal medicine specialist can provide counseling and management to consider how the condition may impact your future pregnancies. Always speak with your health care provider to determine what’s best for you and your pregnancy.

Q: What conditions may lead to a high-risk pregnancy?

A: The following list represents the most common conditions that can lead to a high-risk pregnancy, but note that not all women with these conditions will have a high-risk pregnancy.

  • Diabetes. If you have diabetes before you become pregnant, you will likely be referred to a maternal-fetal medicine specialist to monitor your condition and determine the proper medications. Preconception counseling is ideal. Developing diabetes during pregnancy (gestational diabetes) is very common, and your obstetric provider will likely be able to care for you without a maternal-fetal medicine consult. If a maternal-fetal medicine specialist is consulted for gestational diabetes, he or she will follow your baby’s growth and well-being, and manage your health with nutrition counseling, glucose monitoring and, possibly, medications.
  • Pre-eclampsia. Pre-eclampsia is a condition unique to pregnancy where you have high blood pressure in conjunction with protein in your urine and edema (swelling of the skin). In some women with pre-eclampsia, liver or platelet abnormalities are present. You may be referred to a maternal-fetal medicine specialist depending on the severity of your disease or if you are preterm. “The only treatment for pre-eclampsia is delivering your baby,” explains Henderson, “so this is a condition that requires very close monitoring to balance maternal complications against the risks of delivering your baby early.” 
  • Hypertension. If you have hypertension before pregnancy, a maternal-fetal medicine specialist will monitor your baby’s growth and may be consulted if problems arise. Some medications commonly used outside of pregnancy to treat hypertension are contraindicated in pregnancy.
  • Multiples. Pregnancies with twins or higher-order multiples have a greater risk of complications. Women with multiple pregnancies are more likely to develop pre-eclampsia or go into preterm labor. Twin pregnancies have a higher risk of fetal anomalies and growth problems, especially if they share a placenta. If you have a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend how and when your babies should be delivered. “If you remain healthy and the growth of your babies is normal and without complications, you may continue to see your Ob/Gyn,” says Henderson, “or you may prefer to be seen in a specialty multiples clinic.”
  • Sexually transmitted diseases (STDs). In general, your obstetric provider can treat you for sexually transmitted diseases that may occur during pregnancy or if there is a pre-existing STD, such as herpes. In certain cases, consultation with a maternal-fetal medicine specialist will be required. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide further care and management. Women with HIV are also generally cared for by maternal-fetal medicine specialists because the medication regimens are complex.
  • Obesity. Women who are obese have a greater risk of developing diabetes, hypertension and pre-eclampsia during pregnancy. “Obesity is the one of the only health conditions affecting pregnant women that can be changed before pregnancy, which is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies,” explains Henderson. “The Johns Hopkins Nutrition in Pregnancy Clinic works with obese women during pregnancy to optimize the health of mothers and their babies.”

Q: Will all my future pregnancies be high risk?

A: Having one high-risk pregnancy does not mean that all your future pregnancies will be deemed high risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time.

However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance.

Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.

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